Does Your Health Insurance Cover Medical Equipment?

Serious accidents and illnesses do happen. Too often that means you will need medical equipment to help you recover. Are you ready to pay for the support tools you need?

Did you know that your government health coverage doesn’t usually cover the cost of medical support equipment you may need if you have an accident or illness? If you do qualify for some, you will be supplied with the least expensive appropriate medical equipment or device to assist for your medically essential need. And you only receive it if there is no other resource available to provide the medical equipment requested by your doctor.

Therapeutic, monitoring, mobility assist and support equipment can be costly. What if you need them for an extended period of time (even for the rest of your life)? Do you have the financial resources ready to pay those unexpected expenses?

Spending hundreds or thousands of dollars on medical equipment at any time, and potentially year after year, is a serious financial burden. Not having the support tools, you need can be even more serious.

That’s why health insurance includes extended healthcare benefits. These benefits help you pay for durable medical equipment ordered by a healthcare professional for every day or extended use.

I won’t need medical equipment, will I?

Surprisingly, the odds of needing medical equipment are rising. Consider this:

  • Government initiatives are encouraging more home healthcare for recovery
    Recovering at home may be preferable but it can also mean out of pocket expense to have the equipment you need to adapt to your surroundings.
  • The population is aging and living longer
    While we may not all be elderly, this is an increasing segment of the population.  As our bodies age, achieving and maintaining physical fitness and our independence can be challenging. Wear and tear on our joints and ligaments from arthritis, a simple fall, fracture or a joint replacement can result in mobility difficulties that can be relieved by the support of medical equipment.
  • Rising incidences of chronic diseases
    More individuals wrestle with chronic disease such as diabetes, cancer, kidney failure, stroke, and respiratory disorders like COPD or sleep apnea.  Any of these illnesses or conditions can cause us to be dependent on medical equipment for monitoring and therapy.

What is durable medical equipment?

Durable medical equipment:

  • can withstand repeated use
  • is appropriate for use in the home (or outside a medical facility) and
  • is prescribed by a health professional.

Here are some examples:

  • Crutches which can cost between $40 and $200 depending on your need
  • Walking aids, with canes costing $20 to $60 and walkers and rollators ranging from $60 to $700
  • Wheelchairs which can cost $200 for a basic mechanical chair to $2,500 for powered chair
  • Hospital (medical) beds which can cost up to $3,000
  • Oxygen tanks and equipment range from $500 to $2000
  • Diabetic medical supplies like test strips and lancets, needles and syringes, sensors and continuous glucose monitors with annual costs often from $1000 to $6000
  • Sleep apnea and CPAP devices which may be only partially paid for under provincial health insurance.

Health insurance helps pay for medical equipment

Coverage for durable medical equipment is included with a personal health and dental plan.

Depending on the plan you choose, you can be reimbursed for up to $5,000 per year for the purchase or rental of medically necessary equipment. The maximum benefit payments you will be eligible for may have a dollar limit on specific equipment and supplies. While some plans  have a lifetime maximum there are health insurance plans available without this limitation.

Your benefit will be coordinated with benefits available through your provincial support program, like Ontario’s Assistive Device Program.

To make a claim for any costs over $300, you can apply for authorization and approval from your insurer by submitting a written estimate and a written prescription or functional assessment from a physician or certified authorizer.  For approved claims you will be required to submit your receipt and a copy of any government health insurance plan contribution statement.

And don’t forget: your health insurance will also help pay healthcare expenses you may need for your recovery including:

  • Prescription Drugs
  • Physiotherapy and chiropractic care
  • Dental and vision care
  • Prosthetics
  • Braces or supports
  • Homecare and nursing
  • Orthotics
  • Ambulance services

Don’t be out of pocket for healthcare costs. Get health insurance.

At SBIS, we care about your health and want you to know what your options are. Having durable medical equipment is an important part of many people’s lives. Having an insurance plan that helps pay for the cost of equipment and more can make life a little easier.

Want to ask a question or talk to an expert so you can put your individual health insurance plan in place? At SBIS, we are ready to help. Give us a call today at 1-800-667-0429 Monday to Friday, 8:45 a.m. to 4:45 p.m.


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