Medicare Part B covers most durable medical equipment, but only if your doctor prescribes it and a Medicare-approved supplier provides it

Durable medical equipment — wheelchairs, walkers, oxygen concentrators, hospital beds, continuous positive airway pressure (CPAP) machines, and similar items — falls under Medicare Part B, the part that covers outpatient services and doctor visits. 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 Medicare rates.

The catch is that Medicare will not pay for equipment just because you want it. Your doctor must document that the equipment is medically necessary for your condition, and you must rent or buy it from a Medicare-approved supplier. If you go to a supplier Medicare does not recognize, you pay the full cost yourself. The process takes time — approval can take one to two weeks — so ordering early matters if you need the equipment soon.

Some equipment is covered under different parts of Medicare depending on where you use it. If you are in a hospital or skilled nursing facility, Part A may cover it instead. If you are in a hospice program, your hospice benefit covers it. Understanding which part applies to your situation prevents you from paying when Medicare should.

Key Takeaways

  • Part B covers durable medical equipment at 80 percent of the approved amount after your deductible, but only with a doctor's prescription and a Medicare-approved supplier.
  • Your doctor must document that the equipment is medically necessary; Medicare will not cover items ordered without a prescription or for convenience.
  • You must use a Medicare-approved supplier or you pay the full cost yourself — Medicare does not reimburse you for equipment bought elsewhere.
  • Approval typically takes one to two weeks, so ask your doctor to submit the prescription as soon as you know you need the equipment.
  • Some equipment is covered under Part A if you are in a hospital or skilled nursing facility, so check which part applies to your situation.

What counts as durable medical equipment under Part B

Medicare Part B covers equipment that is expected to last at least three years, is used for a medical reason, and would not be useful to someone without an illness or injury. Common items include wheelchairs and walkers, oxygen and respiratory equipment, hospital beds, diabetic supplies (test strips, lancets, and glucose monitors), continuous positive airway pressure machines, nebulizers, and certain mobility aids.

The list is long but not unlimited. Medicare maintains a specific list of covered items, and your equipment must match the description on that list. For example, a standard walker is covered, but a walker with wheels and a seat (a rollator) may be covered only if your doctor documents that you cannot use a standard walker. A cane is covered only if you have had a stroke or have a leg amputation. Bathroom safety equipment like grab bars and shower chairs is generally not covered because Medicare considers them home modifications rather than medical equipment.

Replacement equipment is covered if your original item is lost, stolen, or irreparably damaged, or if your medical condition changes and you need a different type. Medicare will not pay for a second wheelchair just because you want one for a different location, but it will pay for a replacement if your first one wears out after normal use.

How to order equipment and get Medicare to pay

The process has four steps, and skipping any one of them can leave you paying out of pocket. First, see your doctor and describe what you need. Your doctor does not have to be a specialist — your primary care doctor can write the prescription — but they must document in your medical record that the equipment is medically necessary. "Patient needs a wheelchair" is not enough; the record should say why, such as "patient has severe arthritis and cannot walk more than 50 feet" or "patient has COPD and requires supplemental oxygen at rest and with exertion."

Second, ask your doctor for the prescription or order form. Some doctors send this directly to a supplier; others give it to you to carry. If your doctor is unsure which supplier to use, ask for a recommendation or search Medicare's Supplier Directory online at cms.gov. Third, contact a Medicare-approved supplier and give them the prescription. The supplier will verify that Medicare covers the item, check your coverage, and tell you what your cost will be. Fourth, the supplier submits the order to Medicare for approval. This step usually takes one to two weeks. Once approved, the supplier delivers the equipment and bills Medicare.

Do not buy the equipment yourself and then ask Medicare to reimburse you. Medicare does not work that way. The supplier must submit the order before you receive the item, and Medicare must approve it first. If you buy without approval, you pay the full cost.

What you pay: deductible, coinsurance, and supplier charges

Your out-of-pocket cost depends on three things: whether you have met your Part B deductible for the year, what Medicare approves as the reasonable charge, and whether your supplier accepts Medicare rates.

If you have not met your annual Part B deductible (which varies by year), you pay the full approved amount until the deductible is satisfied. Once you meet it, Medicare pays 80 percent and you pay 20 percent of the approved amount. For example, if Medicare approves $500 for a walker and you have met your deductible, Medicare pays $400 and you pay $100.

Some suppliers charge more than Medicare approves. If a supplier does not accept Medicare rates, you may owe the difference. A supplier who accepts Medicare rates agrees to charge only what Medicare approves, so you know your cost in advance. Before you order, ask the supplier whether they accept Medicare rates and get a written estimate of what you will pay.

