You may know someone who uses a wheelchair or walker to help increase their mobility. But did you know that these items are just a few of many that TRICARE may cover as durable medical equipment?
“TRICARE covers a range of DME, so you and your family can make the most of this equipment if you need it,” said Elan Green, chief, Medical Benefits and Reimbursement Branch for the TRICARE Health Plan. “If you have TRICARE For Life, it’s also important to know how Medicare covers DME.”
Read below to learn more about how TRICARE covers DME.
Q: What does TRICARE consider DME?
A: TRICARE defines DME as an item that can withstand repeated use, serves a medical purpose, and generally isn’t useful to someone who isn’t sick or injured. Common examples of DME include, but aren’t limited to:
Q: When does TRICARE cover DME?
A: TRICARE covers DME only when prescribed by a provider. The DME must:
- Improve, restore, or maintain the function of a body part, or help prevent your condition from getting worse
- Maximize your ability to function (consistent with your medical needs)
- Provide the right level of performance and quality for your condition
TRICARE covers breast pumps and breastfeeding supplies as DME at no cost for new and expecting parents.
TRICARE also covers DME customization or attachments, if your provider decides these are medically necessary or appropriate for your condition. For example, TRICARE may cover a car lift for a wheelchair user.
Your regional contractor will decide to rent or purchase your DME based on the equipment’s cost and your condition.
Q: Does TRICARE cover DME repairs, replacements, and maintenance?
A: If you own DME that needs repairs, TRICARE may cover the repairs.
TRICARE covers DME replacement in the following cases:
- There’s a change to your physical condition.
- The DME is damaged.
- The DME no longer works and can’t be fixed.
- The U.S. Food and Drug Administration says it no longer meets safety standards.
If you need replacement DME, you’ll need a new prescription from your TRICARE-authorized provider. You may also need supporting documentation.
TRICARE only covers regular maintenance, such as testing or cleaning the machine, when the manufacturer requires an authorized technician to service the DME.
Q: How does TRICARE For Life cover DME?
A: If you have TRICARE For Life coverage, you must follow Medicare’s rules for getting DME. This doesn’t apply if you live overseas (not including U.S. territories).
As outlined in the TRICARE For Life Handbook, Medicare Part B (medical insurance) covers DME. Medicare covers DME if your Medicare-enrolled provider prescribes it for use at home. Be sure to ask your DME supplier if they participate in Medicare, as you’ll pay less if they do.
Check out Medicare.gov for more information about DME coverage, including where to find DME equipment and suppliers.
Q: What kind of equipment doesn’t TRICARE cover?
A: TRICARE doesn’t cover equipment if:
- It has deluxe, unnecessary features that increase its cost.
- It doesn’t serve a solely medical purpose, like humidifiers or smart watches.
- You could get the same equipment from a military hospital or clinic, if you’re enrolled at one.
- You’re a patient in a facility that provides the equipment as part of its typical services at no extra cost.
- It’s an exact duplicate of an item you already own and will only serve as a backup.
Note: TRICARE may cover items that aren’t exact duplicates. For example, TRICARE may cover a portable oxygen machine as a backup for a stationary oxygen machine.
Q: What will I pay for DME under TRICARE?
A: Copayments and cost-shares for DME vary depending on your TRICARE plan and sponsor’s status. Typically, network providers and suppliers will cost you less out of pocket than non-network providers and suppliers. Use the TRICARE Compare Costs Tool to check your potential DME costs.
Q: Where can I find more information?
A: If you have questions about DME coverage, check the TRICARE Covered Services tool. This list of covered services and supplies isn’t all inclusive. If you have questions about coverage and costs or you need help finding a network provider or supplier, call your TRICARE regional contractor.
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