Dispositivos para ayuda respiratoria
Medicare Part B (Medical Insurance) covers respiratory assist devices if you’re eligible
Descripción
Respiratory assist devices can help with breathing.
Detalles de la cobertura
Part B covers respiratory assist devices (like home mechanical ventilators and bi-level respiratory assist devices) if you’ve been diagnosed with chronic obstructive pulmonary disease (COPD) and developed chronic respiratory failure (a condition where you have low oxygen and/or high carbon dioxide levels in your blood, making it difficult to breathe on your own).
Medicare covers different kinds of Durable Medical Equipment (DME) in different ways. Depending on the type of equipment:
• You may need to rent the equipment.
• You may need to buy the equipment.
• You may be able to choose whether to rent or buy the equipment.
• Some items become your property after you’ve made a certain number of rental payments.
¿Dónde puedo obtener equipos médicos duraderos (DME) cubiertos?
Quién es elegible
You must meet certain conditions, including:
- You have hypercapnia (high levels of carbon dioxide in your blood) of 52 mmHg or more
- Your hypercapnia isn’t primarily caused by sleep apnea (a sleeping disorder where your breathing repeatedly stops and starts)
Requisitos del proveedor
Make sure your doctors and DME suppliers are enrolled in Medicare. It’s also important to ask your suppliers if they participate in Medicare or will accept assignment of your claims before you get DME.
Costos
Después de alcanzar el deducible de la Parte B, usted paga el 20% de la cantidad aprobada por Medicare .
It’s important to ask a supplier if they participate in Medicare or will accept assignment of your claims before you get DME. If a supplier participates in Medicare, they must accept assignment (which means they can charge you only the Part B deductible and the coinsurance for the Medicare approved amount).
A non-participating provider doesn’t have to accept assignment but may choose to
do so in your case. If a DME supplier doesn’t participate in Medicare or won’t accept
assignment, you may be charged more. For rented DME, make sure the supplier is willing to accept assignment for all rental months, otherwise you’ll have to pay the full cost of your DME upfront. If this happens, Medicare will pay you later for the amount it covers after your claims have been submitted and processed by Medicare.
Con qué frecuencia
- Medicare initially covers respiratory assist devices for 6 months.
- After that, Medicare may continue to cover the device if your doctor or other health care provider certifies that you meet certain criteria and the device is helping you. You must meet with your health care provider at least twice during the first year you have the device (once within the first 6 months, and again during the next 6 months).
Pregúntele a su médico o proveedor de atención médica cuánto costará su prueba, artículo o servicio.
Es posible que su médico le recomiende servicios que Medicare no cubre o que ofrece con demasiada frecuencia. Esto podría resultar en costos adicionales para usted. Asegúrese de consultar con su médico sobre las razones de estas recomendaciones y lo que realmente cubrirá Medicare.
Las cantidades específicas que podría deber dependen de:
Otro seguro que tenga
Cuánto cobre su médico
Si el médico acepta la asignación
El tipo de instalación
El lugar donde obtenga la prueba, artículo o servicio