Aetna provides comprehensive coverage including DME.

Pros: Extensive national network, broad coverage options.
Cons: Some items may need pre-authorization; plan details vary by region.
Ideal For: Individuals seeking a large network and multiple plan types (Employer, Individual, Medicare Advantage).

Eligibility & Documentation:

• Employer: Must meet employer criteria.
• Individual/Family: ACA enrollment periods; income/residency documents may be needed.
• Medicare Advantage: Have Medicare A & B and live in plan area.

Cost and Premium Information:
Premiums vary by plan type and region.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
For employer or marketplace plans, you’ll generally meet a deductible first. Afterward, co-pays or co-insurance apply until you reach your out-of-pocket maximum. For Medicare Advantage, the Part B deductible and co-insurance rules apply. Check your Summary of Benefits or Evidence of Coverage for exact amounts.

Telehealth Services:
Aetna often provides telehealth options for consultations and follow-ups. You may discuss DME needs, get prescriptions, or obtain referrals remotely. Telehealth may have standard co-pays or be low-cost. Verify details on the member portal or by calling member services.

Coverage Limits and Exclusions:
DME must be medically necessary. Some items may have yearly quantity limits or may not be covered if considered “convenience” items.

Prior Authorizations & Referrals:
Certain DME may require prior authorization. A doctor’s prescription or referral might be needed.

How to Verify Coverage:
Check your member handbook or call Aetna member services. Ask for in-network DME providers and pre-authorization requirements.
Claim Submission Tips:
Usually, DME suppliers bill Aetna directly. Keep copies of prescriptions and approval letters.

Aetna Better Health focuses on Medicaid-based managed care, including DME.

Pros: Low or no out-of-pocket cost for eligible individuals.
Cons: Eligibility rules vary by state.
Ideal For: Low-income individuals/families who qualify for Medicaid.

Eligibility & Documentation:

• Must meet state Medicaid income/resource criteria.

Cost and Premium Information:
Generally, minimal or no premiums for Medicaid beneficiaries.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
Medicaid typically imposes little to no deductibles or co-pays for DME. Out-of-pocket costs are minimal, ensuring services remain accessible.

Telehealth Services:
Aetna Better Health may offer telehealth for consultations or follow-ups, saving travel time. This can help quickly secure medical orders or verify DME needs. Confirm availability with member services.

Coverage Limits and Exclusions:
Coverage follows Medicaid guidelines. Some items may require medical justification and certain non-essential items might not be covered.

Prior Authorizations & Referrals:
Many DME items need prior authorization. A doctor’s order is typically required.

How to Verify Coverage:
Review your Medicaid benefits handbook or call Aetna Better Health member services.
Claim Submission Tips:
Your DME supplier usually handles claims. Keep approval letters on file.

Anthem Blue Cross Blue Shield offers various plans (Employer, Individual, Medicare Advantage) with DME coverage.

Pros: Large network, preventive health emphasis.
Cons: Some DME may need pre-authorization; costs vary.
Ideal For: Those seeking a well-known brand and diverse plan options.

Eligibility & Documentation:

• Employer: Meet employer eligibility rules.
• Individual/Family: ACA enrollment; provide residency/income for subsidies.
• Medicare Advantage: Have A & B, reside in service area.

Cost and Premium Information:
Premiums depend on plan type and region.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
For commercial and marketplace plans, you’ll usually have a deductible, then pay co-pays or co-insurance until reaching the out-of-pocket maximum. Medicare Advantage may involve the Part B deductible and a set co-insurance for DME. Refer to your Summary of Benefits or Evidence of Coverage.

Telehealth Services:
Anthem often includes telehealth benefits. You can consult with providers for DME-related needs virtually. Telehealth might have a similar or lower cost-share than in-person visits. Check member resources.

Coverage Limits and Exclusions:
Coverage typically extends to medically necessary DME. Some equipment may have annual quantity limits.

Prior Authorizations & Referrals:
Certain DME may require prior authorization or a referral.

How to Verify Coverage:
Check your Summary of Benefits or call Anthem BCBS member services.
Claim Submission Tips:
Suppliers typically bill Anthem directly. Keep prescriptions and authorization letters.

Cigna provides nationwide coverage across Employer, Individual, and Medicare Advantage plans.

