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When facing illness or injury, you might need to rely on equipment that can help you as you deal with your medical condition, whether it’s temporary or long term. You might need something small, such as a blood sugar meter, or a larger item, perhaps a wheelchair.
Both Medicare and TRICARE can help cover the costs of durable medical equipment (DME). DME are items prescribed by a physician that can withstand repeated use and are primarily and customarily used to serve a medical purpose and generally are not useful to a person in the absence of an illness or injury.
Medicare and TRICARE both cover DME that:
- Must improve, restore, or maintain the function of a malformed, diseased, or injured body part or can otherwise minimize or prevent the deterioration of the patient’s function or condition.
- Maximizes the patient’s function consistent with their physiological or medical needs.
- Provides the medically appropriate level of performance and quality for the current medical condition.
- Is not otherwise excluded by regulation and policy.
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DME may be rented or purchased. For TRICARE, the regional contractor will make the rent/buy decision based on what is more economical and appropriate.
DME Costs Under TRICARE Prime and Select
- Active Duty in Network: $0 Prime; 15% Select
- Active Duty Out of Network: Point of Services (POS) Prime; 20% Select
- Retired in Network: 20% Prime; 20% Select
- Retired Out of Network: POS Prime; 25% Select
- Medically necessary customization or attachments to the DME to accommodate your medical disability.
- Medically necessary covered accessories and attachments to a DME necessary to make the DME “serviceable.” An example is a car lift that is an accessory to a wheelchair.
- Repairs to equipment that you own when needed to make the item serviceable.
- Replacement of DME that you own when there is a change in your physical condition or accidental damage to the DME, the DME is inoperative and can’t be repaired, or the U.S. Food and Drug Administration have declared the DME adulterated (no longer approved for use).
For more information, visit the TRICARE Covered Services Tool or Medicare’s DME coverage webpage.
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