Medicare Coverage of Home Medical Equipment

Medicare Coverage for Durable Medical Equipment (DME)

Choosing the right durable medical equipment (DME) is only part of the decision. Understanding what Medicare covers, and how that coverage works, can help you reduce costs, avoid delays, and select the best option for your needs.

Medicare Part B (Medical Insurance) covers many types of medically necessary home medical equipment when prescribed by a doctor and used in the home. However, coverage depends not only on the equipment itself, but also on how and where it is obtained.

What Is Durable Medical Equipment (DME)?

Durable medical equipment is defined as equipment that is durable and able to withstand repeated use, is used for a medical purpose, is not typically useful to someone who is not sick or injured, is used in the home, and is expected to last at least three years.

These criteria help determine whether a product qualifies for Medicare reimbursement.

What Equipment Does Medicare Cover?

Medicare covers a wide range of DME used for mobility, respiratory care, and home recovery, including:

Mobility Equipment

Medicare covers canes, crutches, walkers, wheelchairs, and mobility scooters.

Respiratory Equipment

Medicare covers CPAP machines, nebulizers and medications, and oxygen equipment and supplies.

Home Recovery Equipment

Home recovery equipment covered by Medicare include hospital beds, patient lifts, pressure-relief mattresses, and support surfaces.

Other Covered Equipment

Other types of DME eligible for Medicare reimbursement include commode chairs, infusion pumps and supplies, suction pumps, continuous passive motion (CPM) devices, and diabetes monitoring supplies.

Coverage may vary depending on the specific product and medical need.

How Medicare Covers Equipment

Medicare coverage is not the same for every item. Depending on the equipment, an eligible Medicare recipient may rent the item or purchase the item and may have the option to choose between renting or buying. Some items will revert to the ownership of the user after a set number of rental payments.

Understanding these differences can help you plan for both short-term and long-term needs.

Who Qualifies for Coverage?

To qualify for Medicare coverage of DME, your doctor or healthcare provider must prescribe the equipment, the equipment must be medically necessary, and it must be used in your home.

Choosing a Medicare-Approved Supplier

One of the most important factors in receiving coverage is where you get your equipment.

To ensure Medicare will pay, your doctor must be enrolled in Medicare, your equipment supplier must be enrolled in Medicare, and the supplier should accept assignment.

Assignment means the supplier agrees to accept the Medicare-approved amount and only charge you your share of the cost.

Understanding Your Costs

After meeting your Part B deductible Medicare typically pays 80% of the approved amount and you pay the remaining 20% coinsurance.

Important Considerations

There are three additional things to be aware of when you consider when deciding on a purchase of durable medical equipment. Suppliers who accept assignment cannot charge more than the approved amount. Non-participating suppliers may charge higher fees. And if a supplier does not accept assignment, you may have to pay upfront and seek reimbursement.

Purchasing from a Medicare-Assigned Supplier vs. Retail (Important to Know)

Many people compare Medicare-covered equipment with products available online through retailers. The key difference is that to receive coverage, Medicare requires equipment providers to be approved suppliers who bill Medicare directly. And most online retailers (including Amazon) do not bill Medicare.

This means that you may pay less when purchasing equipment from Medicare-approved suppliers, but there are more eligibility requirements.

And if you choose to purchase the equipment from a retailer like Amazon, the transaction is faster and more convenient, but the customer will typically have to pay out of pocket for the item.

Special Situations: Disasters and Emergencies

If you live in an area affected by a declared disaster or emergency, Medicare may temporarily adjust its rules to help you replace lost or damaged equipment more quickly.

Making the Right Choice

As a patient who needs durable medical equipment, understanding Medicare coverage helps you choose equipment that may be eligible for reimbursement, compare suppliers and pricing, and avoid unexpected out-of-pocket costs. And if the need is not immediate it can help you plan for recovery and long-term care needs.

Explore Equipment by Category

Learn more about available equipment and suppliers for Mobility Equipment, Respiratory Equipment, Home Recovery Equipment, and Bathroom Safety Products.