Medicare Durable Medical Equipment: What Is Covered and How to Get It

Durable Medical Equipment (DME) -- medical devices and supplies prescribed by a doctor for home use -- is covered under Medicare Part B. From wheelchairs to CPAP machines to home oxygen, DME coverage can be enormously valuable. Here is how it works.

To be covered by Medicare, equipment must meet all four criteria:

1. Durable -- can withstand repeated use
2. Medical purpose -- used to serve a medical purpose
3. Not useful to someone who is not sick or injured -- not primarily for comfort or convenience
4. Used in the home -- intended for home use

Mobility equipment:

• Manual wheelchairs
• Power wheelchairs and scooters (with additional documentation requirements)
• Walkers and rollators
• Canes and crutches
• Hospital beds for home use

Respiratory equipment:

• CPAP and BiPAP machines (for sleep apnea)
• Home oxygen equipment and supplies
• Nebulizers and compressors
• Ventilators

Diabetes supplies:

• Blood glucose monitors
• Test strips and lancets
• Continuous glucose monitors (CGMs) for qualifying patients
• Insulin pumps

Other covered DME:

• Commode chairs
• Traction equipment
• Infusion pumps
• Transcutaneous electrical nerve stimulation (TENS) units
• Orthotic braces (back, knee, ankle)
• Prosthetic limbs and eyes

Cost-sharing: Medicare pays 80% of the approved amount; you pay 20% after the Part B deductible. Medigap Plan G covers this 20%.

Purchase vs. rental: Medicare may pay to rent or purchase DME depending on the item:

• Rental: Oxygen equipment, hospital beds, CPAP machines -- Medicare rents for up to 13 months, then ownership transfers to you
• Purchase: Wheelchairs, walkers, blood glucose monitors -- typically purchased outright

You must use a Medicare-enrolled DME supplier to have Medicare cover the equipment. Using a non-enrolled supplier means Medicare will not pay -- and you will be responsible for the full cost.

How to find enrolled suppliers: Use the Supplier Directory at medicare.gov/care-compare or call 1-800-MEDICARE.

Competitive bidding: In many areas, Medicare uses competitive bidding to set prices for certain DME categories. In competitive bidding areas, you must use a contract supplier for covered items -- or pay full price.

1. Doctor's order: Your doctor must write a prescription/order documenting medical necessity
2. Find an enrolled supplier: Use medicare.gov/care-compare to find suppliers in your area
3. Supplier verifies coverage: The supplier checks your Medicare eligibility and coverage
4. Equipment delivered: The supplier delivers and sets up the equipment
5. Medicare billed: The supplier bills Medicare directly; you pay your 20% coinsurance

Unsolicited equipment: Never accept DME you did not request. Fraudulent suppliers sometimes deliver equipment and bill Medicare without a legitimate order.

Upcoding: Billing for more expensive equipment than what was provided. Review your Medicare Summary Notice for accuracy.

Supplier not enrolled: Always verify your supplier is Medicare-enrolled before accepting equipment.

Missing documentation: If Medicare denies a DME claim, it is often due to missing documentation of medical necessity. Work with your doctor to provide complete documentation.

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.