March 19th 2024
By Ari Parker
Discover everything you need to know about durable medical equipment covered by Medicare in this article.
By Ari Parker
Many people with mobility issues and medical conditions rely on durable medical equipment (DME). DME includes any device that your doctor prescribes to help you manage a health condition at home. Some examples include wheelchairs, CPAP machines, and blood sugar monitors.
Medicare covers a lot of durable medical equipment—but usually, your doctor needs to determine that the device is medically necessary for it to be covered. In this guide, we’ll share which DME Medicare covers, what your out-of-pocket costs should be, and what the eligibility criteria may be for the equipment you need.
Durable medical equipment is a medical device you need at home to manage a condition or heal after an injury.
Medicare covers a lot of durable medical equipment, including more common devices such as CPAP machines, blood sugar monitors, and mobility devices.
Medicare defines durable medical equipment as any medical device that is:
Sturdy and can withstand repeated use
Necessary to use for a medical reason
Usually only useful for someone with a medical condition or injury
Used at home
Expected to last for three years or more
You may need DME if you have issues with mobility, sleep apnea, or diabetes. DME is also commonly used to treat or manage a chronic condition at home.
Your doctor needs to recommend DME for Medicare to help pay for the equipment. You also need to receive your equipment from a supplier that's enrolled in Medicare and accepts Medicare assignment. Accepting Medicare assignment means that the supplier accepts the Medicare-approved cost for a device. A supplier who isn’t enrolled in Medicare and doesn’t accept assignment could charge you more.
Depending on the equipment and your need, Medicare may require you to rent the equipment rather than purchase it. Sometimes you have a choice to do either.
Regardless of whether you pay rent or own, you’ll pay 20% of the Medicare-approved cost after you meet your Part B deductible for the DME you need.
Your Medicare Advantage plan must cover the same DME as Original Medicare does if the devices are medically necessary. However, there are a few important notes to be aware of when it comes to Medicare Advantage plans and DME coverage:
The cost of your DME depends on your specific Medicare Advantage plan. Additionally, DME suppliers may vary with Medicare Advantage plans as well.
Medicare Advantage plans require prior authorization more often than Original Medicare. If you’re denied prior authorization and you need the DME, you can appeal your Medicare Advantage plan’s denial and receive an independent review of your request for coverage.
Check the details of your Medicare Advantage plan carefully and contact your plan to make sure that it covers the device you need. The Evidence of Coverage document will include information on how your plan covers DME.
Check the list below for what DME you can get covered by Medicare. We’ve broken them up by categories of conditions and kinds of support.
Wheelchairs
Walkers
Scooters
Canes
Crutches
Continuous passive motion machines, devices, and accessories
Traction equipment
Oxygen concentrators
Portable oxygen tanks
Oxygen equipment and accessories
Commode chair
Home infusion services, including infusion pumps and supplies
Hospital beds
Patient lifts
Suction pump
Nebulizers and nebulizer medications
Pressure-reducing support surfaces
Blood sugar test strips
Blood sugar meters
Lancet devices and lancets
Continuous Positive Airway Pressure (CPAP) machines
To receive coverage for DME, you’ll first need your doctor to recommend the device for you. The equipment must be medically necessary to treat, manage, or support an injury or condition at home. Once your device is deemed medically necessary, select a supplier that’s approved by Medicare to ensure that you’ll only pay 20% of the costs for the DME.
Finding the DME that you need is vital to recovering from an injury or managing a disease. If you have more questions about what medical devices are covered by Medicare or what else your plan pays for, contact a licensed Medicare Advisor for free, personalized guidance. Call us at 855-900-2427 or schedule a time to chat today.
