What is considered a medical device under Obamacare?

Kyle Walton

7 years ago

“To sum it up…”

Any type of prosthetic device, mobility aid, body supporting, testing and medically necessary equipment is considered a covered item with Obamacare
You must follow the guidelines of having a recent documented medical necessity, proper order from a medical team and current evaluation to have a medical device approved
The medical device tax only applied to manufacturers
Medical devices are only tax deductible if the exceed 10 percent of your adjusted gross income
The Obamacare rules for medical device approval and use has increased the purchase by 43 percent according to 2014 figures

What types of medical devices are covered?

Any type of prosthetic, mobility, body supporting, testing and medical necessary aid that is approved by the FDA for use is covered by Obamacare plans. The amount that you will have to pay out-of-pocket varies by the area you live and the plan coverage you have. The devices have to be ordered by your primary care physician and considered medically necessary for quality of life and sustaining health.

Durable Medical Equipment, or DME, is considered any item that will stand up to use for at least 3 years, be FDA approved for medical use and determined to be helpful to the patient. The list of items is large and those with Medicare Part B coverage can count on being able to obtain items like:

Wheelchairs
Tub and bed lifts
Hospital beds
Bedside commodes
Diabetic testing supplies
Catheters
Pumps and Pump essentials
Crutches
Walkers, and more

How can I get approval for a medical device?

There are certain conditions that have to be met for the approval of a medical device under the rules of Obamacare and coverage by plans like Medicare and Medicaid.

Gone are the days of lax oversight, since the taxpayer and manufacturer are ultimately paying for the reduced costs or complete costs of the device. This is due to the tax increase for Medicare and new medical device tax. Durable Medical Equipment will only be approved if:

The desired device is FDA approved for use with humans.
It is considered a reasonable device for the stated medical condition and found to offer reasonable improvement in mobility, pain reduction, diagnostics and support.
The device will last at least three years before needing replacement.
The patient has undergone a thorough evaluation by the physician, physician’s assistant or other qualified medical staff within six months of ordering the medical device.
There is an existing order by a qualified medical team member that states the need for the device within six months of the order.

Not following any of these specific guidelines could mean that the claim is denied and the patient will have to purchase the device out-of-pocket in full. It is designed to be a way to help prevent Medicare and Medicaid fraud.

Do I have to pay the medical device tax?

The biggest controversy surrounding the medical device tax brought about with Obamacare is fear by the public that they will have a share in this.

The fact is, the medical device tax is an excise tax of 2.3 percent applied to each device to the manufacturer. This is not a tax that is levied on the consumer.

The reasoning behind the tax is that the manufacturers stand to gain huge profits from the availability of coverage by consumers to buy the devices. Overall, they will experience greater gains and the tax money can be collected to help pay for the Obamacare coverage. Whether the tax will remain in place is yet to be seen, but it is not a tax burden that is meant for the patient to absorb.

Is a medical device tax deductible?

If you file taxes using an itemized schedule A form, you can include medical devices for tax deductions if the amount exceeds 10 percent of your Adjusted Gross Income. What this translates to is an inability for most people to use them as a tax deduction, unless there are many devices that have to be purchased during the year.

The simple use of a walker, or crutches will not bring you into the financial range of being able to use the item as a tax deduction.

The tax deduction option is helpful for you, or a family member that has had a life-altering illness, or injury that requires numerous devices for mobility and care. Save all receipts and fill out the schedule A form to get all needed tax relief from these purchases. It is wise to consult a tax professional if you have any questions.

How has Obamacare coverage expanded Medical Device Use?

The sales of Durable Medical Equipment has risen from $95 billion dollars in 2005 to $136 billion dollars in 2014, which was the year that Congress demanded usable and current figures. That is an astounding 43 percent increase in medical device sales.

There is no denying that Obamacare has expanded the demand in the medical community to set patients up with the equipment they need to live a healthier and more productive life.

The well-designed plan of incorporating a small excise tax to the boosted sales has the government on track to collecting the desired $20 billion extra dollars needed to help fund the Obamacare initiatives. This is a plan that seems to be working, even when viewing the numbers in the harsh light of day.

Obamacare strives to make a difference in allowing more access to the care and equipment needed to live a healthier, more productive life. Contact your insurance provider if you or a loved one has needs for Durable medical Equipment and see what may, or may not be covered today!

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