Medicare covers a broad variety of durable medical equipment if a healthcare provider prescribes it. Both the provider and the supplier must be enrolled in Medicare.
Covered durable medical equipment (DME) ranges from large items, such as hospital beds for home use, to small items such as blood sugar monitors.
In original Medicare, the coverage falls under Part B. Out-of-pocket costs include coinsurance and deductibles. Advantage plans also cover DME, but costs vary.
This article describes what DME Medicare does and does not cover, as well as the out-of-pocket costs. It also looks at renting versus buying DME, and the difference between using Medicare-enrolled suppliers versus Medicare-participating suppliers.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare covers DME that healthcare providers consider medically necessary. Providers may include doctors, physician assistants, nurse practitioners, or clinical nurse specialists, and they must be enrolled in Medicare.
Below is a partial list of covered DME:
- blood sugar test strips
- blood sugar monitors
- hospital beds
- pressure-reducing beds
- patient lifts
- commode chairs
- oxygen equipment
- suction pumps
- infusion pumps and supplies
- continuous passive motion machines
- trachea equipment
- sleep apnea devices
- power wheelchairs
Other covered DME include orthotic and prosthetic items, such as:
- neck, arm, leg, and back braces
- orthopedic shoes, if they are part of a leg brace
- artificial limbs
- therapeutic shoes for people with diabetes
- breast prostheses
- urological supplies
- costomy bags and certain supplies
Medicare also covers cataract glasses and intraocular lenses. After the surgical insertion of an intraocular lens, coverage includes conventional glasses or contact lenses.
Some medical equipment and supplies do not meet the medically necessary criteria for Medicare coverage.
|Motorized wheelchair||only if used in the home||not if used outside the home|
|Catheters||for permanent conditions only||not for temporary conditions|
|Disposables||some coverage, including for gauze and intravenous |
|items such as catheters|
|Convenience and comfort- related||none||air conditioners, grab bars, bathtub seats, and stairway elevators|
|Home modifications||none||modifications for wheelchair access, such as widened doorways or ramps|
Original Medicare is composed of Part A, hospital insurance, and Part B, medical insurance. If a person has original Medicare, then Part B provides the coverage for DME. Out-of-pocket expenses include 20% of the Medicare-approved cost. The annual deductible of $198 also applies.
Medicare Advantage, or Part C, is the alternative to original Medicare. It provides all the coverage of parts A and B, but it has different deductibles, copays, and coinsurance. A person can check with their plan to find out if the DME is covered, and the costs.
Medigap is Medicare supplement insurance that a person with original Medicare may buy. It pays 50–100% of parts A and B out-of-pocket costs, which would include those for DME.
The only other Medicare program is Part D, prescription drug coverage. It does not cover DME costs.
A person may rent or buy DME, but most items would fall into the rental category. Medicare makes monthly payments, but the number of months it pays varies with the item. The supplier covers the cost of repairs.
The DME that someone may buy are often inexpensive items, such as canes and walkers. If a person owns the DME, Medicare covers the cost of repairs and replacement parts.
In some instances, a person has a choice in renting or buying DME.
How to find durable medical equipment
In general, DME must be used in the home, and be prescribed for a medical reason. It must also be durable enough for repeated use and expected to last for at least 3 years.
To find a supplier in a particular area, people can use this online tool. They may also call 1-800-MEDICARE (1-800-633-4227).
Medicare only covers DME if the supplier has enrolled in Medicare. To receive Medicare’s approval, a supplier must meet strict standards. Unless a store has a supplier number indicating its enrollment, Medicare will not pay the claim.
If a supplier has agreed to accept Medicare assignments, it means it is a participating supplier and will accept the Medicare-approved amount for DME. This supplier cannot charge a person more.
In contrast, if a supplier is enrolled but not participating, it may charge more than the Medicare-approved amount.
Before arranging to rent or buy DME, a person should check with the supplier if it is enrolled and participating in Medicare.
Medicare covers DME that a doctor considers medically necessary, but not items that make life more convenient or comfortable.
If a person has original Medicare, Part B covers 80% of the approved cost after they meet the deductible of $198. For someone with Medicare Advantage, the out-of-pocket costs vary with the plan.
When individuals look for a DME supplier, it is a good idea to ensure the supplier is both enrolled and participating in Medicare. When a supplier does not meet these two criteria, people may have higher costs.