Medicare covers some medical equipment, but not all of it, and what you pay depends on which part of Medicare you have and whether you meet specific conditions.

Medicare Part B covers durable medical equipment — items like wheelchairs, walkers, oxygen tanks, and hospital beds — if a doctor prescribes them for use at home and they are medically necessary. Part B typically pays 80 percent of the approved amount after you meet your deductible; you pay the remaining 20 percent. Some equipment, like diabetic testing supplies and certain prosthetics, follows different payment rules.

What Medicare will not cover includes items for convenience or comfort (like grab bars you install yourself), equipment that is not prescribed by a doctor, or items your doctor says you do not need for a medical condition. Rental versus purchase also matters: Medicare may cover renting a piece of equipment for a limited time, but if you need it long-term, you may be required to buy it instead.

Key Takeaways

  • Medicare Part B covers durable medical equipment prescribed by a doctor for home use, and you pay 20 percent of the approved amount after your deductible.
  • Your doctor must document that the equipment is medically necessary for a specific condition before Medicare will consider covering it.
  • Some equipment like diabetic supplies, prosthetics, and orthotics have their own coverage rules and may be covered under different parts of Medicare.
  • Medicare distinguishes between rental and purchase; if you need equipment long-term, you may be required to buy it rather than rent it.
  • Suppliers must be enrolled in Medicare for the equipment to be covered; using a non-enrolled supplier means Medicare will not pay.

How to Know if Your Equipment Is Covered

The first step is to ask your doctor whether the equipment you need is medically necessary for your condition. Your doctor does not have to fill out a form or contact Medicare — they straightforward need to write a prescription or order that states what you need and why. Without that documentation, Medicare will not pay.

Once you have a prescription, contact a Medicare-enrolled supplier in your area. You can find enrolled suppliers by visiting Medicare.gov and using their supplier directory, or by calling 1-800-MEDICARE. The supplier will verify with Medicare whether the specific item is covered and what your out-of-pocket cost will be. Do not assume that because a supplier sells something, Medicare covers it; the supplier's job is to tell you what Medicare will and will not pay for.

If Medicare denies coverage, the supplier or your doctor can request a review. This process is called an appeal, and you have the right to challenge the decision if you believe the equipment is medically necessary.

Common Equipment Medicare Covers

Medicare Part B covers wheelchairs and scooters when a doctor prescribes them because you cannot walk safely without one. Walkers, canes, and crutches are covered the same way. Oxygen equipment and supplies — including oxygen tanks, concentrators, and tubing — are covered if your doctor prescribes oxygen therapy. Hospital beds, mattresses, and bed rails are covered when medically necessary, as are seat lifts and positioning aids.

Diabetic supplies have their own coverage: test strips, lancets, and glucose monitors are covered under Part B, and insulin pumps and continuous glucose monitors may be covered if your doctor prescribes them. Prosthetics — artificial limbs — and orthotics — braces and supports — are covered under Part B when prescribed by a doctor.

Enteral nutrition supplies (feeding tubes and related equipment) and parenteral nutrition supplies (intravenous nutrition) are covered when medically necessary. Negative pressure wound therapy equipment, used to treat certain wounds, is also covered.

Equipment Medicare Does Not Cover

Medicare does not cover equipment for convenience or comfort, such as grab bars you install yourself, raised toilet seats you buy over the counter, or shower chairs that are not prescribed by a doctor. Hearing aids are not covered by Medicare Part B, though some Medicare Advantage plans may offer limited coverage. Eyeglasses and contact lenses are not covered, nor are routine vision exams.

Equipment that is not prescribed by a doctor is not covered, even if it would help you. For example, if you buy a walker without a doctor's order, Medicare will not pay for it. Replacement equipment is covered only if your original equipment is lost, stolen, or irreparably damaged; routine wear and tear does not may have access to for a replacement at Medicare's expense.

Items that are primarily for comfort — like air purifiers, humidifiers, or heating pads — are generally not covered unless your doctor prescribes them for a specific medical condition and documents that they are medically necessary.

Rental Versus Purchase: How Medicare Decides

For some equipment, Medicare allows you to rent it for a limited time. Oxygen equipment, for example, may be rented for up to 36 months, after which you must purchase it or stop using it through Medicare. Wheelchairs and scooters may also be rented initially, but if you need them beyond a certain period, you are required to buy them instead.

