Medicare coverage for durable medical equipment

Medicare Part B covers medically necessary durable medical equipment (DME). But what is considered DME? Typically, DME is used in the home for a medical reason, and it is durable—that is, it includes devices that have a lifetime of at least 3 years.1 Read on to learn more about Medicare coverage for DME.

Do Medicare benefits include DME?

Whether you need short-term or long-term support, DME is covered under your Original Medicare Part B benefits. You’ll need a prescription from your doctor to access coverage to rent or buy eligible equipment. You’ll be responsible for 20% of the Medicare-approved amount for the device, and Medicare Part B should cover 80%, as long as you’ve met your deductible.1

Types of DME and supplies covered by Medicare

Covered DME may include:

  • Canes
  • Crutches
  • Wheelchairs
  • Walkers
  • Oxygen equipment
  • Hospital beds
  •  Blood sugar monitors
  • Continuous Glucose Monitors (CGMs)—examples include Dexcom and Libre (available through your provider, such as CenterWell Pharmacy)

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Types of DME not covered by Medicare

Not all types of DME are covered by Medicare. If a device is designed for use outside the home, it’s likely you can’t cover it through Medicare. Also, if a piece of equipment is for convenience or comfort, Medicare typically does not cover it.

Items not covered by Medicare may include:2

  • Modifications to the home, such as ramps
  • Most disposable or single-use items
  • Stair elevators
  • Motorized scooters
  • Air conditioners
  • Toilet seats
  • Grab bars

Eligibility criteria for DME Medicare coverage

To get your DME covered by Medicare, it must meet the following 2 conditions:

  1. First, your prescriber should issue a prescription or order for the device. Your healthcare provider must state in the document that you need the equipment to help with a medical condition and the equipment is for home use.
  2. Next, you must take your order or prescription to a Medicare-approved supplier to get the device covered.3

How can I get durable medical equipment?

You’ll have to use the right supplier for your DME if you want it covered. If you use Original Medicare, make sure your equipment supplier is Medicare-approved and takes assignment.4 Taking assignment means that the supplier agrees to Medicare’s approved amount for an item for payment.5

If you use Medicare Advantage, you’ll have to follow the rules of your insurance plan to get coverage. You may have to use a particular brand or shop within a network of suppliers. Rules may vary between plans, so make sure to check your plan or contact your insurance provider before buying equipment.4

Where to find Medicare coverage for durable medical equipment

Once you have a prescription or order for a device, you can get DME from Medicare-approved suppliers that take assignment. You can search for Medicare-approved suppliers near your ZIP code on the Medicare website.

Don’t be afraid to ask questions

Medicare doesn’t cover everything. If you have a healthcare need and you’re not sure if it’s covered, ask your doctor’s office to check for you.

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Sources

  1.  “Durable medical equipment (DME) coverage,” Medicare.gov, last accessed Oct. 22, 2024.
  2. “Equipment and supplies excluded from Medicare coverage,” Medicare Interactive, last accessed Oct. 22, 2024.
  3. “Eligibility for DME coverage,” Medicare Interactive, last accessed Oct. 22, 2024.
  4. “DME supplier basics,” Medicare Interactive, last accessed Oct. 22, 2024.
  5. “Original Medicare DME costs,” Medicare Interactive, last accessed Oct. 22, 2024.

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