Pros: Global network, various plan options.
Cons: Some plans may have higher premiums or require referrals.
Ideal For: Those needing coverage in multiple locations.

Eligibility & Documentation:

• Employer: Meet employer criteria.
• Individual/Family: Enroll during ACA periods; income/residency docs as needed.
• Medicare Advantage: Have A & B, reside in plan area.

Cost and Premium Information:
Premiums vary by plan type.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
After meeting your deductible, co-pays or co-insurance may apply. Out-of-pocket maximums limit yearly costs. Medicare Advantage members follow Part B rules plus plan specifics. Check your plan’s Summary of Benefits.

Telehealth Services:
Cigna typically offers telehealth. You can get consults, approvals, or prescriptions for DME items online, often at reduced cost. Review your member portal for telehealth details.

Coverage Limits and Exclusions:
DME must be medically necessary. Non-essential items may be excluded.

Prior Authorizations & Referrals:
Some DME requires prior authorization and a physician’s order.

How to Verify Coverage:
Review your Explanation of Coverage or call Cigna member services.
Claim Submission Tips:
DME providers usually handle claims. Retain prescriptions and approvals.

Empire BCBS serves New York State with various plan types (Employer, Individual, Medicare Advantage).

Pros: Strong local network.
Cons: Coverage varies by tier; pre-authorizations may apply.
Ideal For: NY residents seeking a well-known, local plan.

Eligibility & Documentation:

• Employer: Follow employer eligibility rules.
• Individual/Family: ACA enrollment; NY residency/income for subsidies.
• Medicare Advantage: Have A & B, live in Empire’s NY service area.

Cost and Premium Information:
Premiums differ by plan. Subsidies may apply for marketplace plans.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
You’ll typically meet a deductible, then pay co-pays or co-insurance for DME. Medicare Advantage members may owe Part B cost-sharing. Annual out-of-pocket maximums limit expenses. Check your Summary of Benefits.

Telehealth Services:
Empire often includes telehealth options to consult with providers for DME prescriptions or follow-ups. Telehealth may have similar or lower cost-sharing than in-person visits. Confirm details in member materials.

Coverage Limits and Exclusions:
DME must be medically necessary. Non-essential or comfort items may not be covered.

Prior Authorizations & Referrals:
Some DME requires prior authorization and a doctor’s prescription.

How to Verify Coverage:
Review plan materials or call Empire BCBS member services.
Claim Submission Tips:
Suppliers typically bill directly. Keep medical necessity documents.

Fidelis Care offers Medicaid, Child Health Plus, Essential Plans, and Medicare Advantage in NY.

Pros: Affordable state-sponsored options.
Cons: Regional limitations in NY.
Ideal For: NY residents seeking cost-effective coverage through public programs.

Eligibility & Documentation:

• Medicaid/CHP/Essential: Meet income/resource limits; provide residency/income proof.
• Medicare Advantage: Have A & B, live in service area.

Cost and Premium Information:
Medicaid/CHP often have no or low premiums. Essential Plans and Medicare Advantage vary.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
Medicaid beneficiaries typically have minimal or no cost-sharing. Essential and Medicare Advantage plans may have small co-pays or co-insurance. Check plan specifics.

Telehealth Services:
Fidelis often supports telehealth appointments. Members can get DME-related consults or follow-ups online, potentially with low or no co-pay. Confirm with member services.

Coverage Limits and Exclusions:
DME must be medically necessary. Certain limits apply.

Prior Authorizations & Referrals:
Many DME items require authorization and a doctor’s order.

How to Verify Coverage:
Check the member handbook or call Fidelis member services.
Claim Submission Tips:
Suppliers handle billing. Keep approval letters.

Humana focuses on Medicare Advantage plans with DME coverage.

Pros: Senior-focused plans, good support.
Cons: Availability varies by county.
Ideal For: Medicare beneficiaries seeking a range of plan options.

Eligibility & Documentation:

• Medicare Advantage: Have A & B, reside in Humana’s service area.

Cost and Premium Information:
Monthly premiums may apply in addition to Part B.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
You may owe the Part B deductible if not already met, plus co-insurance for DME. Humana Medicare Advantage plans have an annual out-of-pocket maximum that limits your total spending.

Telehealth Services:
Humana often offers telehealth coverage. You can discuss DME needs, get prescriptions, or seek authorizations virtually. Costs are often similar or less than in-person visits. Check your Evidence of Coverage.

