Durable Medical Equipment (DME)
Durable medical equipment refers to reusable devices prescribed to assist with medical conditions or mobility challenges. Examples include wheelchairs, walkers, hospital beds, oxygen systems, and CPAP machines. Health insurance plans typically reimburse a percentage of the cost up to a maximum per item or per period.
How It Works
To qualify as durable medical equipment, a device generally has to withstand repeated use, be appropriate for use in the home or outside a medical facility, and be prescribed by a health professional. Disposable medical devices fall outside this category because they are not reusable. Most Canadian provinces do not cover the cost of this equipment, though exceptions exist for people enrolled in specialty programs such as social assistance, and when a provincial plan does supply a device it usually provides the least expensive appropriate option and only when no other resource is available to deliver what the doctor requested. In private health insurance, durable medical equipment coverage is usually part of the extended health benefits, alongside prescription drugs, vision care, and hospital services, and both renting and purchasing of equipment can be covered. As an example of how a workplace plan can frame this, the Canada Life-administered Public Service Health Care Plan reimburses durable equipment at a set percentage of reasonable and customary charges, requires a prescription from a physician or nurse practitioner, and limits coverage to cost-effective, non-motorised equipment unless motorised equipment is medically proven necessary.
Example:
Picture a Canadian recovering from a joint replacement who is prescribed a walker and a hospital bed to use at home. Their provincial plan does not cover this equipment, but their employer's extended health benefits plan reimburses a percentage of the cost up to a per-item maximum. After submitting the physician's prescription and obtaining pre-authorization, they are reimbursed for the eligible portion and pay the remainder themselves, with the bed replaceable only on the plan's set schedule.
What to Watch For:
Because most provincial plans do not pay for durable medical equipment, the cost often falls to private or extended health benefits, and those plans usually reimburse only a percentage up to a maximum per item or per period. Most insurers require medical documentation or pre-approval, so submit the physician's prescription and get pre-authorization before you buy or rent. Watch for replacement time limits as well, since plans commonly cap how often an item can be replaced, with the Public Service Health Care Plan limiting items such as a wheelchair or walker to one every several years and a hospital bed to one in a lifetime.