Rental versus purchase also affects cost. Some equipment, like oxygen, is usually rented. Others, like wheelchairs, can be rented or bought. Medicare covers both, but rental costs accumulate over time. If you rent for more than a certain period (usually 13 months for a wheelchair), Medicare switches you to a purchase, and you own the equipment after that. Ask your supplier which option makes sense for your situation.

Equipment covered under Part A instead of Part B

If you are an inpatient in a hospital or skilled nursing facility, the facility provides durable medical equipment as part of your stay, and Part A covers it. You do not order it separately or pay Part B coinsurance. The equipment stays at the facility unless your doctor orders it for you to take home after discharge.

When you leave the hospital or nursing facility, you may need equipment at home. If your doctor prescribes it before you are discharged, the facility may provide it, or you may need to order it from a Medicare-approved supplier after you go home. Ask the discharge planner or your doctor which equipment you will need and whether it will be provided or whether you need to arrange it yourself.

If you are in a hospice program, your hospice benefit covers durable medical equipment related to your terminal illness. You do not pay Part B coinsurance for hospice-covered equipment. Ask your hospice team what equipment is included in your benefit.

Finding a Medicare-approved supplier

Using a non-approved supplier means you pay the full cost yourself. Medicare maintains a searchable directory of approved suppliers at cms.gov/Medicareprovider-directory. You can search by equipment type and location. The directory shows whether each supplier is approved for the specific item you need — a supplier might be approved for wheelchairs but not for oxygen, for example.

Ask your doctor for a recommendation if you are unsure where to start. Many doctors work regularly with one or two suppliers and know they are reliable and accept Medicare rates. If you have a Medigap or Medicare Advantage plan, check whether your plan has a preferred supplier list; using a preferred supplier may lower your cost.

Call the supplier before you place an order and ask three questions: Are you Medicare-approved for this specific item? Do you accept Medicare rates? How long does approval usually take? A good supplier can answer all three in a few minutes and will give you a written estimate before you commit.

Common reasons Medicare denies equipment requests

Medicare denies requests most often because the doctor's prescription does not document medical necessity clearly enough, the item is not on Medicare's covered list, or the supplier is not Medicare-approved. Less common reasons include that you already have a similar item that is still usable, or that the equipment is considered a home modification rather than medical equipment.

If Medicare denies your request, you have the right to appeal. The supplier or your doctor can file an appeal on your behalf, or you can do it yourself. An appeal must be filed within 120 days of the denial notice. Include any new medical information that supports your need for the equipment. Many denials are overturned on appeal because the first submission lacked enough detail about your medical condition.

If you cannot afford the equipment even with Medicare coverage, ask your doctor or the supplier whether you may have access to for information programs. Some equipment manufacturers offer patient information programs for people with limited income. Local aging agencies and disease-specific organizations (like the American Lung Association for oxygen equipment) sometimes help pay for equipment too.

Frequently Asked Questions

Can I use my Medicare Advantage plan to get durable medical equipment?

Yes. Medicare Advantage plans must cover all Part B services, including durable medical equipment, at the same or lower cost than Original Medicare. Some plans have preferred suppliers or require prior approval before you order. Check your plan documents or call the plan to find out what you need to do before ordering equipment.

What if I need equipment right away and approval takes two weeks?

Tell your doctor and the supplier that you need expedited approval. Some suppliers can request faster review if your doctor documents that the delay would harm your health. You may also be able to rent equipment temporarily while waiting for approval of a purchase. Ask the supplier what options are available.

Do I have to buy from the supplier Medicare approves, or can I choose any supplier?

You can choose any Medicare-approved supplier. Medicare does not assign you to a specific one. However, if you use a supplier who is not Medicare-approved, Medicare will not pay anything, and you pay the full cost yourself. Always verify that your supplier is approved before you place an order.

If I buy equipment with my own money, can I ask Medicare to pay me back?

No. Medicare only pays when the supplier submits the order before you receive the equipment. If you buy first and ask for reimbursement later, Medicare will deny the request. Always have Medicare approval before you purchase or take possession of the equipment.

Does Medicare cover replacement batteries or supplies for my equipment?

Yes, but only if they are on Medicare's covered list. Batteries for a wheelchair, test strips for a glucose monitor, and oxygen refills are covered. Other supplies, like replacement tubing or filters, may or may not be covered depending on the item. Ask your supplier or doctor whether the specific supply you need is covered before you order.