What Durable Medical Equipment (DME) is Not Covered by Medicare?

Original Medicare does not cover any durable medical equipment (DME) that does not meet strict criteria set by the U.S. Centers for Medicare & Medicaid Services.

For example, a powered wheelchair or scooter you need only outside your home is not covered by Original Medicare. But if your doctor determines that it is medically necessary that you have one to get around your home, Medicare will cover it.

Typical DME that Medicare will cover includes hospital beds, wheelchairs, walkers and home oxygen equipment.

Medicare will not cover any disposable supplies — unless the supplies are used in conjunction with recognized durable medical equipment that is used inside the home. For example, Medicare will cover diabetes test strips (used with testing equipment), but not supplies like adult diapers.

If you qualify for Medicaid, the home use limitation on durable medical equipment and supplies does not apply.

Medicaid will cover DME and supplies that are needed for you to function in your community, not just in your home.

Medicaid will also cover some supplies not used in conjunction with covered DME — as long as the supplies are needed in order for you to function in your community. This could include disposable supplies such as adult diapers.

To qualify for Medicaid, you have to meet requirements for limited income and financial resources, but you can be enrolled in both Medicare and Medicaid at the same time. When you qualify for both programs it is called dual eligibility.

The list of durable medical equipment that Medicare does not cover is lengthy. If you wonder whether a specific item is covered, you should check with Medicare or your plan’s administrator.

Typically, anything that fails to meet Medicare’s five criteria for durable medical equipment is not covered.

Notably, the modifications you make to your home as you age and become less mobile or in the event that you become disabled, are not considered DME under Medicare’s rules and, therefore, are not covered.

Medicare will not cover any DME if your doctor and your DME supplier are not enrolled in Medicare. If they are not Medicare-enrolled, Medicare will not pay the claims they file, and you may have to pay the full price of any equipment you receive.

Medicare Advantage plans are sold by private insurers that contract with Medicare. There are some differences between how Original Medicare — Medicare Part A and Part B — and Medicare Advantage plans treat durable medical equipment.

Medicare Advantage plans are required by law to cover everything that Original Medicare covers. But Medicare Advantage plans may also offer benefits that Original Medicare does not, such as coverage for certain items that Original Medicare does not consider to be durable medical equipment.

If these and other potential benefits appeal to you or your health situation, you should ask about additional benefits when shopping for a Medicare Advantage plan.