Coverage Limits and Exclusions:
Only medically necessary DME is covered.

Prior Authorizations & Referrals:
Many DME items require prior authorization and a doctor’s prescription.

How to Verify Coverage:
Review your Evidence of Coverage or call Humana member services.
Claim Submission Tips:
Suppliers usually bill Humana. Keep Medicare and Humana IDs on hand.

Affinity Health Plan provides Medicaid managed care.

Pros: Comprehensive low-cost coverage for eligible NY residents.
Cons: Limited regional availability.
Ideal For: Medicaid-eligible individuals seeking managed care options.

Eligibility & Documentation:

• Medicaid Managed Care: Meet NY Medicaid income/resource criteria.

Cost and Premium Information:
Typically no premiums for Medicaid enrollees.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
Medicaid usually involves little to no cost-sharing for DME. Out-of-pocket expenses are minimal or zero.

Telehealth Services:
Affinity may offer telehealth visits for DME-related consultations. This can streamline getting approvals or prescriptions. Verify with member services.

Coverage Limits and Exclusions:
Must be medically necessary. Certain limits apply based on Medicaid rules.

Prior Authorizations & Referrals:
Many DME requests require prior authorization and a doctor’s order.

How to Verify Coverage:
Check Affinity member materials or call member services.
Claim Submission Tips:
Suppliers file claims. Keep any approval letters.

AgeWell NY integrates Medicare and Medicaid for seniors and those needing long-term care.

Pros: Integrated, senior-focused coverage.
Cons: Regional to NY.
Ideal For: NY seniors who are dual-eligible.

Eligibility & Documentation:

• Medicare: Have A & B.
• Medicaid: Meet state criteria.

Cost and Premium Information:
Dual-eligibles often pay little to no premiums.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
Dual-eligible plans usually have minimal out-of-pocket costs for DME due to Medicaid subsidies.

Telehealth Services:
AgeWell may provide telehealth for LTC and DME coordination. Seniors can get assessments or renew prescriptions remotely. Check with member services.

Coverage Limits and Exclusions:
DME must be medically necessary. Certain limits may apply.

Prior Authorizations & Referrals:
Prior authorization common. A physician’s order is typically required.

How to Verify Coverage:
Review plan materials or call AgeWell member services.
Claim Submission Tips:
Suppliers handle claims. Keep approval letters.

AlphaCare offers integrated Medicare-Medicaid services, focusing on home/community-based care.

Pros: Strong in-home support for chronic conditions.
Cons: Limited NY service area.
Ideal For: Those needing coordinated in-home LTC.

Eligibility & Documentation:

• Medicare: Have A & B.
• Medicaid: Meet eligibility rules.

Cost and Premium Information:
Dual-eligibles often have minimal costs.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
Usually minimal or no out-of-pocket costs for DME, given dual coverage.

Telehealth Services:
AlphaCare may offer telehealth visits for DME needs. This can expedite authorization and reduce travel. Confirm with member services.

Coverage Limits and Exclusions:
DME must be needed for home care. Some limits apply.

Prior Authorizations & Referrals:
A physician’s order and authorization commonly required.

How to Verify Coverage:
Review AlphaCare materials or call member services.
Claim Submission Tips:
Suppliers bill directly. Keep documentation.

Elder Plan focuses on Medicare/Medicaid LTC for seniors, including DME.

Pros: Excellent for LTC, integrated coverage.
Cons: Primarily for older adults in certain NY areas.
Ideal For: Seniors needing combined Medicare/Medicaid benefits.

Eligibility & Documentation:

• Medicare: A & B.
• Medicaid: Low-income criteria.

Cost and Premium Information:
Dual-eligible seniors often have minimal premiums.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
For dual-eligibles, cost-sharing for DME is minimal or none.

Telehealth Services:
Elder Plan may support telehealth for LTC coordination. Remote visits can facilitate DME approvals. Check member resources.

Coverage Limits and Exclusions:
DME must be medically necessary for LTC at home.

Prior Authorizations & Referrals:
Prior authorization and a doctor’s prescription likely needed.

How to Verify Coverage:
Check Elder Plan docs or call member services.
Claim Submission Tips:
Suppliers handle claims. Retain approvals.

