Durable medical equipment (DME) refers to equipment and supplies that are ordered by a health care provider for use in the home setting. When you are dealing with an illness or injury, you may need services, such as hospitalization, doctor’s visits, diagnostic tests, and ambulance transportation. You may also need DME to assist you at home with managing your condition or your daily activities. Medicare covers DME under certain circumstances, which are outlined in this article. In general, DME is covered under Medicare Part B and includes a wide variety of equipment and supplies, ranging from hospital beds and wheelchairs to blood sugar test strips and oxygen. Read below for a comprehensive look at your Medicare benefits for DME.
What Is Durable Medical Equipment?
According to the Centers for Medicare and Medicaid Services (CMS), DME is defined as equipment that:
- Can withstand repeated use (durable, not disposable). DME should last for up to three years. You may rent or purchase DME. If you rent it and return it to the supplier, it can be sanitized and issued to other patients.
- Is primarily used to serve a medical purpose and support the management of your health condition.
- Generally is not useful in the absence of illness or injury.
- Is appropriate for use in the home setting.
For purposes of this article, other supplies, and devices that may not be technically considered DME are discussed. For example, breast implants or therapeutic shoe inserts are intended and fashioned for individual use, unlike a hospital bed or walker. These devices are covered by Part B if they meet coverage criteria. Likewise, blood sugar test strips are disposable, and not durable, but are covered under Part B. The acronym for durable medical equipment, prosthetics, orthotics, and supplies is DMEPOS.
Does Medicare Cover Durable Medical Equipment?
Medicare covers DME under the following conditions:
- It must be deemed medically necessary, needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and meet accepted standards of medicine.
- It must be ordered by your healthcare provider, and your provider must be enrolled in Medicare.
- It must be provided by a supplier that is enrolled in Medicare.
Medicare Advantage Plans may have additional requirements for DME coverage, such as using network providers and obtaining prior authorization.
What Parts of Medicare Cover Durable Medical Equipment?
Medicare covers DME under Part A if it is used as part of your hospital or skilled nursing facility stay or if you are in hospice. Medicare Part B covers medically necessary DME and supplies for use in the home and a long-term care facility. DME benefits are available to you whether you have Original Medicare or a Medicare Advantage Plan.
Who Is Eligible for Medicare Coverage of Durable Medical Equipment?
You must have Original Medicare Part B (medical insurance) to get DME coverage for use in the home or long-term care setting. You must have Original Medicare Part A (hospital insurance) to get DME that is included in your hospital or skilled nursing facility stay. Your healthcare provider must write an order for your DME and may have to document why it is medically necessary for you. Your doctor and your supplier must be enrolled in Medicare.
You must be enrolled in Medicare Parts A and B to join a Medicare Advantage Plan. As an enrollee, you are eligible for DME coverage according to your plan’s rules about how to obtain it.
What Durable Medical Equipment Does Medicare Cover?
Medicare covers DME which is medically necessary. Your DME must be ordered and supplied by providers and suppliers enrolled in Medicare. Medicare has strict requirements for suppliers, and they must have a Medicare supplier number, or Medicare will not pay.
Medicare coverage and payment for DMEPOS items can be complicated because there are so many types of equipment and devices available. For instance, there are more than five types of air mattresses or bed overlays to prevent bedsores if you are confined to a bed. Your Medicare supplier should know what Medicare will pay for and what documentation is required from your physician.
In January 2021, Medicare established the DMEPOS Competitive Bidding Program, which adjusts the amount Medicare pays for certain DMEPOS. Under this new program, suppliers submit bids to provide certain items and supplies to people with Original Medicare living in or visiting, competitive bidding areas. Medicare uses these competitive bids to set the amount it pays for each item and only awards contracts to suppliers who are screened thoroughly. Currently, the only DMEPOS included in the program are off-the-shelf back and knee braces. If you have Original Medicare, you must get these braces from a contract supplier if you live in a competitive bidding area. Your supplier must accept the Medicare-approved charge.
Here are lists of what Medicare covers, separated into two categories: DME and supplies, and prosthetics and orthotics. Below each item is information about what is covered, what may be excluded from coverage, and your costs.
DME and supplies Medicare covers include but aren’t limited to:
- Air mattresses and overlays, pressure-reducing beds used to prevent bedsores:
- Covered if you have or are highly susceptible to bedsores and if your physician is overseeing your course of treatment.
