# Monday, January 14, 2019
                 
Durable medical equipment, or DME, refers to devices that provide some sort of therapeutic benefit to people suffering with a medical condition or illness.

Common types of DME are wheelchairs, medical beds, crutches, canes and walkers, just to name a few.

But what sort of coverage is out there for durable medical equipment via Canadian private health insurance and public healthcare plans? Let’s read on to find out!

About Durable Medical Equipment

A common use of durable medical equipment occurs when a Canadian has an accident and then requires some type of temporary assistance while recovering from that accident.

A person may have to use durable medical equipment for just a few weeks, or they may need assistance for the rest of lives, depending on the severity of their illness or accident.

Note that disposable medical devices are not technically classified as durable medical equipment since they are not reusable (i.e. they are not "durable").

There are numerous types of devices out there that are considered to be durable medical equipment. The following lists just some examples of DME:
  • Crutches and canes
  • Wheelchairs
  • Hospital (medical) beds
  • Walkers
  • Prostheses (i.e. artificial limbs)
  • Oxygen tanks and equipment
  • Insulin pumps
  • Needles and test strips for diabetics
  • Traction equipment
  • Pressure mattresses
  • Medical lifts
  • Various monitors
  • Bili lights and blankets
  • Bath chairs
  • Breast pumps
  • Sleep apnea and CPAP devices

Durable Medical Equipment Coverage via Canadian Provincial Healthcare Plans

Many Canadians believe that their provincial healthcare plan will cover the cost of durable medical equipment if they need it in order to help them recover from an accident or illness.

The opposite is true, actually. In fact, most provinces do not offer coverage for DME. There are exceptions to this, however, especially if a Canadian is enrolled in some sort of specialty program (e.g. social assistance, etc.).

Manitoba’s healthcare plan, Manitoba Health, may cover some durable medical equipment if it falls under the umbrella of personal home care.

Nova Scotia’s healthcare plan may also cover some prosthetics.

To find out more please go to your province’s provincial healthcare web site.

Employee Benefits Coverage for Durable Medial Equipment

Employee benefits,  also referred to as "group insurance", is private health insurance that is obtained through an employer. With these group plans the employer pays anywhere from 50% to 100% of the premium costs.

Durable medical equipment coverage is usually part of the extended health benefits coverage, which also covers things like prescription drugs, vision care, hospital services and more.

Group insurance coverage for durable medical equipment varies. However, we can say that a TYPICAL employee benefits plan offers 100% coverage for DME, up to a maximum of roughly $5,000 to $10,000 per year.

Copays (the portion of the cost that is paid for by the employee) are not common when it comes to durable medical equipment due to the expensive nature of these devices.

Note that for durable medial equipment to be covered it must be considered medically necessary, and also be prescribed by a doctor.

Individual Health Insurance Coverage for Durable Medical Equipment

Individual health insurance, also called "personal health insurance", is not obtained through an employer. It is obtained on an individual, couple or family basis, and (unlike group insurance) you do not lose your coverage if you lose your job.

These personal health insurance plans are either guaranteed issue (no medical questions) or they are medically underwritten (see Guaranteed Issue Health Insurance vs Underwritten Plans for more information).

With personal health and dental plans coverage for durable medial equipment is usually part of the plan’s core coverage (i.e. it is not optional).

Personal health insurance coverage for DME is tends to be lower than coverage obtained via an employee benefits plan. On the flip side, though, personal health insurance premiums are often substantially less than group insurance premiums.

Diabetic Medical Supplies

Coverage exists for diabetic medical supplies is something that we are often asked about as Canadian health insurance brokers.

Diabetic medical supplies consist of devices such as pens, needles and test strips.

A good health insurance plan for diabetic medical supplies is the ComboPlus Starter plan by Manulife Financial. It is guaranteed issue, and almost pays for itself via its coverage for diabetic medical supplies.

Personal Health Plan Coverage Amount for DME

Then following table outlines the amount of coverage for durable medical equipment via personal Canadian health insurance plans:

Insurance Plan

Coverage Amount

Coverage Details

Blue Vision (Ontario Blue Cross)

Express and Global plans

Eligible expenses covered at 80% without deductible:   

  • Surgical stocking: up to a max. of $100 per calendar year.
  • Orthopedic shoes or podiatric ortheses: up to max. refund of $175 per calendar year for both combined.
  • Purchase or rental of equipment up to a max.
    refund of $2,500 per calendar year.

Flexcare
(Manulife)

DentalPlus and ComboPlus Starter plans

  • $3,500 per year if under 65
  • $4,000 per year if 65-plus
  • $225 max. per anniversary year for Orthotics, which is part of Durable Medical Equipment.

Flexcare
(Manulife)

DrugPlus and ComboPlus Basic and Enhanced plans

Maximum per anniversary year:

  • Year 1: $1,000
  • Year 2: $1,300
  • Year 3: $1,500
  • Year 4: $1,700
  • Year5+: $3,000

Flexcare
(Manulife)

Catastrophic add-on (optional)

Additional $25,000 in coverage if annual claims exceed $7,500 per anniversary year. Lifetime maximum of $100,000.

Personal Health Insurance
(Sun Life Financial)

Basic plan

Medical equipment and in-home nursing: $2,500/yr. max. $20,000 lifetime max combined with medical equipment and services

Personal Health Insurance
(Sun Life Financial)

Standard plan

Medical equipment and in-home nursing: $5,000/yr. max. $25,000 lifetime max. combined with medical equipment and services

Personal Health Insurance
(Sun Life Financial)

Enhanced plan

Medical equipment and in-home nursing: $10,000/yr. max. $30,000 lifetime max. combined with medical equipment and services

Sonata
(Great West Life)

Core plan

100% to plan max., $100 max. per year for orthotics

Sonata
(Great West Life)

Core Plus and Elite plans

100% to plan max., $300 max. per year for orthotics

Conclusion

We hope you found this article about durable medical equipment coverage via public healthcare and private health insurance plans useful.

If you have any questions please feel free to contact us, as experienced Canadian health insurance brokers we are here to help!

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