What Durable Medical Equipment is Covered by Medicare?
Durable Medical Equipment (DME) is reusable medical equipment that has been deemed medically necessary. Your doctor or health care provider will determine your need for DME. They will provide an assessment of your health, what equipment you can use, and what equipment can be used in your home.
Medicare defines Durable Medical Equipment as equipment that is:
- Durable (can withstand repeated use)
- Used for a medical reason
- Typically only useful to someone who is sick or injured
- Used in your home
- Expected to last at least 3 years
Medicare Part B will cover most DME after your doctor or PCP has determined it medically necessary. If you need DME in your home, your doctor or provider must prescribe the type of equipment you need by filling out an order. For some equipment, Medicare may also require your doctor to provide additional information documenting your medical need for the equipment. Your supplier will work to make sure your doctor submits all required information to Medicare. If your needs and/or condition change, your doctor must complete and submit a new, updated order.
Medicare only covers DME if you get it from a supplier enrolled in Medicare. This means that the supplier has been approved by Medicare and has a Medicare supplier number. When you contact a supplier, be sure to ask whether they agree to accept the Medicare-approved amount as full payment.
Additionally, some Medicare Advantage plans (part c) offer extra benefits bundled with your Part A and Part B to help cover DME. They also often also bundle your Part D drug plan, being a comprehensive option. Compare Plans or speak with a licensed agent to help get Medicare coverage fit for you.
Read more below about which DME is covered, which is not, and what your costs will be.
What Durable Medical Equipment is covered by Medicare?
Medicare-covered DME covers many health care necessities, including but not limited to:
- Prosthetics, prosthetic devices and orthotics
- Blood sugar monitors, glucose monitors & test strips
- Canes
- Commode chairs
- Continuous passive motion machines, devices & accessories
- Continuous Positive Airway Pressure (CPAP) machines
- Crutches
- Hospital beds
- Infusion pumps & supplies
- Nebulizers & nebulizer medications
- Oxygen equipment, including portable oxygen, & accessories
- Patient lifts
- Pressure-reducing support surfaces
- Suction pumps
- Traction equipment
- Walkers
- Manual Wheelchairs & scooters (your health care provider must state you need a power wheelchair or scooter. Medicare will not cover power wheelchairs you only need and use outside of the home.)
What Durable Medical Equipment is not covered by Medicare?
Medicare will not cover certain items and medical supplies. DME coverage by Medicare includes:
- Items that change or modify your home, such as ramps or widened doors
- Any equipment that is intended for use outside of the home
- Equipment that can not be used for at-home use, such as paraffin bath units used in hospitals
- Any items that are intended to provide mainly convenience or comfort, such as air conditioners
- Disposable or consumable items that are thrown away after use, or that aren’t used with equipment, such as catheters
Will I Need Prior Authorization?
Some durable medical equipment will require prior authorization to determine it is necessary. The prior authorization process helps to keep costs down and keep you safe.
Some items that require prior authorization include:
- Electric scooters
- Motorized wheelchairs
- Lower limb prosthetics
Your doctor will submit a prior authorization request for you. This process can take up to two weeks. Medicare may also require your doctor to provide additional information documenting your medical need for the equipment. Your supplier will work to make sure your doctor submits all required information to Medicare. In the case that your needs or condition change, your doctor must complete and submit a new order.
Your costs in Original Medicare
Before Medicare pays for your equipment, you must first meet the Part B deductible. Once met, you pay 20% of the Medicare-approved amount, and Medicare Part B covers 80%. However, Medicare will cover the costs of the equipment in various ways. Depending on the type of equipment:
- You may need to rent the equipment.
- You may need to buy the equipment.
- You may be able to choose whether to rent or buy the equipment.
It’s important to check that your doctors and DME suppliers are enrolled in Medicare. It’s also important to ask a supplier if they participate in Medicare before you get DME. If suppliers are participating in Medicare, they can charge you only the coinsurance and Part B deductible for the Medicare‑approved amount. If suppliers aren’t participating in Medicare and don’t accept assignment, you will likely have to pay for the full cost of the DME. Checking ensures you keep your Medicare costs low.
Things to know
If you live in an area that’s been declared a disaster or emergency, the usual rules for your medical care may change for a short time. Learn more about how to replace lost or damaged equipment in a disaster or emergency. Additionally, during this time, or any Special Enrollment Period, you can shop for plans that may offer better coverage for DME.
If you qualify for Medicaid, you can enroll in Medicaid for more help with Durable Medical Equipment.
During a stay in a Skilled nursing facility (SNF) or long-term care covered under Medicare Part A (Hospital Insurance), the facility is responsible for providing any DME you need while you’re in the facility. This is covered for up to 100 days.
If you have Medicare Supplement Insurance (Medigap) that pays your Part B coinsurance, your Medigap plan should cover the cost for insulin.
Visit Medicare.gov/medical-equipment-suppliers to find a supplier in your area.