- If you live in certain states, you may have to get prior approval for different types of bed overlays.
- What types of pressure-reducing beds aren’t covered?
- Air-fluidized beds, if you don’t meet stringent conditions, including the presence of a deep bedsore and confinement to bed.
- How much will my pressure-reducing bed cost?
- Costs with Part A: Included with your Medicare-covered hospital or facility stay. If you are on hospice, basic air mattresses are covered.
- Costs with Part B: 20% of approved Medicare charge after meeting your annual deductible.
- Costs with Part C: Copay may apply, depending on your plan.
- Costs with Medigap: Most plans pay the Part B coinsurance after you meet your annual deductible.
- Blood sugar (glucose) monitors:
- Covered under the following conditions:
- You’ve been diagnosed as having diabetes.
- Your physician states that you or a responsible caregiver can be trained to use the particular device prescribed properly.
- The device is designed for home rather than clinical use.
- What types of blood sugar monitors aren’t covered?
- Those designed for clinical use by a skilled professional. These monitors require frequent testing and recalibration.
- How much will my blood sugar monitor bed cost?
- Costs with Part A: Included with your Medicare-covered hospital or facility stay. If you are on hospice, blood sugar monitoring by professional staff is covered.
- Costs with Part B: 20% of approved Medicare charge after meeting your annual deductible.
- Costs with Part C: Copay may apply, depending on your plan.
- Costs with Medigap: Most plans pay the Part B coinsurance after you meet your annual deductible.
- Blood sugar (glucose) test strips, lancet devices, and lancets (diabetic test supplies):
- Diabetic test supplies are covered as DME. Your test strips, lancet devices, and lancets are provided and appropriate to use with your type and brand of blood sugar monitor.
- If you use insulin, you may be able to get up to 100 test strips and lancets every month and one lancet device every six months. If you do not use insulin, you may be able to get 100 test strips and lancets every three months and one lancet device every six months.
- What types of diabetic test supplies aren’t covered?
- The kind used with a blood glucose monitor in the clinical setting.
- How much will my diabetic test supplies cost?
- Costs with Part A: Included with your Medicare-covered hospital or facility stay.
- Costs with Part B: 20% of approved Medicare charge after meeting your annual deductible.
- Costs with Part C: Copay may apply, depending on your plan.
- Costs with Medigap: Most plans pay the Part B coinsurance after you meet your annual deductible.
- Canes, crutches, and walkers (considered mobility assistance equipment):
- Covered under the following conditions:
- You have a mobility limitation that prevents you from doing your daily activities.
- You can safely use the equipment, and it will improve your mobility.
- You can use your equipment inside your home.
- What types of canes, crutches, or walkers aren’t covered?
- White canes used by blind persons.
- Rollators (walkers with seats) are covered only if medically necessary.
- How much will my cane or crutch cost?
- Costs with Part A: Not applicable. You would most likely purchase a cane, crutches, or walker through Part B for use in an inpatient setting as part of your discharge education for use at home.
- Costs with Part B: 20% of approved Medicare charge after meeting your annual deductible.
- Costs with Part C: Copay may apply, depending on your plan.
- Costs with Medigap: Most plans pay the Part B coinsurance after you meet your annual deductible.
- Commode chairs:
- Covered if you are confined to your bedroom.
- What types of commodes aren’t covered?
- All commodes are generally covered if ordered by your physician.
- How much will my commode cost?
- Costs with Part A: Included with your Medicare-covered hospital or facility stay. If you are in hospice, commode chairs are provided.
- Costs with Part B: 20% of the approved Medicare charge after you meet your annual deductible.
- Costs with Part C: Copay may apply, depending on your plan.
- Costs with Medigap: Most plans pay the Part B coinsurance after you meet your annual deductible.
- Continuous passive motion (CPM) machines:
- Covered for 21 days if you have knee replacement surgery. Use of the machine must begin within two days of surgery.
- What types of CPM machines aren’t covered?
- Any type that may be useful after a different type of surgery, for instance, shoulder repair. You may be able to rent a CPM from a supply company in your area and pay out of pocket.
- How much will my CPM machine cost?
- Costs with Part A: Not applicable. CPM machines are for home use.
- Costs with Part B: 20% of approved Medicare charge after meeting your annual deductible.
- Costs with Part C: Copay may apply, depending on your plan.