Medicare is a federal program for seniors and certain disabled individuals. Part B covers medically necessary DME.

Pros: Nationwide coverage.
Cons: Some cost-sharing applies.
Ideal For: Individuals 65+ or with qualifying disabilities.

Eligibility & Documentation:

• Age 65+ or qualifying disability, with Parts A & B.

Cost and Premium Information:
Part B premiums apply.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
You must meet the Part B deductible, then typically pay 20% co-insurance for DME. If you have a Medigap or Medicare Advantage plan, your out-of-pocket may be lower.

Telehealth Services:
Medicare covers certain telehealth services. For DME, you may consult with a doctor virtually to get prescriptions or referrals, subject to Medicare’s telehealth rules.

Coverage Limits and Exclusions:
Only medically necessary DME is covered.

Prior Authorizations & Referrals:
Some DME may require prior authorization and a prescription.

How to Verify Coverage:
Consult “Medicare & You” or call Medicare.
Claim Submission Tips:
Medicare-enrolled suppliers bill Medicare directly. Keep your Medicare ID handy.

MetroPlus offers Medicaid, Medicare Advantage, and marketplace plans in NYC.

Pros: Low-cost coverage, local NYC focus.
Cons: Limited to NYC.
Ideal For: NYC residents seeking affordable coverage.

Eligibility & Documentation:

• Medicaid/CHP: Meet income limits.
• Medicare Advantage: Have A & B, NYC resident.
• Marketplace: ACA enrollment; residency/income proof.

Cost and Premium Information:
Medicaid: minimal or no premium. Medicare Advantage/Marketplace: premiums vary.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
Medicaid members generally have low cost-sharing. Medicare Advantage/Marketplace members have deductibles and co-pays, limited by out-of-pocket maxima. Check plan documents.

Telehealth Services:
MetroPlus often provides telehealth. You can address DME needs, prescriptions, or approvals remotely. Confirm co-pays or coverage details with member services.

Coverage Limits and Exclusions:
DME must be medically necessary. Some limits apply.

Prior Authorizations & Referrals:
Many DME items require prior authorization.

How to Verify Coverage:
Check MetroPlus materials or call member services.
Claim Submission Tips:
Suppliers handle billing. Keep authorization letters.

New York Medicaid covers DME for low-income residents.

Pros: No or minimal cost for eligible individuals.
Cons: Must meet strict income/resource guidelines.
Ideal For: Low-income NY residents needing full coverage.

Eligibility & Documentation:

• Meet NY Medicaid income/resource limits.

Cost and Premium Information:
Generally no premiums for qualifying individuals.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
Medicaid typically imposes no or very low cost-sharing. DME often comes at no out-of-pocket cost if covered.

Telehealth Services:
NY Medicaid may support telehealth visits, making it easier to obtain prescriptions and approvals for DME. Confirm with the Medicaid helpline or your plan.

Coverage Limits and Exclusions:
Must be medically necessary. Some limits apply.

Prior Authorizations & Referrals:
Prior authorization often required. A doctor’s prescription is needed.

How to Verify Coverage:
Review official Medicaid materials or call NY Medicaid helpline.
Claim Submission Tips:
Providers file claims. Keep approval letters.

Amida Care specializes in Medicaid coverage for individuals with HIV/AIDS or chronic conditions.

Pros: Condition-focused support.
Cons: Targeted eligibility, NY-based.
Ideal For: Medicaid-eligible individuals with specific health conditions.

Eligibility & Documentation:

• Must have HIV/AIDS or similar chronic condition and meet Medicaid criteria.

Cost and Premium Information:
Typically no premiums for Medicaid-eligible enrollees.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
Minimal or no cost-sharing for DME, ensuring affordability.

Telehealth Services:
Amida Care may provide telehealth options to manage DME-related needs, reducing travel and waiting times. Contact member services for info.

Coverage Limits and Exclusions:
DME must be medically necessary. Some limits may apply.

Prior Authorizations & Referrals:
Prior authorization and a doctor’s order are often required.

How to Verify Coverage:
Review Amida Care documents or call member services.
Claim Submission Tips:
Suppliers usually bill the plan directly. Keep records.

Clover Health offers Medicare Advantage plans.

Pros: Preventive care emphasis, tech-oriented.
Cons: Limited service areas.
Ideal For: Medicare beneficiaries wanting a modern approach.

