What Part of Medicare Covers Durable Medical Equipment?

What Is Durable Medical Equipment (DME)?

Durable medical equipment (DME) encompasses medical devices and supplies designed to serve a medical purpose, withstand repeated use for at least three years, and be appropriate for use in the home. Medicare Part B generally defines DME as equipment that:

• Is durable (can last for at least three years)
• Is primarily and customarily used for a medical reason
• Is not generally useful to individuals who are not sick or injured
• Is used in your home
• Is prescribed by a doctor or other qualified healthcare provider

Common examples of DME covered by Medicare include:
Wheelchairs, walkers, and scooters, hospital beds, oxygen equipment, continuous positive airway pressure (CPAP) machines, nebulizers, blood glucose monitors, diabetic testing supplies, patient lifts, and specialized cushions or mattresses for pressure sore prevention.

If you are interested in understanding how DME fits into your broader healthcare coverage, you may also find our article on Medicare Part A helpful for a complete understanding of inpatient and outpatient benefits.

How Medicare Part B Covers DME

Medicare Part B, sometimes referred to as “medical insurance,” covers durable medical equipment when it is deemed medically necessary, prescribed by a Medicare-enrolled healthcare provider, and used primarily in your home. To qualify for coverage, both you and your supplier must meet several important requirements:

• Eligibility: You must be enrolled in Medicare Part B at the time of receiving the equipment.
• Prescription Requirements: A written order, or prescription, from your medical provider is required. The prescription must detail your medical need, specify the type of DME, and outline the duration for which it’s needed. Some devices, such as power wheelchairs, require a face-to-face exam and extra documentation-like a Certificate of Medical Necessity.
• Supplier Enrollment: The equipment must be purchased or rented from a Medicare-enrolled DME supplier who accepts assignment, agreeing to Medicare’s approved payment amount. If the supplier is not enrolled, Medicare will not pay, and you could be responsible for the full cost.

For additional Medicare basics and enrollment information, review our guide on how to get Medicare.

Eligibility and Prescription Requirements

Medicare’s eligibility criteria for DME coverage are straightforward but precise, designed to ensure only medically necessary and appropriate items are covered.

• Medically Necessary: The DME must be prescribed by a Medicare-enrolled healthcare provider for a medical need that arises in the treatment of a disease or injury. For instance, if you have mobility issues following surgery, your doctor may prescribe a walker or wheelchair.
• Face-to-Face Examination: For some high-cost or complex items, Medicare requires a face-to-face examination with your healthcare provider before writing the prescription.
• Written Prescription: Your doctor’s written order should include a statement that the item is required, what specific equipment is needed, and for how long. The prescription must be provided before the supplier delivers the equipment.

It’s essential to use a Medicare-approved supplier, as highlighted in our article on True Out-of-Pocket Costs (TrOOP) in Medicare, to avoid higher out-of-pocket expenses.

What Types of Equipment Are Covered?

Medicare Part B covers a comprehensive range of DME. This includes, but is not limited to:

• Wheelchairs (manual and power) and scooters
• Walkers and canes (except white canes for visual impairment)
• Hospital beds, hospital mattresses, and pressure-reducing pads
• Patient lifts and trapeze bars
• Home oxygen equipment, oxygen concentrators, and related supplies
• Continuous positive airway pressure (CPAP) machines and accessories
• Blood glucose monitors, test strips, lancets, and other diabetes supplies (excluding most insulin unless used with an insulin pump)
• Nebulizers and medications for the nebulizer
• Commodes, bedside commode chairs, and crutches
• Infusion pumps and related monitoring equipment
• Suction pumps and traction equipment

For a specific example, someone with severe sleep apnea might receive a prescription for a CPAP machine and necessary supplies, while an individual post-surgery may need a rented hospital bed for home recovery. However, Medicare does not cover items that are only for convenience, comfort, or general use (such as grab bars, most bath aids, or air conditioners).

Costs: Deductibles, Coinsurance, Rental vs. Purchase

Understanding the cost structure for Medicare DME coverage is crucial for budgeting and avoiding surprises.

Deductible

Each year, you must pay the Medicare Part B deductible (set at $233.50 for 2025) before your DME coverage begins. Expenses incurred before the deductible is met are your responsibility.

Coinsurance

Once the deductible is met, you will typically pay 20% of the Medicare-approved amount for DME as coinsurance. Medicare covers the remaining 80%. If your supplier does not accept Medicare assignment, you could pay more than 20%.