- Costs with Medigap: Most plans pay the Part B coinsurance after you meet your annual deductible.
- Hospital beds:
- Covered under the following conditions:
- Your condition requires frequent repositioning that cannot be accomplished with an ordinary bed. For instance, to alleviate pain, promote good body alignment, prevent contractures, and avoid respiratory infections.
- Your condition requires special attachments that cannot be used on an ordinary bed.
- What types of hospital beds aren’t covered?
- There are different types of hospital beds including those with manual or electric controls. Your condition and physician’s orders determine what type of bed Medicare will pay for. Medicare won’t cover more than a standard, manually operated bed unless your doctor says you need a bed:
- That raises and lowers because you have severe arthritis, a cardiac condition, or a spinal cord injury that prevents you from easily stepping into or out of bed.
- That has electric-powered controls to raise and lower the head and foot of the bed because you cannot tolerate a delay in repositioning.
- With side rails to help you self-position.
- How much will my hospital bed cost?
- Costs with Part A: Included with your Medicare-covered hospital or facility stay. If you are in hospice, a standard hospital bed is covered.
- Costs with Part B: 20% of the approved Medicare charge after you meet your annual deductible.
- Costs with Part C: Copay may apply, depending on your plan.
- Costs with Medigap: Most plans pay the Part B coinsurance after you meet your annual deductible.
- Infusion pumps and supplies:
- Covered when necessary to administer certain drugs. Home infusion supplies include pumps, IV poles, tubing, catheters, and certain infusion drugs, such as antibiotics. Medicare also covers infusion pumps and supplies for enteral and parenteral nutrition therapy if ordered by your physician.
- What types of infusion pumps and supplies aren’t covered?
- External infusion pump for vancomycin (an antibiotic).
- Implantable infusion pumps for blood-clotting disorders or diabetes.
- How much will my infusion pump and supplies cost?
- Costs with Part A: Included with your Medicare-covered hospital or facility stay. If you are in hospice, pain pumps and medications are covered.
- Costs with Part B: 20% of approved Medicare charge after meeting your annual deductible.
- Costs with Part C: Copay may apply, depending on your plan.
- Costs with Medigap: Most plans pay the Part B coinsurance after you meet your annual deductible.
- Manual wheelchairs and power mobility devices (power wheelchairs or scooters needed for use inside the home):
- Manual wheelchairs are covered if you have a doctor’s order and medical necessity. Power mobility devices require a face-to-face examination and a written prescription from a doctor or other treating provider before Medicare helps pay. Motorized wheelchairs or powered scooters are only covered if you meet mobility assistive device criteria, including:
- Sufficient upper extremity function and strength.
- Postural stability to facilitate movement of the device in your home.
- What types of wheelchairs and power mobility devices aren’t covered?
- There are many types of mobility devices available, but Medicare will only cover medically necessary devices usable by you or your caregiver. Less expensive and non-motorized or non-powered devices must be tried and ruled out first.
- How much will my wheelchair or scooter cost?
- Costs with Part A: Not applicable.
- Costs with Part B: 20% of approved Medicare charge after meeting your annual deductible.
- Costs with Part C: Copay may apply, depending on your plan.
- Costs with Medigap: Most plans pay the Part B coinsurance after you meet your annual deductible.
- Nebulizers and some nebulizer medications (if reasonable and necessary):
- Covered if your ability to breathe is severely impaired.
- What types of nebulizers and medications aren’t covered?
- Any that aren’t ordered and prescribed by your physician. Most medications used in nebulizers have a generic form covered by Medicare.
- How much will my nebulizer and medications cost?
- Costs with Part A: Included with your Medicare-covered hospital or facility stay. If you are on hospice, nebulizers and meds are covered.
- Costs with Part B: 20% of approved Medicare charge after meeting your annual deductible.
- Costs with Part C: Copay may apply, depending on your plan.
- Costs with Medigap: Most plans pay the Part B coinsurance after you meet your annual deductible.
- Oxygen equipment and accessories:
- Covered only if you have significant hypoxemia (low blood oxygen levels), medical documentation, a diagnosis, and lab tests to support the need for home oxygen use. You must have severe lung disease or symptoms that are likely to improve with oxygen use.
- What types of oxygen equipment and accessories aren’t covered?
- Any type of oxygen equipment required for air travel.