Eligibility & Documentation:

• Medicare Advantage: Have A & B, reside in service area.

Cost and Premium Information:
Premiums may apply alongside Part B.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
Part B deductible and co-insurance may apply for DME. Clover Health caps your annual out-of-pocket costs.

Telehealth Services:
Clover Health supports telehealth. You can get DME consultations, approvals, or prescriptions remotely, often at standard co-pay rates. Check your Evidence of Coverage.

Coverage Limits and Exclusions:
DME must be medically necessary.

Prior Authorizations & Referrals:
Prior authorization likely needed.

How to Verify Coverage:
Review your Evidence of Coverage or call Clover member services.
Claim Submission Tips:
Suppliers handle billing. Keep approvals.

Hamaspik serves individuals with intellectual/developmental disabilities via Medicaid.

Pros: Specialized, personalized care.
Cons: Strict eligibility.
Ideal For: Those needing tailored Medicaid LTC.

Eligibility & Documentation:

• Must have a qualifying disability and meet Medicaid rules.

Cost and Premium Information:
No or minimal premiums for Medicaid-eligible.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
Typically no or very low cost-sharing for DME under Medicaid guidelines.

Telehealth Services:
Telehealth may be offered to coordinate DME needs, reducing in-person visits. Confirm with Hamaspik member services.

Coverage Limits and Exclusions:
DME must be medically necessary. Some limits apply.

Prior Authorizations & Referrals:
Prior authorization and specialist evaluation may be required.

How to Verify Coverage:
Check plan materials or call member services.
Claim Submission Tips:
Suppliers handle claims. Keep evaluation reports.

Health Care Partners offers coordinated care through Medicare Advantage or employer plans.

Pros: Integrated, patient-centered approach.
Cons: Regional availability.
Ideal For: Those valuing coordinated care.

Eligibility & Documentation:

• Medicare Advantage: Have A & B.
• Employer Plans: Meet employer criteria.

Cost and Premium Information:
Premiums vary by plan type.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
For Medicare Advantage, after meeting the Part B deductible (if applicable), co-insurance applies until reaching the out-of-pocket maximum. Employer plans follow their own deductible/co-pay structure. Check your Summary of Benefits.

Telehealth Services:
Telehealth may be available for DME assessments, simplifying the process. Contact member services to learn more.

Coverage Limits and Exclusions:
Only medically necessary DME covered.

Prior Authorizations & Referrals:
Prior authorization often required. Referrals may be needed.

How to Verify Coverage:
Check plan materials or call member services.
Claim Submission Tips:
Suppliers bill the plan. Keep approvals.

ICS provides Medicaid-managed LTC in NY, including DME.

Pros: Personalized LTC support at home.
Cons: Must qualify for nursing-home level care.
Ideal For: Disabled or elderly needing in-home care.

Eligibility & Documentation:

• Medicaid MLTC: Meet financial and functional criteria.

Cost and Premium Information:
No premiums for Medicaid-eligible. DME typically low or no cost.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
Usually no deductible or co-pays for Medicaid LTC plans, making DME affordable.

Telehealth Services:
ICS may offer telehealth assessments for DME. This can expedite approvals without an in-person visit.

Coverage Limits and Exclusions:
DME must be crucial for in-home care. Some limits apply.

Prior Authorizations & Referrals:
Prior authorization often required. Nurse assessments may be needed.

How to Verify Coverage:
Check ICS materials or call member services.
Claim Submission Tips:
Providers handle claims. Keep assessment reports.

Integra MLTC provides Medicaid LTC at home, including DME.

Pros: Personalized home-care plans.
Cons: Must need nursing-home level care.
Ideal For: Chronically ill or disabled adults needing LTC at home.

Eligibility & Documentation:

• Medicaid financial and functional criteria required.

Cost and Premium Information:
No premiums for Medicaid-qualified individuals.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
Minimal to no cost-sharing for DME under MLTC.

Telehealth Services:
Telehealth visits may be offered to assess DME needs, reducing in-home provider visits. Contact Integra.

Coverage Limits and Exclusions:
DME must support independence at home. Some limits apply.

Prior Authorizations & Referrals:
Prior authorization and assessments needed.

How to Verify Coverage:
Review Integra materials or call member services.
Claim Submission Tips:
Providers submit claims. Keep authorization records.

