Takeaways
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Medicare Part B covers durable medical equipment (DME) that is medically necessary, prescribed by a doctor for home use, and obtained from a Medicare-approved supplier. Typically, Medicare covers 80 percent of the approved amount.
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Key steps before obtaining DME include getting a prescription, verifying supplier approval, understanding rental versus purchase options, and checking out-of-pocket costs and insurance coverage.
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Medicare does not cover equipment that is not primarily for home use, items not used with DME, or home modifications for comfort rather than medical necessity.
Durable medical equipment (DME) plays a crucial role in helping people manage chronic conditions, recover from injuries, and maintain independence at home. But with so many types of equipment and different rules for coverage, understanding how DME works, especially under Medicare, can be confusing. Here’s a helpful guide on what durable medical equipment is, what Medicare covers, and how to make smart decisions when you need to buy or rent these types of items.
What Is Durable Medical Equipment?
Durable medical equipment refers to medical devices and supplies that are intended for repeated use and are expected to last at least three years. DME needs to serve a medical purpose and be appropriate for home use, although it can also be used outside the home.
Examples of DME include:
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Wheelchairs
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Power scooters
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Walkers, crutches, and canes
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Hospital beds
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Portable oxygen equipment
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Prosthetics and orthotics
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Some diabetes supplies, including glucose monitors
What DME Does Medicare Cover?
Medicare Part B, which focuses on doctor visits and preventive services, covers DME if your doctor or treating provider prescribes it for use at home and the equipment is for a medical condition or injury. Medicare typically covers 80 percent of the Medicare-approved amount for DME, while you or your supplemental insurance are responsible for the remaining 20 percent, after the Medicare Part B deductible is met.
For durable medical equipment to be covered, it must be medically necessary and your doctor must document the medical need for the device. Both your doctor and the DME supplier must be enrolled in, and be in good standing with, Medicare.
You must get the equipment from a Medicare-approved supplier. Medicare likely will not reimburse you if you buy DME from a supplier that is not enrolled in Medicare or does not accept Medicare assignment.
Note that Medicare Advantage (Part C) plans often have different rules and networks, so you should check with your plan for specific coverage details.
Medicare will cover some supplies and prescription medications that are used with durable medical equipment, even if they are only used once. Examples of these include lancets and test strips used with diabetes self-testing equipment and medication used with nebulizers.
Generally, Medicare will not cover the following:
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Equipment that isn’t for use in the home or is mainly for use outside the home
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Things that aren’t used with durable medical equipment or get thrown away after use
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Modifications to the home or equipment intended only to make life more convenient or comfortable
What to Know Before Buying or Renting DME
Before you purchase or rent DME, here are key things to keep in mind:
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Get a prescription and necessary documentation. Medicare requires a written order from your doctor for most equipment. In some cases, such as for power wheelchairs, Medicare may also require a face-to-face exam and detailed written documentation.
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Determine whether you will be renting or buying the DME. Medicare sometimes rents DME instead of buying it outright. For example, Medicare beneficiaries typically must rent oxygen equipment.
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Make sure the supplier is Medicare-approved and takes assignment. Use Medicare’s official DME supplier directory to find approved suppliers in your area. Using a nonapproved supplier could leave you responsible for the full cost.
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Understand your out-of-pocket costs. Even with Medicare, you’ll usually owe 20 percent of the cost. If you have a Medigap policy or other supplemental insurance, it may cover some or all of that cost. Check with your insurer.
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Ask about maintenance, returns, and repairs. Before accepting the equipment, ask the supplier who will be responsible for repairs, what the return policy is, and whether training or in-home setup is included.
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Beware of unsolicited offers. Be wary of suppliers offering “free” equipment or contacting you without your doctor’s referral. Medicare fraud involving DME is common, and you could be held liable for equipment that you don’t have a prescription or approval for.
Learn More About DME and Medicare
Durable medical equipment can improve a person’s quality of life and help people stay independent for longer, but navigating the rules can be challenging. Make sure the equipment is medically necessary, work with Medicare-approved providers, and understand whether the costs will be for purchase or rental.
Taking the time to understand Medicare’s DME policies can save you money and ensure you get the right equipment for your health needs. For more information, visit Medicare Interactive or Medicare.gov or call 1-800-MEDICARE (1-800-633-4227).
You may also consider contacting an elder law attorney in your area for help navigating Medicare benefits.
For additional reading about Medicare and DME, check out the following articles:
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