The supplier handles the transition from rental to purchase; you do not have to do anything except understand that your costs will change. Once you own the equipment, Medicare covers repairs and replacement parts, but you are responsible for maintenance.

If you rent equipment and then decide you no longer need it, you can return it to the supplier. There is no penalty for returning rented equipment early, but you are still responsible for the rental payments up to the date you return it.

What You Pay Out of Pocket

After you meet your Part B deductible for the year, Medicare pays 80 percent of the approved amount for durable medical equipment, and you pay 20 percent. The approved amount is set by Medicare, not by the supplier's asking price. If a supplier charges more than the approved amount, you are responsible only for the 20 percent of the approved amount; the supplier must write off the difference.

If you have a Medigap policy, it may cover some or all of your 20 percent coinsurance, depending on which plan you have. If you have a Medicare Advantage plan, your costs may be different; some plans charge a copay instead of coinsurance, and some may have different coverage rules for certain equipment.

If you have not yet met your Part B deductible, you pay the full approved amount until you reach the deductible threshold, then you begin paying 20 percent coinsurance. Your supplier can tell you whether you have met your deductible for the year.

How to Order Equipment Through Medicare

Step one: Ask your doctor for a prescription or order for the equipment you need. The prescription should state what the equipment is, why you need it, and any specific measurements or settings (for example, the weight capacity of a wheelchair or the oxygen flow rate).

Step two: Find a Medicare-enrolled supplier. Use the Medicare supplier directory at Medicare.gov, or call 1-800-MEDICARE and ask for suppliers near you that carry the equipment you need.

Step three: Contact the supplier with your prescription. The supplier will verify your Medicare coverage, confirm the approved amount, and tell you what your out-of-pocket cost will be. The supplier will also check whether you have met your deductible.

Step four: Authorize the order. Once you understand your costs, you can authorize the supplier to bill Medicare and send the equipment to you. The supplier submits the claim to Medicare on your behalf.

Step five: Receive the equipment and pay your share. The equipment is delivered to your home, and you pay the supplier your coinsurance or copay at that time or according to a payment plan you arrange with them.

If Medicare Denies Your Equipment

If Medicare denies coverage for equipment your doctor prescribed, you have the right to request a review. The denial notice will explain why Medicare said no and will tell you how to appeal. You have 120 days from the date of the denial to file an appeal.

You can appeal on your own, or you can ask your doctor or supplier to appeal on your behalf. Many suppliers are experienced with appeals and may do this at no cost to you. The appeal process has multiple levels: reconsideration, hearing before an administrative law judge, and further review if needed.

Common reasons for denial include: the equipment was not prescribed by a doctor, the doctor did not document medical necessity, the supplier was not Medicare-enrolled, or Medicare determined the equipment is not medically necessary for your condition. If you believe the denial was wrong, the appeal gives you a chance to provide more information or have your doctor explain why the equipment is necessary.

Frequently Asked Questions

Does Medicare cover wheelchairs and scooters?

Yes, if your doctor prescribes them because you cannot walk safely without one. Medicare pays 80 percent of the approved amount after your deductible. You may rent initially, but if you need the equipment long-term, you will be required to purchase it.

What about oxygen equipment and supplies?

Medicare covers oxygen tanks, concentrators, tubing, and related supplies when a doctor prescribes oxygen therapy. You pay 20 percent coinsurance after your deductible. Rental is usually covered for up to 36 months, after which you must purchase the equipment.

Are hearing aids covered by Medicare?

No, hearing aids are not covered by Medicare Part B. Some Medicare Advantage plans may offer limited coverage, so check your plan documents. You can also look into programs run by your state or local health department that may help with hearing aid costs.

Do I need a prescription for grab bars or a shower chair?

Grab bars and shower chairs you buy yourself are not covered. However, if your doctor prescribes them as medically necessary for a specific condition and documents that prescription, Medicare may cover them. Ask your doctor whether they think the equipment qualifies.

What happens if the supplier charges more than Medicare approves?

The supplier must write off the difference. You pay only 20 percent of the amount Medicare approves, not 20 percent of what the supplier charges. Always ask the supplier for the Medicare-approved amount before you authorize the order.