Medicare Part B covers durable medical equipment, but only specific items and only when a doctor orders them for use at home

Durable medical equipment (DME) is equipment that can withstand repeated use, serves a medical purpose, and is not useful to someone without an illness or injury. Medicare Part B pays 80 percent of the approved amount after you meet your annual deductible. You pay the remaining 20 percent, plus any difference between what Medicare approves and what the supplier charges if they do not accept assignment.

The catch is that Medicare does not cover every piece of equipment a doctor might recommend. The item must be medically necessary, prescribed by a doctor, and on Medicare's list of covered DME. A wheelchair, oxygen equipment, or hospital bed might be covered. A hot tub, air purifier, or massage chair will not be, even if your doctor thinks they would help.

You must rent or buy the equipment from a Medicare-approved supplier. Using an unapproved supplier means you pay the full cost yourself. Finding an approved supplier takes one phone call to Medicare or a search on their website.

Key Takeaways

  • Medicare Part B covers DME only when a doctor orders it in writing for medical use at your home.
  • You pay 20 percent of the Medicare-approved amount after your deductible; Medicare pays 80 percent.
  • The equipment must appear on Medicare's covered DME list — common items like wheelchairs and oxygen are covered, but comfort items are not.
  • You must use a Medicare-approved supplier, which you can find by calling Medicare or searching their supplier directory online.
  • Some equipment has rental limits; after a set number of months, you own it and Medicare stops paying.

Which items Medicare actually covers

Medicare covers oxygen equipment, hospital beds, wheelchairs, walkers, canes, crutches, nebulizers, CPAP machines, blood glucose monitors, and certain wound care supplies. It also covers some diabetic shoes and orthotics, though those have their own rules. The full list changes, so the most reliable source is Medicare's DME coverage page or a call to 1-800-MEDICARE.

Items that look medical but are not on the list do not get covered. Grab bars, raised toilet seats, shower chairs, and commodes are considered home modifications or bathroom safety equipment, not DME, so Medicare does not pay for them. Compression stockings, back braces, and knee braces fall into a gray area — some are covered under specific conditions, others are not. Your doctor's office should know whether the item they want to prescribe is covered before they write the order.

If your doctor prescribes something and Medicare denies it, you have the right to appeal. The denial letter will explain why and tell you how to request a review. Many denials are overturned on appeal, especially if your doctor provides additional medical records showing why the equipment is necessary for your condition.

How to get Medicare to pay

Your doctor must write a written order for the equipment. A phone call or a note in your chart is not enough — Medicare requires a signed prescription. The order should state what the equipment is, why you need it, and how long you will need it. Your doctor's office usually handles this, but confirm they understand it needs to go to a Medicare-approved supplier.

Once you have the prescription, contact a Medicare-approved supplier. You can find one by calling 1-800-MEDICARE, searching the Medicare supplier directory online, or asking your doctor's office for a referral. When you call, tell them what equipment you need and ask whether they accept Medicare assignment — this means they agree to accept Medicare's approved amount as full payment for their services, so you only owe your 20 percent coinsurance.

The supplier will submit the order to Medicare for prior authorization on most items. This means Medicare reviews the prescription before you get the equipment to make sure it is medically necessary and covered. Prior authorization usually takes a few days to a week. Once approved, the supplier delivers the equipment and bills Medicare and you. If Medicare denies the request, the supplier will tell you and you can appeal or ask your doctor whether a different item might work.

Renting versus buying, and when ownership transfers

For some equipment, you have a choice between renting and buying. For other items, Medicare requires you to rent first. Oxygen equipment, for example, is usually rented. A wheelchair might be rented or bought, depending on whether you need it temporarily or long-term.

If you rent, Medicare pays the supplier a monthly rental fee. After you have rented for a certain number of months — typically 13 months for a wheelchair, 36 months for a hospital bed — you own the equipment and Medicare stops paying the rental. At that point, if the equipment breaks, you pay for repairs yourself, or you can ask Medicare whether a replacement is covered.

If you buy, you pay your 20 percent coinsurance upfront and Medicare pays 80 percent of the approved amount. Buying makes sense if you know you will need the equipment for years. Renting makes sense if you are not sure how long you will need it or if you want to avoid a large upfront cost.

What you pay out of pocket

Your costs depend on whether you have met your Part B deductible for the year. For 2024, the Part B deductible is $240 (this amount changes yearly). Once you meet the deductible, you pay 20 percent of Medicare's approved amount for the equipment. If the supplier charges more than Medicare approves and does not accept assignment, you also pay that difference.

Example: Medicare approves $500 for a wheelchair. You have met your deductible. You pay $100 (20 percent). Medicare pays $400. If the supplier charges $600 and does not accept assignment, you also pay the $100 difference, for a total of $200 out of pocket.

If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower. Medigap plans often cover the 20 percent coinsurance. Medicare Advantage plans have their own rules about DME coverage and may require you to use suppliers in their network. Check your plan documents or call your plan to understand your DME costs before you order.

When Medicare denies DME and what to do

Medicare denies DME requests for several reasons: the item is not on the covered list, the doctor's order does not meet Medicare's medical necessity standards, the supplier is not approved, or the prior authorization review finds the equipment is not medically necessary for your condition.

If you receive a denial, you have the right to appeal. The denial letter includes instructions for requesting a review. You can ask your doctor to provide additional medical records or a statement explaining why the equipment is necessary. Many appeals succeed because the initial review did not have enough clinical detail. You can also ask your doctor whether a different, covered item might meet your needs.

While you appeal, you can still buy or rent the equipment yourself and pay out of pocket. If your appeal is approved later, Medicare may reimburse you for part of what you paid, though this is not may provide. Ask the supplier or Medicare whether reimbursement is possible before you pay.

Medicare Advantage and Medigap: different DME rules

If you have a Medicare Advantage plan, your DME coverage works differently. The plan sets its own rules about which items are covered, which suppliers you can use, and what you pay. Some Advantage plans cover more DME than Original Medicare; others cover less. You need to check your plan's formulary or call the plan before you order.

If you have a Medigap plan, it works alongside Original Medicare. Medigap does not change what Medicare covers, but it may pay some or all of your 20 percent coinsurance. Check your Medigap plan documents to see whether DME coinsurance is included in your coverage.

Frequently Asked Questions

Does Medicare cover grab bars or raised toilet seats?

No. Medicare classifies these as home modifications or bathroom safety equipment, not durable medical equipment. Some state Medicaid programs cover them, and some home modification programs do. Your local Area Agency on Aging can point you toward programs that might help.

Can I buy DME from an online retailer instead of a Medicare-approved supplier?

You can, but Medicare will not pay for it. You must use a Medicare-approved supplier for Medicare to cover any part of the cost. If you buy from an unapproved supplier, you pay the full price yourself.

What happens if my doctor prescribes DME but I do not have Part B?

Part B is what covers DME. If you have Original Medicare, you have Part B (unless you chose to delay it). If you have a Medicare Advantage plan, it includes Part B coverage. If you do not have Part B, you would need to enroll or pay the full cost yourself.

How long does it take to get DME after my doctor writes the prescription?

Prior authorization usually takes three to seven business days. Once approved, delivery depends on the supplier and the item — some equipment arrives within days, others take weeks. Ask the supplier for an estimated delivery date when you place the order.

If I own my equipment after renting it, can I sell it?

Yes, you own it after the rental period ends. You can sell it, give it away, or keep it. Medicare has no claim on it once ownership transfers to you.