Does Medicare Cover Durable Medical Equipment?
Durable medical equipment is a long-term, reusable device that provides a therapeutic benefit to patients. This can include wheelchairs, walkers and hospital beds. Medicare Part B covers this equipment if it is considered medically necessary and prescribed by your doctor.
What Is Durable Medical Equipment?
Durable medical equipment, or DME, is a medical device used within your home to help improve accessibility or perform tasks of daily living.
The equipment must be prescribed by your doctor for a medical reason.
- Power scooters
- Commode chairs
- Continuous passive motion (CPM) machines
- Hospital beds
- Blood sugar testing devices and test strips
- Oxygen equipment and accessories
- Suction pumps
- Continuous positive airway pressure (CPAP) machines
Medicare usually does not cover disposable items. However, there are a few exceptions to this rule, including diabetes test strips and lancets.
Medicare Part B beneficiaries typically pay 20 percent of the approved cost for durable medical equipment. Your Part B deductible also applies.
You may be required to either rent or buy your equipment.
Medicare Part B also covers 80 percent of approved expenses for prosthetic and orthotic items. This includes arm, leg, back and neck braces as well as therapeutic shoes or inserts for people with severe diabetic foot disease.
Wheelchairs, Walkers and Power Scooters
Power wheelchairs and scooters are only covered by Medicare if a doctor prescribes this equipment because of a medical condition. It will not cover this equipment if it is only needed and used outside your home.
You must also prove that you need your wheelchair or scooter because you are unable to perform activities of daily living, even with the help of a cane, crutch or walker.
Before you can get a power wheelchair or scooter, you must complete a medical exam with your doctor.
If your doctor decides you can safely operate the device, he or she will submit a written order to Medicare describing why you need the equipment and that you can operate it safely.
You will owe 20 percent of the Medicare-approved amount for a wheelchair or scooter, and the Part B deductible applies.
Similar costs and eligibility rules also apply to walkers, canes and crutches.
There are 33 types of power wheelchairs that require you to undergo a pre-approval process — known as prior authorization — to receive Medicare coverage.
If your physician prescribes one of these wheelchairs to you, your durable medical supplier will submit a prior authorization request along with other documentation to Medicare on your behalf.
Medicare then reviews this information to verify your eligibility and make sure you meet all requirements for the item.
Blood Sugar Monitors and Test Strips
Medicare Part B covers devices such as blood sugar monitors and test stripes used to help people with diabetes monitor their condition.
You may also qualify to have diabetes supplies shipped directly to your home.
- Blood glucose monitors
- Continuous blood glucose monitors
- Blood glucose test strips
- Lancet devices and lancets
- Insulin pumps and the insulin they use
The Medicare Part B deductible applies for diabetes supplies. You will owe a 20 percent coinsurance payment.
Oxygen Equipment and Accessories
Medicare Part B generally covers the rental of oxygen equipment and related accessories, but you must meet certain criteria to qualify.
- Your doctor diagnoses you with a severe lung disease or determines you’re not getting enough oxygen.
- Other alternative measures aren’t working.
- Oxygen therapy may help improve your health.
- Your arterial blood gas level falls within a certain range.
You will pay 20 percent of Medicare-approved costs along with the Part B deductible for oxygen equipment.
Other breathing therapy devices such as nebulizers and continuous positive airway pressure (CPAP) machines may also be covered with Medicare Part B.
A lift chair, or a recliner that uses a mechanism to elevate you into a standing position, is partly covered by Medicare. For example, Medicare won’t pay for the fabric and cushions on a lift chair, but it will reimburse you for 80 percent of the motor and the mechanism used to lift you out of the seat.
6 Cited Research Articles
- Medicare.gov. (2019, October). Medicare’s Wheelchair & Scooter Benefit. Retrieved from https://www.medicare.gov/Pubs/pdf/11046-Medicare-Wheelchair-Scooter.pdf
- Centers for Medicare & Medicaid Services. (n.d.). Current Medicare Coverage of Diabetes Supplies. Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE18011.pdf
- Centers for Medicare & Medicaid Services. (n.d.). Medicare Coverage of Durable Medical Equipment. Retrieved from https://www.medicare.gov/Pubs/pdf/11045-Medicare-Coverage-of-DME.pdf
- Medicare.gov. (n.d.). Continuous Positive Airway Pressure devices. Retrieved from https://www.medicare.gov/coverage/continuous-positive-airway-pressure-devices
- Medicare.gov. (n.d.). Durable medical equipment (DME). Retrieved from https://www.medicare.gov/coverage/durable-medical-equipment-dme-coverage
- Medicare.gov. (n.d.). Walkers. Retrieved from https://www.medicare.gov/coverage/walkers