Rental vs. Purchase

• Rental: For many expensive DME items, Medicare may require you to rent instead of purchase. Medicare pays the supplier as long as the item is medically necessary. Typical rental periods last up to 13 months, after which you may own the equipment.
• Purchase: Some less expensive devices-like canes, walkers, and basic blood glucose monitors-may be purchased outright if you prefer.

Supplier Assignment Impact

Always verify that your supplier accepts Medicare assignment. Otherwise, you could be liable for significant additional costs.

Medicare’s approach to cost sharing, coinsurance, and deductible is also pertinent if you are managing costs for various covered services, as discussed in detail on our True Out-of-Pocket (TrOOP) page.

How to Get DME Through Medicare

1. Consult Your Doctor: The process starts with a conversation with your doctor, specialist, or other healthcare provider to discuss your medical needs. If DME is necessary, your provider will issue a prescription outlining the type of equipment and reason for its use.
2. Choose a Medicare-Enrolled Supplier: Use resources such as getmedicaresolutions.com or Medicare’s supplier directory to find a supplier who is enrolled in Medicare and accepts assignment.
3. Supplier Submits Your Claim: The supplier will work with your doctor to gather required documentation and submit the claim to Medicare. Certain high-cost equipment might require written advance approval (called prior authorization) before it is supplied.
4. Pay Your Portion: After you receive your equipment, be prepared to pay the Part B deductible if it has not yet been met, and 20% coinsurance for the Medicare-approved cost.

For a step-by-step printable checklist to guide you through this process, please contact your supplier or plan provider for downloadable resources tailored to your individual health situation.

Medicare Advantage and DME Coverage

Medicare Advantage (Part C) plans are private insurance options that must provide at least the same level of DME coverage as Original Medicare (Part B). However, these plans may feature:

• Different supplier networks-coverage may be limited to specified suppliers within the plan’s network
• Varied prior authorization policies-additional documentation or authorization might be required for certain DME
• Adjustable out-of-pocket costs-deductibles, copayments, and coinsurance may differ from Original Medicare

It’s vital to understand your plan’s network, requirements, and benefit structure before receiving DME. For a deeper dive into these differences, review our dedicated article on Medicare Part C.

Comparison: Original Medicare vs. Medicare Advantage DME Coverage

Feature	Original Medicare (Part B)	Medicare Advantage (Part C)
Covered DME	Standardized, federally defined	Must cover at least same as Part B, can add supplemental items
Supplier Choice	Any Medicare-approved supplier nationwide	Plan network suppliers only (may be limited)
Authorization Process	Some items require prior authorization	More extensive pre-authorization may be required
Costs (Deductible, Coinsurance)	Part B deductible + 20% coinsurance	Varies by plan; may include fixed copays or different coinsurance
Appeals Process	Standard Medicare appeals	Plan-specific appeals, may differ from Medicare rules

Frequently Asked Questions About DME and Medicare

Q: Does Medicare cover all types of DME?
A: Medicare Part B covers only equipment that meets its definition of “durable medical equipment” and is shown to be medically necessary via a doctor’s prescription. Items for general comfort, convenience, or outside of the home (e.g., ramps, exercise equipment, or daily living aids) are not covered.

Q: Can I buy my equipment instead of renting?
A: Often, yes-but not always. Medicare allows you to purchase outright less expensive, routinely purchased equipment, such as walkers or basic commodes. Larger or high-cost items, such as hospital beds or power wheelchairs, are generally rented first. Your supplier will clarify your options at the time of ordering.

Q: What if my claim is denied?
A: If Medicare or your Medicare Advantage plan denies a claim, you have the right to appeal. Appeals often require additional documentation or clarification from your provider. For Medicare Advantage plan denials, you must follow your plan’s specific process, which may be outlined in your member handbook or on their website.

Q: Do I need to use a specific supplier?
A: Yes. To ensure maximum coverage and avoid unexpected costs, always use a Medicare-approved supplier who accepts assignment. This is especially important with Medicare Advantage plans, which may restrict coverage to suppliers in their networks.

Q: What happens if my DME is lost, damaged, or destroyed in a disaster?
A: Medicare makes exceptions in emergency situations. If your equipment is lost, destroyed, or damaged due to a disaster or emergency, you may be eligible for replacement. Contact your supplier, Medicare, or your Medicare Advantage plan as soon as possible for specific steps and documentation requirements.

For more on medication and equipment coverage, see our article covering Medicare Part D Plans in Texas, which addresses costs and coverage for outpatient prescription drugs.

For further clarification on any aspect of DME or to check your eligibility for Medicare, consult the resources at getmedicaresolutions.com.