Medicare Part B covers durable medical equipment, but only the items your doctor prescribes and only from suppliers enrolled in Medicare

Durable medical equipment (DME) is equipment your doctor says you need to use at home for a medical condition. Medicare Part B pays 80 percent of the approved amount after you meet your deductible. You pay the remaining 20 percent, plus any difference between what Medicare approves and what the supplier charges if they do not accept Medicare assignment.

The equipment must be prescribed by a doctor, physician assistant, nurse practitioner, or other may have access to provider. It must be something you can use repeatedly — not a single-use item — and it must be medically necessary for your condition. Medicare does not cover items for convenience, comfort, or general use.

You must order from a Medicare-enrolled DME supplier. If you use a supplier who is not enrolled, Medicare will not pay anything, and you will owe the full cost. You can search for enrolled suppliers on the Medicare website or call 1-800-MEDICARE to find one near you.

Key Takeaways

  • Medicare Part B covers wheelchairs, walkers, oxygen equipment, hospital beds, and similar items when your doctor prescribes them as medically necessary.
  • You must use a Medicare-enrolled supplier; if you do not, Medicare pays nothing and you owe the entire bill.
  • Medicare pays 80 percent of the approved amount after your Part B deductible; you pay 20 percent out of pocket.
  • Your doctor's prescription must state that the equipment is medically necessary for your condition; items for general comfort are not covered.
  • Some items require prior authorization from Medicare before you order them, so ask your supplier whether approval is needed first.

What types of equipment Medicare covers

Common DME items covered by Medicare include wheelchairs and scooters, walkers and canes, hospital beds, oxygen equipment and supplies, continuous positive airway pressure (CPAP) machines, nebulizers, blood glucose monitors, and seat lift chairs. Crutches, canes, and walkers are covered if your doctor prescribes them. Commodes, bedpans, and urinals are covered. Traction equipment, certain bath safety equipment, and pressure mattresses are also included.

The full list of covered items is longer, but the rule is the same for all of them: your doctor must prescribe it, it must be something you can use more than once, and it must be medically necessary for your specific condition. If you are unsure whether a particular item is covered, ask your doctor or call the DME supplier and ask them to check with Medicare before you place an order.

What Medicare does not cover

Medicare does not cover items used only for comfort or convenience, even if your doctor thinks they would help. Grab bars installed in your home, raised toilet seats, shower chairs, and bath benches are not covered. Heating pads, air purifiers, and humidifiers are not covered. Replacement parts and routine maintenance are your responsibility, though some suppliers include them in their rental agreement.

Items that are primarily for cosmetic reasons or general wellness are not covered. Compression stockings for prevention (rather than treatment of a specific condition) are not covered. Certain items like seat lift chairs are covered only in limited circumstances, so your doctor's prescription must clearly state the medical reason you need it.

How to order DME through Medicare

First, talk to your doctor about what equipment you need. Your doctor will write a prescription that states the equipment is medically necessary and includes details about your condition. Bring this prescription to a Medicare-enrolled DME supplier. You can find enrolled suppliers by searching the Medicare Supplier Directory on Medicare.gov or by calling 1-800-MEDICARE.

The supplier will check whether your prescription requires prior authorization from Medicare. Some items do; some do not. If prior authorization is required, the supplier will submit the request to Medicare and wait for approval before sending you the equipment. This can take one to two weeks. If no prior authorization is needed, the supplier can send the equipment right away, but Medicare will still review the claim after delivery.

Ask the supplier whether they accept Medicare assignment. If they do, they bill Medicare directly and you pay only your 20 percent coinsurance. If they do not accept assignment, you may owe more. Always ask about the total cost you will pay before you agree to the order.

Rental versus purchase

For some items, Medicare allows you to rent instead of buy. Oxygen equipment, hospital beds, and wheelchairs are often available as rentals. The supplier charges a monthly rental fee, and Medicare pays 80 percent of the approved rental amount. After you have paid rental fees equal to the purchase price, the equipment becomes yours and there are no more rental charges.

For other items, Medicare covers purchase only, not rental. Your doctor's prescription and the supplier will determine whether rental or purchase is the right option for you. Ask the supplier to explain the difference in cost between renting and buying, because sometimes buying outright costs less over time.

Your costs and how to manage them

You pay 20 percent of the Medicare-approved amount for DME after you have met your Part B deductible for the year. The deductible is the same whether you are buying DME or seeing a doctor. Once you meet it, you pay 20 percent of all covered services for the rest of the calendar year.

If the supplier does not accept Medicare assignment, you may also owe the difference between what they charge and what Medicare approves. For example, if Medicare approves $500 and the supplier charges $700, Medicare pays $400 (80 percent of $500) and you owe $300 ($100 coinsurance plus the $200 difference). Always ask the supplier for an estimate before you order.

If you have a Medigap or Medicare Advantage plan, it may cover some or all of your 20 percent coinsurance. Check your plan documents or call your plan to find out what DME coverage you have.

Prior authorization and appeals

Some DME items require Medicare to approve them before the supplier sends them to you. Your supplier will know which items need prior authorization and will submit the request on your behalf. Medicare reviews the request to make sure the equipment is medically necessary for your condition. This usually takes five to ten business days.

If Medicare denies the request, the supplier will tell you and explain why. You have the right to appeal. You can ask your doctor to provide more information about why you need the equipment, and the supplier can resubmit the request with that additional information. If you disagree with the denial, you can file a formal appeal through Medicare. The supplier can help you understand the appeal process.

Frequently Asked Questions

Does Medicare cover replacement parts and repairs?

Medicare covers replacement parts that are medically necessary and directly related to the equipment's function. Routine maintenance and repairs are generally your responsibility. Some suppliers include repairs in their rental agreement, so ask before you rent. If equipment breaks and cannot be repaired, you may be able to get a replacement if your doctor still prescribes it as medically necessary.

Can I order DME online or by mail?

You must order from a Medicare-enrolled supplier, but many enrolled suppliers operate online or by mail. Before you order, confirm that the supplier is enrolled in Medicare by checking the Medicare Supplier Directory or calling 1-800-MEDICARE. Ordering from a non-enrolled supplier means Medicare will not pay anything.

What if my doctor prescribes equipment but Medicare denies it?

Medicare may deny coverage if it decides the equipment is not medically necessary for your condition or if your prescription does not meet Medicare's rules for that item. Ask your doctor to provide more detailed information about your condition and why you need the equipment. Your supplier can resubmit the request with this additional information, or you can file a formal appeal with Medicare.

Does Medicare Part D cover DME?

No. Part D covers prescription drugs only. DME is covered under Part B. If you have questions about what your specific plan covers, call the plan directly or check your plan documents.

What happens if I need DME while traveling outside the United States?

Original Medicare does not cover DME purchased or rented outside the United States. If you travel internationally, bring your equipment with you or arrange to rent it before you leave. Some Medicare Advantage plans may have different rules, so check with your plan before you travel.