- Your Medicare supplier is not required to provide liquid oxygen.
- How much will my oxygen equipment and supplies cost?
- Costs with Part A: Included with your Medicare-covered hospital or facility stay. If you are on hospice and need oxygen to manage your symptoms, oxygen and supplies are covered.
- Costs with Part B: 20% of approved Medicare charge after meeting your annual deductible. You can rent your oxygen equipment from your supplier for up to five years. You may have to pay your supplier out-of-pocket for maintenance and servicing of your equipment if they come to your home.
- Costs with Part C: Copay may apply, depending on your plan.
- Costs with Medigap: Most plans pay the Part B coinsurance after you meet your annual deductible.
- Patient lifts (a medical device used to lift you from a bed or wheelchair):
- Covered if you have a physician’s order and caregivers trained in using it. Manual full-body and stand-assist lifts are covered under the following conditions:
- You require at least two people to help you transfer from or to a bed or wheelchair.
- You would be confined to bed without a lift.
- What types of lifts aren’t covered?
- Electric lifts aren’t covered.
- How much will my lift cost?
- Costs with Part A: Included with your Medicare-covered hospital or facility stay. If you are on hospice and lifts are necessary for the provision of your care at home, lifts are covered.
- Costs with Part B: 20% of approved Medicare charge after meeting your annual deductible.
- Costs with Part C: Copay may apply, depending on your plan.
- Costs with Medigap: Most plans pay the Part B coinsurance after you meet your annual deductible.
- Sleep apnea and continuous positive airway pressure (CPAP) devices and accessories:
- Covered for a three-month trial if you’ve been diagnosed with obstructive sleep apnea (OSA). After the trial period, Medicare may continue to cover longer CPAP therapy if you meet with your doctor face-to-face, and documentation supports your need for ongoing therapy.
- What types of sleep apnea and CPAP devices and accessories aren’t covered?
- Any devices you use that don’t meet OSA requirements. You may need physician documentation to cover certain oxygen delivery devices instead of a mask, such as a smaller nose attachment.
- How much will my CPAP devices and accessories cost?
- Costs with Part A: Included with your Medicare-covered hospital or facility stay.
- Costs with Part B: 20% of approved Medicare charge after meeting your annual deductible. You may pay extra out-of-pocket if you prefer to not use a mask.
- Costs with Part C: Copay may apply, depending on your plan.
- Costs with Medigap: Most plans pay the Part B coinsurance after you meet your annual deductible.
- Suction pumps:
- Covered if reasonable and medically necessary. There are different kinds of suction pumps for different uses, including:
- Gastric pumps with intermittent or continuous suction for people who are unable to empty gastric secretions through their gastrointestinal system.
- Tracheal or oropharyngeal respiratory pumps for those who cannot clear secretions themselves, due to throat or mouth cancer, tracheostomy, a problem with swallowing muscles, or unconsciousness.
- Wound suction pumps that are used to remove exudate from a wound when it cannot be managed by other means.
- What types of suction pumps aren’t covered?
- Any suction pumps that do not meet the above criteria.
- How much will my suction pump cost?
- Costs with Part A: Included with your Medicare-covered hospital or facility stay. If you are on hospice, oropharyngeal suction pumps and tubing are covered.
- Costs with Part B: 20% of approved Medicare charge after meeting your annual deductible.
- Costs with Part C: Copay may apply, depending on your plan.
- Costs with Medigap: Most plans pay the Part B coinsurance after you meet your annual deductible.
- Traction equipment:
- Covered if you have orthopedic impairment requiring traction equipment that prevents ambulation during the period of use.
- What types of traction equipment aren’t covered?
- Any that is not medically necessary for your recovery.
- How much will traction cost?
What Durable Medical Equipment Does Medicare Not Cover?
Medicare will not cover DME that is obtained from a supplier who does not participate in Medicare nor DME that is ordered by a health care provider not enrolled in Medicare. DME must be deemed medically necessary. Even though the following items may be helpful, Medicare will not cover items like:
- Dentures (may have partial coverage through a Medicare Advantage Plan).
- Eyeglasses or contact lenses (partial coverage through most Medicare Advantage Plans).
- Cosmetic prostheses.
- Wigs or hair covering for hair loss.
- Bathtub lifts and seats.
- Elastic stockings.
- Exercise equipment.
- Massage devices.
- Overbed tables.