Local 1199 provides health benefits for 1199SEIU union members.

Pros: Strong, negotiated benefits.
Cons: Limited to union members and dependents.
Ideal For: 1199SEIU members seeking comprehensive coverage.

Eligibility & Documentation:

• Must be an active union member or dependent. Show union ID/employment verification.

Cost and Premium Information:
Minimal or no premiums depending on the union contract.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
Union plans often have low cost-sharing for DME. Check your union benefits guide for exact amounts.

Telehealth Services:
Many union plans include telehealth, making it easier to get DME approvals or follow-ups. Check your benefits handbook.

Coverage Limits and Exclusions:
DME must be medically necessary.

Prior Authorizations & Referrals:
Prior authorization may be needed. Doctor’s referral might be required.

How to Verify Coverage:
Check union benefits handbook or call member services.
Claim Submission Tips:
Suppliers bill the plan. Keep prescriptions.

MagnaCare administers employer and union health plans.

Pros: Large networks, flexible benefits.
Cons: Must be covered through an employer/union partner.
Ideal For: Employees/union members under MagnaCare plans.

Eligibility & Documentation:

• Employer/Union-based: Meet the organization’s criteria.

Cost and Premium Information:
Costs vary by negotiated plan.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
Typically, a deductible applies, followed by co-insurance or co-pays. An out-of-pocket maximum limits costs. Check your Summary of Benefits.

Telehealth Services:
Many MagnaCare-administered plans offer telehealth. This can help secure DME prescriptions remotely. Confirm details with member services.

Coverage Limits and Exclusions:
DME must be medically necessary.

Prior Authorizations & Referrals:
Prior authorization is common for DME.

How to Verify Coverage:
Check employer’s HR portal or call MagnaCare member services.
Claim Submission Tips:
Suppliers bill the plan. Keep authorization docs.

Molina Healthcare offers Medicaid, Medicare, and marketplace plans.

Pros: Affordable, focusing on low-income and senior populations.
Cons: Limited state availability.
Ideal For: Those seeking cost-effective public or subsidized coverage.

Eligibility & Documentation:

• Medicaid/CHIP: Meet state income guidelines.
• Medicare Advantage: Have A & B, reside in service area.
• Marketplace: ACA enrollment periods, provide income/residency info.

Cost and Premium Information:
Medicaid: no/low premium. Medicare Advantage/Marketplace vary.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
Medicaid beneficiaries often pay little to nothing for DME. Medicare Advantage/Marketplace enrollees have deductibles, co-pays, and limited out-of-pocket maximums. Check plan details.

Telehealth Services:
Molina typically supports telehealth visits. You can consult providers remotely about DME needs, often at lower cost. Confirm coverage via member services.

Coverage Limits and Exclusions:
DME must be medically necessary.

Prior Authorizations & Referrals:
Prior authorization common. A doctor’s order required.

How to Verify Coverage:
Check your benefit documents or call member services.
Claim Submission Tips:
Suppliers handle billing. Keep approval letters.

Senior Whole Health by Molina serves dual-eligibles with integrated Medicare/Medicaid coverage.

Pros: Integrated coverage, low cost for seniors.
Cons: Must meet dual-eligibility criteria.
Ideal For: NY seniors enrolled in Medicare and Medicaid.

Eligibility & Documentation:

• Dual-eligible: Medicare A & B plus Medicaid eligibility.

Cost and Premium Information:
Dual-eligibles usually have minimal or no premiums.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
With dual eligibility, DME cost-sharing is often negligible. Medicaid helps cover Medicare’s cost-sharing.

Telehealth Services:
Telehealth may be available to manage DME needs from home, improving convenience for seniors. Confirm details with member services.

Coverage Limits and Exclusions:
Must be medically necessary DME.

Prior Authorizations & Referrals:
Prior authorization and a doctor’s order likely needed.

How to Verify Coverage:
Check plan documents or call member services.
Claim Submission Tips:
Suppliers bill directly. Keep approvals.

VNS Choice, affiliated with Visiting Nurse Service of NY, focuses on home-based LTC (Medicare/Medicaid).

Pros: Home health expertise, integrated LTC.
Cons: Limited NY regions.
Ideal For: Those needing comprehensive in-home LTC coverage.

