Medicare Part B pays for durable medical equipment, but only after you meet your deductible and pay your coinsurance

Durable medical equipment — wheelchairs, walkers, oxygen tanks, hospital beds, and similar items — is covered under Medicare Part B, the part that covers outpatient services and medical supplies. Part B requires you to pay a yearly deductible (which changes each year) before Medicare begins to pay. After you meet that deductible, Medicare typically pays 80 percent of the approved amount, and you pay the remaining 20 percent coinsurance.

The equipment must be prescribed by a doctor and deemed medically necessary for your condition. Medicare will not pay for equipment you buy on your own or that a doctor has not ordered. The supplier you use must be enrolled as a Medicare provider — not all medical supply companies are — so it matters where you rent or purchase the item.

Key Takeaways

  • Medicare Part B covers durable medical equipment after you pay your yearly deductible, then covers 80 percent of the approved cost.
  • Your doctor must prescribe the equipment and document that it is medically necessary for your specific condition.
  • The supplier must be a Medicare-enrolled provider; using an unenrolled supplier means Medicare will not pay.
  • Some equipment requires prior authorization from Medicare before you obtain it, which can add one to two weeks to the process.
  • If you have a Medigap or Medicare Advantage plan, your coinsurance amount may be lower or covered entirely, depending on your plan.

What counts as durable medical equipment under Part B

Durable medical equipment is defined as items that can withstand repeated use, are primarily medical in nature, and are not useful to someone without an illness or injury. Common examples include manual and electric wheelchairs, walkers, canes, crutches, hospital beds, oxygen equipment, continuous positive airway pressure (CPAP) machines, nebulizers, and blood glucose monitors.

Diabetic supplies such as test strips and lancets are also covered under Part B, though they follow slightly different rules. Prosthetics and orthotics — artificial limbs and braces — are covered as well. Items like grab bars, raised toilet seats, and shower chairs may be covered if your doctor orders them as medically necessary, though some are considered home modifications and fall outside Part B coverage.

Items that are not covered include comfort items (like heating pads), convenience items (like bedside commodes that are not medically necessary), or equipment that serves a general household purpose. If you are unsure whether a specific item is covered, your doctor or a Medicare-enrolled supplier can check before you purchase or rent.

How to get durable medical equipment through Medicare Part B

The first step is to see your doctor and explain why you need the equipment. Your doctor must write an order that includes the specific item, the medical reason you need it, and how long you will need it. Some equipment — like wheelchairs and certain oxygen systems — requires prior authorization, meaning Medicare must approve it before you obtain it. Your doctor's office or the supplier can submit this authorization request on your behalf.

Once your doctor has written the order, you choose a Medicare-enrolled supplier. You can find enrolled suppliers by visiting the Medicare provider search tool on Medicare.gov or by calling 1-800-MEDICARE. When you contact the supplier, tell them you have a doctor's order and ask them to verify your Medicare coverage and calculate what you will owe out of pocket based on your deductible status.

The supplier will submit the claim to Medicare. If prior authorization was required and has been approved, the supplier will proceed. If not, Medicare will process the claim and send you an Explanation of Benefits (EOB) showing what they paid and what you owe. You will receive the equipment once payment is arranged.

Renting versus buying: what Medicare pays

For some equipment, you have the choice to rent or buy. Medicare's rules differ depending on which you choose. For items like wheelchairs, oxygen equipment, and hospital beds, Medicare allows rental for a limited time — usually 13 months — after which the equipment becomes yours. During the rental period, you pay coinsurance on the monthly rental fee. After 13 months, you own the equipment and do not pay further rental fees, though you remain responsible for maintenance.

If you buy equipment outright instead of renting, you pay coinsurance on the full purchase price upfront. For some items, buying is more economical if you will need the equipment for a long time. For others, renting makes sense if you need it temporarily. Your supplier can explain the cost difference for your specific situation and help you decide which option works for your budget.

If you rent equipment and later decide you no longer need it, you can return it and stop paying rental fees. If you have already paid for 13 months of rental, the equipment is yours to keep or dispose of as you wish.

