Medicare Part B covers durable medical equipment, but you pay a share of the cost
Medicare Part B pays for durable medical equipment — items like wheelchairs, walkers, oxygen tanks, and hospital beds — if a doctor prescribes them for use at home and they meet Medicare's definition of medical necessity. You typically pay 20 percent of the approved amount after you meet your Part B deductible. The equipment must be prescribed by a doctor, ordered through a Medicare-approved supplier, and used for a condition that makes it medically necessary.
What Medicare covers and what it does not depends on specific rules about the item itself, your diagnosis, and whether the supplier is enrolled in Medicare. A wheelchair might be covered for one person but not another, depending on their medical situation. The same applies to grab bars, raised toilet seats, and other items that seem like they should be covered but sometimes are not.
Key Takeaways
- Medicare Part B covers durable medical equipment prescribed by a doctor and ordered through a Medicare-approved supplier, and you pay 20 percent of the approved amount after your deductible.
- The item must be medically necessary for your condition, not just helpful or convenient, and your doctor must document why you need it.
- You can find Medicare-approved suppliers by searching the Medicare Supplier Directory on Medicare.gov or calling 1-800-MEDICARE.
- If Medicare denies coverage, you have the right to appeal, and your supplier or doctor can help you gather the medical records needed to support your case.
What counts as durable medical equipment under Medicare
Durable medical equipment is defined as items that can withstand repeated use, are primarily and customarily used to serve a medical purpose, are generally not useful to someone without an illness or injury, and are appropriate for use in the home. This definition excludes many items that seem medical but do not fit these criteria.
Common items Medicare covers include oxygen equipment, CPAP machines, wheelchairs, walkers, canes, crutches, hospital beds, seat lift chairs, commodes, and nebulizers. Less obvious items that may be covered include blood glucose monitors, continuous positive airway pressure (CPAP) supplies, enteral nutrition pumps, and certain types of compression stockings. The coverage depends on your specific diagnosis and what your doctor documents as medically necessary.
Items Medicare does not cover include grab bars, raised toilet seats, shower chairs, bathtub benches, and most bathroom safety equipment — even though these items help prevent falls. Medicare considers these modifications to the home rather than medical equipment. Some supplemental insurance plans or Medicaid may cover these items, depending on your state.
How to order durable medical equipment through Medicare
Your doctor must write an order or prescription for the equipment. The prescription must include the specific item, the medical reason you need it, and how long you will need it. Your doctor does not need to use a special form, but the order must be clear enough that a supplier can understand what to provide.
Once you have a prescription, contact a Medicare-approved supplier to place your order. You can find approved suppliers in your area by searching the Medicare Supplier Directory at Medicare.gov or by calling 1-800-MEDICARE. Using an approved supplier is important because Medicare will not pay a non-approved supplier, even if the item itself is covered.
The supplier will verify your Medicare coverage, explain your out-of-pocket costs, and arrange delivery and setup. Before you receive the equipment, ask the supplier for an estimate of what Medicare will pay and what you will owe. Some suppliers rent equipment; others sell it. Medicare covers rental for some items and purchase for others, so confirm which option applies to you.
Your costs for durable medical equipment
You pay 20 percent of the Medicare-approved amount for the equipment after you meet your Part B deductible for the year. The approved amount is what Medicare decides the item is worth, not what the supplier charges. If a supplier charges more than the approved amount, you are responsible only for your 20 percent share of the approved amount, not the difference.
For rental equipment, you pay 20 percent of the approved rental amount each month. After you have paid the equivalent of the purchase price in monthly rental payments, Medicare stops paying for further rentals of that item, and you own it.
If you have a Medigap or Medicare Advantage plan, your supplemental coverage may pay some or all of your 20 percent share. Check your plan documents or call your plan to find out what durable medical equipment costs you will have.
When Medicare denies coverage for durable medical equipment
Medicare may deny coverage if the item is not on the covered list, if your doctor did not document medical necessity clearly enough, if you ordered from a non-approved supplier, or if Medicare determines the item is not medically necessary for your condition. A denial does not mean you cannot have the equipment — it means Medicare will not pay for it, and you would pay the full cost yourself.
You have the right to appeal a denial. Your supplier or doctor can help you gather the medical records, test results, and clinical notes that support the medical necessity of the equipment. Appeals often succeed when the initial denial was based on incomplete information. The appeal process takes time, so ask your supplier whether they will hold the equipment or continue providing it while you appeal.
If you believe the denial was wrong, you can also ask your doctor to contact Medicare directly to discuss your case. Some denials are reversed after a doctor speaks with a Medicare medical reviewer about your specific situation.
Durable medical equipment covered under Medicare Part A
If you are in a hospital or skilled nursing facility, durable medical equipment provided during your stay is covered under Medicare Part A as part of your inpatient care. You do not pay separately for equipment used in the hospital.
When you are discharged from the hospital or nursing facility, Medicare Part B takes over. If you need equipment at home after discharge, your doctor must write a new prescription, and you will work with a Medicare-approved supplier to obtain it. The equipment you used in the hospital stays there; you cannot take it home unless your doctor prescribes it separately and a supplier delivers it.
Frequently Asked Questions
Does Medicare cover a wheelchair if I do not have a specific diagnosis?
No. Medicare requires a doctor to document a medical reason you need the wheelchair — such as difficulty walking due to arthritis, stroke, or another condition. The doctor must explain why a cane or walker would not meet your needs. A general statement that you have mobility problems is not enough.
Can I buy durable medical equipment from any supplier?
Medicare will only pay a Medicare-approved supplier. If you buy from a non-approved supplier, Medicare will not reimburse you, and you pay the full cost. You can verify a supplier's Medicare status by searching the Medicare Supplier Directory or calling 1-800-MEDICARE before you order.
What happens if my doctor prescribes equipment and Medicare says it is not medically necessary?
You can appeal the denial. Ask your doctor to send additional medical records, test results, or a detailed letter explaining why the equipment is necessary for your condition. Many appeals succeed when Medicare receives more complete clinical information. Your supplier can also help you file the appeal.
Do I have to rent equipment, or can I buy it?
Medicare decides whether each type of equipment is rented or purchased. Some items, like oxygen equipment, are rented. Others, like walkers and canes, are purchased. Your supplier will tell you which option Medicare covers for your specific item. If you prefer to buy something Medicare covers as a rental, you can pay out of pocket to purchase it instead.
If I have a Medicare Advantage plan, does it cover durable medical equipment the same way?
Medicare Advantage plans must cover at least what Original Medicare covers, but they may have different rules about which suppliers you can use or require prior approval from the plan before you order. Contact your plan before you order equipment to find out what it covers and what you will owe.