Eligibility & Documentation:

• Medicaid MLTC: Meet financial/functional criteria.

Cost and Premium Information:
Minimal or no premiums for Medicaid-qualified individuals.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
Typically minimal or no cost-sharing for LTC-related DME under Medicaid MLTC.

Telehealth Services:
VNS Choice may use telehealth for care coordination. You can request DME consultations remotely. Check member materials.

Coverage Limits and Exclusions:
DME must be essential for home care.

Prior Authorizations & Referrals:
Prior authorization common, with nurse or physician assessment needed.

How to Verify Coverage:
Consult VNS Choice materials or call member services.
Claim Submission Tips:
Suppliers handle billing. Keep assessments and approvals.

ArchCare supports elderly care, MLTC, and PACE programs in NY.

Pros: Specialized elderly/long-term care support.
Cons: Limited to NY regions.
Ideal For: Seniors needing PACE or MLTC in NY.

Eligibility & Documentation:

• PACE: 55+ and nursing-home level care.
• MLTC: Medicaid-eligible with LTC needs.

Cost and Premium Information:
Often no or low premiums due to Medicaid eligibility.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
Minimal or no cost-sharing for covered DME under PACE/MLTC programs.

Telehealth Services:
ArchCare may offer telehealth for consultations and care coordination, including DME needs. Check member services.

Coverage Limits and Exclusions:
Only medically necessary DME. Some limits apply.

Prior Authorizations & Referrals:
Prior authorization common. A care assessment may be required.

How to Verify Coverage:
Review ArchCare materials or call member services.
Claim Submission Tips:
Suppliers bill the plan. Keep approvals.

BCBS of Western NY provides regional coverage (Individual, Family, Medicare Advantage).

Pros: Strong local network.
Cons: Limited to Western NY region.
Ideal For: Western NY residents wanting community-based coverage.

Eligibility & Documentation:

• Individual/Family: ACA enrollment, residency proof.
• Medicare Advantage: A & B, in coverage area.

Cost and Premium Information:
Premiums vary by plan.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
Generally, you must meet a deductible, then pay co-pays or co-insurance for DME. Medicare Advantage includes Part B cost-sharing. Out-of-pocket maximums limit total spending. Check your Summary of Benefits.

Telehealth Services:
BCBS of Western NY often includes telehealth. You can obtain DME-related consultations online, possibly at lower cost. Confirm in your plan documents.

Coverage Limits and Exclusions:
DME must be medically necessary.

Prior Authorizations & Referrals:
Prior authorization may be required.

How to Verify Coverage:
Check Summary of Benefits or call member services.
Claim Submission Tips:
Suppliers bill directly. Keep prescriptions.

Bright Healthcare provides Individual/Family and Medicare Advantage plans in select regions.

Pros: User-friendly, preventive care focus.
Cons: Limited regional availability.
Ideal For: Those wanting a modern, simplified plan experience.

Eligibility & Documentation:

• Individual/Family: ACA enrollment.
• Medicare Advantage: A & B, reside in service area.

Cost and Premium Information:
Premiums vary by plan type and location.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
For marketplace plans, meet your deductible, then pay co-pays or co-insurance until you hit the out-of-pocket max. Medicare Advantage: Part B rules apply with a plan-specific maximum. Check your Evidence of Coverage or Summary of Benefits.

Telehealth Services:
Bright Healthcare supports telehealth appointments. This can speed up getting DME-related prescriptions or approvals. Review your member portal.

Coverage Limits and Exclusions:
Only medically necessary DME covered.

Prior Authorizations & Referrals:
Prior authorization often required.

How to Verify Coverage:
Review your Evidence of Coverage or call member services.
Claim Submission Tips:
Suppliers handle billing. Keep approvals.

Care Connect (availability may vary) focused on preventive care and integrated coverage.

Pros: Preventive care focus.
Cons: Availability changed; verify current offerings.
Ideal For: Those who previously accessed Care Connect’s model.

Eligibility & Documentation:

• Individual/Family: ACA enrollment if still available.
• Employer Plans: Follow employer rules.

Cost and Premium Information:
Premiums vary; check current status.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
If still active, you would meet a deductible first, then co-pays/co-insurance apply. An out-of-pocket maximum caps yearly costs. Refer to plan documents.