Your out-of-pocket costs and how Medigap or Medicare Advantage affects them

Your out-of-pocket cost depends on whether you have met your Part B deductible for the year and what supplemental coverage you carry. If you have not met your deductible, you pay the full cost of the equipment until the deductible is satisfied. Once you meet it, you pay 20 percent coinsurance on the Medicare-approved amount for the equipment.

If you have a Medigap plan (also called Medigap insurance), the plan may cover some or all of your coinsurance, depending on which Medigap plan you chose. Plans C, D, G, and M cover the Part B coinsurance, so you would pay little to nothing out of pocket. Plans A, B, and F cover the deductible as well. Check your Medigap policy documents to see what your plan covers.

If you have a Medicare Advantage plan (Part C), your out-of-pocket costs work differently. Advantage plans set their own deductibles and coinsurance amounts, which may be higher or lower than Original Medicare. Some Advantage plans cover durable medical equipment with no coinsurance; others charge a copay per item. Review your plan's formulary or call the plan to find out what you will owe before you order equipment.

What happens if Medicare denies your claim

Medicare may deny a claim for durable medical equipment if the equipment was not prescribed by a doctor, if the doctor's order does not document medical necessity, if the supplier was not Medicare-enrolled, or if the item itself is not covered under Part B. You will receive a denial notice in the mail explaining the reason.

If you disagree with the denial, you have the right to appeal. The appeal process has multiple levels: you can first ask Medicare to review the decision (called a redetermination), then request a hearing before an administrative law judge if you disagree with the redetermination. Your doctor can submit additional documentation to support medical necessity during the appeal. Many people find it helpful to ask their doctor's office to handle the appeal on their behalf, since the office has the clinical records.

If cost is the barrier — for example, if the equipment is expensive and your coinsurance is high — ask your doctor whether a less expensive alternative might work, or ask your supplier about payment plans. Some suppliers offer financing options that are separate from Medicare.

Prior authorization: when it is required and how long it takes

Prior authorization means Medicare must approve the equipment before you obtain it. This is required for certain high-cost items, including power wheelchairs, certain oxygen systems, continuous positive airway pressure (CPAP) machines, and some other equipment. Your doctor or supplier will submit the authorization request to Medicare, which typically responds within 5 to 10 business days.

If Medicare approves the request, you can proceed with obtaining the equipment. If Medicare requests more information, your doctor will need to provide it — this can add another week or two. If Medicare denies the request, you can appeal using the same process described above.

To avoid delays, make sure your doctor's order includes specific details: the exact item you need, the medical reason, how long you will need it, and any relevant test results or clinical notes. Suppliers who work with Medicare regularly know what information Medicare typically requests and can guide your doctor on what to include.

Frequently Asked Questions

Does Medicare Part D cover durable medical equipment?

No. Part D covers prescription drugs only. Durable medical equipment is covered under Part B. If you are confused about which part covers something, your doctor or a Medicare-enrolled supplier can tell you which part applies and what your costs will be.

Can I use my Medicare to rent equipment from a supplier who is not enrolled with Medicare?

No. Medicare will not pay if you use a non-enrolled supplier. You would pay the full cost yourself. Always verify that your supplier is Medicare-enrolled before you rent or buy. You can check on Medicare.gov or ask the supplier directly for their Medicare provider number.

What if I need equipment urgently and do not have time for prior authorization?

Talk to your doctor and supplier when ready. Some urgent situations may may have access to for expedited authorization, which can be processed in 24 to 48 hours. Your doctor will need to document the urgency in the authorization request. If authorization cannot be expedited, you may choose to pay out of pocket temporarily and then file a claim once authorization is approved.

Will Medicare pay to replace equipment that breaks or wears out?

Yes, if the equipment is no longer repairable. You will need a new doctor's order and documentation that the old equipment cannot be fixed. Medicare will then pay for a replacement following the same rules as the original equipment — you pay coinsurance after your deductible is met. If you are renting, the supplier typically handles replacement at no additional cost to you.

Can I buy equipment online and then submit the receipt to Medicare for reimbursement?

Not typically. Medicare pays the supplier directly, not you. If you buy equipment on your own without going through a Medicare-enrolled supplier, Medicare will not reimburse you. Always work with a Medicare-enrolled supplier and have your doctor's order in place before you purchase or rent.