Medicare Coverage for Durable Medical Equipment (DME)

What Counts as Durable medical equipment?

Durable medical equipment is equipment that is Medically necessary, can be used repeatedly, and is mainly useful to someone who is sick or injured. Medicare covers DME for use in your home.

Common examples include:

• Wheelchairs and scooters
• Walkers and canes
• Hospital beds
• Oxygen equipment and supplies
• CPAP machines and related supplies for sleep apnea
• Blood sugar monitors and test strips
• Nebulizers and certain related medications
• Patient lifts
• Commode chairs

This is not an exhaustive list. Medicare’s coverage rules for DME are specific, and not every type of equipment your doctor recommends will automatically qualify. The equipment generally needs to be something that would not be useful to someone who is not sick or injured, which is part of why everyday items like grab bars or ramps are often not covered the same way.

How Part B Covers DME

Durable medical equipment falls under Medicare Part B, your medical insurance.

Here is how the coverage generally works:

1. You pay the Part B Deductible first, if you have not already met it for the year.
2. After that, Medicare pays 80% of the Medicare-approved amount.
3. You are responsible for the remaining 20% Coinsurance.

For most DME, Medicare pays its share whether the equipment is rented or purchased, depending on the type of item. Many items are rented rather than purchased outright. For certain more expensive equipment, such as wheelchairs and hospital beds, the equipment becomes your property after you have made rental payments for 13 months.

Throughout the rental period and after you own the equipment, the same general cost-sharing applies: you are responsible for 20% of the Medicare-approved amount, and the Part B deductible applies.

Supplier Requirements: Why It Matters Where You Get Your Equipment

Not just any store or company can supply Medicare-covered DME. To have your equipment covered, two requirements generally need to be met:

1. You need a doctor’s order

Your equipment must be ordered by a doctor or other Medicare-enrolled provider who determines it is medically necessary for your condition. This is usually documented through a written order or prescription, along with supporting medical records.

2. The supplier must be Medicare-enrolled

The company providing your equipment must be enrolled in Medicare. Beyond that, it matters whether the supplier “accepts Assignment”:

Before you accept delivery of any equipment, it is worth asking directly: “Are you enrolled in Medicare, and do you accept assignment?” That single question can save you a significant amount of money and hassle.

How Medigap Can Help With Your 20% Share

Even with Medicare paying 80% of the approved amount, that remaining 20% can add up, especially for higher-cost items like power wheelchairs, hospital beds, or ongoing oxygen equipment and supplies.

This is where a Medigap (Medicare Supplement) policy can make a real difference. Depending on the plan you choose, Medigap can help cover:

• The Part B coinsurance, which is typically your 20% share for DME
• The Part B deductible, depending on the plan

For example, Medicare Supplement Plan G covers the Part B coinsurance amount in full, which means your DME costs become far more predictable. Plan N also covers Part B coinsurance for most services, generally with small copays for certain office and emergency room visits.

Instead of facing a bill for 20% of an expensive piece of equipment, a Medigap policy can turn that into a cost you already planned for in your monthly Premium. If you would like to compare what different plans might do for situations like this, our guide to saving on Medicare Supplement coverage is a good place to start.

Tips for a Smoother DME Experience

A few simple steps can help you avoid surprises:

• Get the doctor’s order in writing before you shop for equipment. Suppliers will need this documentation to bill Medicare.
• Confirm the supplier is Medicare-enrolled and accepts assignment before you accept delivery.
• Ask whether the item will be rented or purchased, and what the total cost is expected to be over time.
• Keep all paperwork, including the doctor’s order, supplier invoices, and any Medicare summary notices related to the equipment.
• Check whether your equipment needs periodic renewal or recertification, particularly for items like CPAP supplies or oxygen equipment.

Frequently Asked Questions

Does Medicare cover the full cost of durable medical equipment?
No. Medicare Part B generally covers 80% of the Medicare-approved amount after you meet the Part B deductible. You are responsible for the remaining 20% unless you have additional coverage, such as a Medigap policy, that helps with that cost.

Can I use any supplier I want for my equipment?
You should use a supplier that is enrolled in Medicare. If the supplier does not accept assignment, you could pay significantly more, and you may need to pay upfront and request reimbursement.

Do I need a new doctor’s order every time I need equipment?
In many cases, yes, especially for new equipment or when supplies need to be replaced or renewed. Your doctor’s office can tell you what documentation is required for your specific situation.

Will I ever own equipment that Medicare helped pay for?
For certain higher-cost equipment, such as wheelchairs and hospital beds that are rented, the equipment generally becomes your property after 13 months of rental payments, as long as you continue to need it.

Does Medigap cover items that Medicare does not cover at all?
No. Medigap helps pay your share of costs for services and equipment that Medicare already covers, such as the Part B coinsurance and deductible. It does not expand coverage to items Medicare excludes.

Bottom Line

Durable medical equipment can be essential to staying safe, mobile, and healthy at home, and Medicare’s Part B benefit is designed to help you get it. Understanding how the 80/20 cost-sharing works, choosing a Medicare-enrolled supplier that accepts assignment, and knowing what paperwork you need can save you time, stress, and money.

If you want to make sure your out-of-pocket costs for equipment like this stay predictable, a Medigap policy can help cover the share Medicare leaves behind.

Want a simple way to track what you need before you enroll or make changes to your coverage? Download the REMEDIGAP Medicare Checklist to help you stay organized every step of the way.

This article is for educational purposes only and is not medical or legal advice. Medicare coverage rules for durable medical equipment can vary by item and change over time. Confirm current coverage details and costs directly with Medicare or a licensed Medicare advisor before making decisions about your equipment or coverage.

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