Telehealth Services:
If offered, telehealth can help with DME needs. Check if Care Connect still provides telehealth benefits.

Coverage Limits and Exclusions:
DME must be medically necessary.

Prior Authorizations & Referrals:
Likely needed for certain DME.

How to Verify Coverage:
If plan still operates, contact member services or review documentation.
Claim Submission Tips:
Suppliers usually bill the plan. Keep approvals.

ConnectiCare serves Connecticut residents with various plans (Individual, Family, Employer).

Pros: Local CT focus, strong preventive care.
Cons: Limited to Connecticut.
Ideal For: CT residents seeking a community-oriented insurer.

Eligibility & Documentation:

• Individual/Family: ACA enrollment in CT.
• Employer: Meet employer criteria.

Cost and Premium Information:
Premiums vary; subsidies may apply on the CT marketplace.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
Typically, you’ll face a deductible, then co-pays or co-insurance for DME. An annual out-of-pocket maximum caps costs. Check your Summary of Benefits.

Telehealth Services:
ConnectiCare usually supports telehealth visits, allowing remote DME-related consultations at convenient rates. Confirm details with member services.

Coverage Limits and Exclusions:
DME must be medically necessary.

Prior Authorizations & Referrals:
Prior authorization may be required.

How to Verify Coverage:
Check ConnectiCare materials or call member services.
Claim Submission Tips:
DME suppliers bill the plan. Keep medical necessity docs.

UnitedHealthcare offers various plans (Employer, Individual, Medicare Advantage) with DME coverage.

Pros: Extensive national network.
Cons: Costs and coverage vary widely.
Ideal For: Those wanting nationwide coverage.

Eligibility & Documentation:

• Employer: Meet employer criteria.
• Individual/Family: ACA enrollment; subsidies possible.
• Medicare Advantage: A & B, reside in service area.

Cost and Premium Information:
Varies by plan type.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
Commercial and marketplace plans have deductibles, co-pays/co-insurance, and an out-of-pocket max. Medicare Advantage includes Part B rules plus plan limits. Check your Summary of Benefits or Evidence of Coverage.

Telehealth Services:
UHC often provides telehealth. You can address DME needs remotely, often with standard cost-sharing. Review member materials.

Coverage Limits and Exclusions:
Must be medically necessary DME.

Prior Authorizations & Referrals:
Prior authorization may be needed.

How to Verify Coverage:
Check your Summary of Benefits or call UHC member services.
Claim Submission Tips:
Suppliers bill UHC. Keep authorization letters.

Blue Cross Blue Shield is a federation of local companies offering DME coverage.

Pros: Nationwide recognition, local presence.
Cons: Benefits vary by region.
Ideal For: Those looking for a trusted brand with local variations.

Eligibility & Documentation:

• Employer: Meet employer criteria.
• Individual/Family: ACA enrollment.
• Medicare Advantage: A & B, service area restrictions.

Cost and Premium Information:
Premiums depend on local BCBS affiliate and plan type.

Deductibles, Co-Pays, and Out-of-Pocket Costs:
Typically, a deductible applies, followed by co-insurance or co-pays. Out-of-pocket maximum limits expenses. Medicare Advantage follows Part B cost-sharing plus plan rules.

Telehealth Services:
Most BCBS affiliates offer telehealth. This can help secure prescriptions or authorizations for DME remotely.

Coverage Limits and Exclusions:
Medically necessary DME only.

Prior Authorizations & Referrals:
Often required for certain DME items.

How to Verify Coverage:
Check local BCBS documents or call member services.
Claim Submission Tips:
Suppliers typically handle claims. Keep records.

(Duplicate Entry) Aetna offers comprehensive coverage including DME. See the main Aetna entry above.

Deductibles, Co-Pays, and Out-of-Pocket Costs: Refer to main Aetna details.
Telehealth Services: Refer to main Aetna details.

(Duplicate Entry) Cigna covers DME. See the main Cigna entry above.

Deductibles, Co-Pays, and Out-of-Pocket Costs: Refer to main Cigna details.
Telehealth Services: Refer to main Cigna details.

(Duplicate Entry) Humana Medicare Advantage covers DME. See main Humana entry above.

Deductibles, Co-Pays, and Out-of-Pocket Costs: Refer to main Humana details.
Telehealth Services: Refer to main Humana details.