Medicare Coverage for Durable Medical Equipment: Wheelchairs, CPAP, and More

Durable medical equipment (DME) -- wheelchairs, walkers, hospital beds, CPAP machines, oxygen equipment -- can be expensive. Medicare Part B covers DME when it's medically necessary, but the rules around suppliers, documentation, and cost-sharing trip up many seniors.

DME is equipment that:

• Is durable (can withstand repeated use)
• Is primarily used for a medical purpose
• Is not useful to someone who isn't sick or injured
• Is used in the home

Common examples: wheelchairs, walkers, crutches, hospital beds, oxygen equipment, CPAP/BiPAP machines, blood glucose monitors, nebulizers, and infusion pumps.

Medicare Part B covers 80% of the Medicare-approved amount for DME after you meet the Part B deductible ($166 in 2016). You pay the remaining 20%.

With a Medigap plan, the 20% coinsurance is covered, so you pay nothing for covered DME.

Medical necessity: Your doctor must certify that the equipment is medically necessary for your condition. A written order or prescription is required.

Medicare-enrolled supplier: You must get your DME from a Medicare-enrolled supplier. Not all medical supply companies accept Medicare. Using a non-enrolled supplier means Medicare won't pay.

Competitive bidding areas: In certain metropolitan areas (including parts of Florida), Medicare uses competitive bidding to set prices and limit which suppliers can provide certain types of DME. In these areas, you must use a contract supplier for covered DME.

Wheelchairs and scooters: Covered when you have a mobility limitation that significantly impairs your ability to participate in mobility-related activities of daily living. A face-to-face exam and detailed written order from your doctor are required.

CPAP machines: Covered for sleep apnea diagnosed by a sleep study. Medicare covers the machine as a rental for the first 13 months, then you own it. Supplies (masks, tubing) are covered on an ongoing basis.

Oxygen equipment: Covered for chronic obstructive pulmonary disease (COPD) and other conditions causing low blood oxygen levels. Medicare rents oxygen equipment for 36 months, after which the supplier must continue providing equipment and supplies for an additional 24 months at no charge.

Hospital beds: Covered when medically necessary for your condition (e.g., severe GERD, heart failure, or a condition requiring positioning). Requires a doctor's order.

Blood glucose monitors: Covered for all Medicare beneficiaries with diabetes, regardless of whether they use insulin. Supplies (test strips, lancets) are also covered.

Walkers and crutches: Covered when medically necessary. Standard walkers are covered; wheeled walkers (rollators) may require additional documentation.

For most DME, Medicare pays for rental until you own the equipment (typically 13 months for most items). After the rental period, you own the equipment and Medicare continues to cover maintenance and repairs.

For inexpensive items, Medicare may pay for purchase rather than rental.

1. Get a written prescription from your doctor that includes the diagnosis and why the equipment is medically necessary
2. Verify the supplier is Medicare-enrolled before ordering
3. In competitive bidding areas, use a contract supplier
4. Keep records of your doctor's orders and supplier receipts
5. If denied, you have the right to appeal

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.