- Pulse oximeters.
- Raised toilet seats.
- Surgical leggings or support hose.
- Telephone alert systems.
- Toilet seats.
The lists above are not all-inclusive. Your Medicare supplier or Medicare Advantage Plan will be able to tell you what is covered or not covered by Medicare.
How Much Does Durable Medical Equipment Cost?
Most DMEPOS are covered under Part B. You pay 20% of the Medicare-approved amount (if your supplier accepts the assignment) after you pay your annual deductible ($233 in 2022). Medicare pays for different kinds of DME in different ways. Depending on the type of equipment:
- You may need to rent the equipment, for instance, a hospital bed or oxygen concentrator.
- You may need to buy the equipment, for instance, most prosthetics or orthotics.
- You may be able to choose whether to rent or buy the equipment, depending on your Medicare supplier.
Original Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Suppliers who participate in Medicare must accept assignments. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims they submit. Find your local Medicare equipment and suppliers here.
If you have a Medigap plan to supplement Original Medicare, your costs for most DME items are covered after you meet your annual Part B deductible. Plans K and L pay a percentage of your Part B coinsurance up to an out-of-pocket max of $6,620 and $3,310 respectively in 2022. You must pay a monthly premium for a Medigap plan. If you don’t have a Medigap plan with Original Medicare, there is no limit on what you may spend for DME.
Medicare Advantage Plans must cover DME according to Medicare guidelines, but your cost-sharing will be different. You may have an annual deductible and pay either copays or coinsurance for DME. You must follow your plan’s rules regarding network providers and prior authorization requirements, or your plan may not pay. Medicare Advantage Plans have an annual maximum out-of-pocket limit for Medicare-covered items ($7,550 in-network, $11,300 for in-network, and out-of-network combined in 2022).
What Are Your Options to Help Pay for Durable Medical Equipment?
Original Medicare plus Medigap
If you have a Medigap plan, your costs for Medicare-covered Part A and Part B services and supplies are more predictable. You pay the annual Part B deductible and your monthly Medigap premium. Most DME costs are covered. Find Medicare equipment and suppliers who accept Medicare assignments here. Visit Medicare’s site to find a Medigap plan available in your area.
Medicare Advantage Plan
If you have a Medicare Advantage Plan as an alternative way to receive your Medicare benefits, your DME is covered by your plan. Costs and copays vary, depending on your plan, but many offer standard DME at zero or low cost. You may pay a monthly premium and an annual deductible. Your DME options may be limited to in-network providers, and you may have to obtain prior authorizations before your plan will pay. Find out what your plan covers and what you pay in your plan’s Evidence of Coverage document.
Medicaid
If you qualify for Medicare and Medicaid due to low income and resources, Medicaid may help cover your DME costs. Contact your local State Medical Assistance (Medicaid) Office to see if you are eligible for financial assistance.
Bidding
If you need a back or knee brace, you may have access to the lowest possible cost if you live in a competitive bidding area. The program may expand its reach and include different types of DME in the future.
Secondhand
Your community secondhand medical supply store. Many communities have medical equipment and supply stores where people can donate new or gently used items. These items are then resold at reasonable prices to people who need them and can’t afford retail.
Medicare for Durable Medical Equipment Expert Tips
- Rely on your Medicare supplier to tell you which DME Medicare will cover and what documentation is required from your physician. If you have Original Medicare, make sure your supplier takes assignments. If you have a Medicare Advantage Plan, make sure you follow network and authorization requirements. It may take some leg work and phone calls on your part to ensure Medicare or your Medicare Advantage Plan will cover the DME you need.
- If you find out that the DME you prefer is not covered, talk with your doctor or your supplier about suitable alternatives. Ask your supplier how much they would charge you out-of-pocket if you decide to bypass insurance.
- Remember your rights as a Medicare beneficiary. You have a right to appeal a DME coverage decision. Ensure you have documentation from your physician to support your appeal. You also have a right to complain about your DME. Find out what you need to know here.
- Check your community’s secondhand stores for smaller items, such as walkers, crutches, and disposable supplies. Contact a home care or hospice agency in your area to find out where people make donations of equipment and supplies that they no longer need.
- Most Senior Centers have a loan closet of DME. Wyoming Services for Independent Living also has a loan closet of DME that has been donated, available to any consumer of WSIL.
Also see:
Medical Equipment Loan Closets
