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 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% 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 40 types of power wheelchairs that require you to undergo a preapproval process — known as prior authorization — to receive Medicare coverage.
If your physician prescribes one of these wheelchairs to you, your durable medical equipment 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% 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.
DME Repairs and Maintenance
Durable does not mean forever, and at some point you will likely have to repair or perform routine maintenance on your durable medical equipment.
Original Medicare coverage for repair and maintenance varies depending on whether you rent or own DME.
- If You Own the DME
- Medicare covers the costs of repairing or maintaining your durable medical equipment when the work requires a professional if the DME is not under warranty. Medicare will pay 80% of the Medicare-approved amount if the supplier takes assignment, meaning the supplier accepts Medicare’s approved amount for services rendered. You have to pay the remaining 20% as coinsurance.
- If the DME Is Rented
- If you are paying a rental fee, the supplier is responsible for all necessary repairs and maintenance to DME that requires a professional. The supplier is not allowed to charge you for this service.
Coverage may also vary depending on whether you have Original Medicare or a Medicare Advantage plan. You should check with your Medicare Advantage plan administrator to find out what the rules are for paying repair and maintenance costs.
DME Upgrades or Special Features
Medicare typically pays for only the most basic types of durable medical equipment. If you want DME with special features, you may have to pay for any upgrades out of your own pocket.
If your doctor includes the upgrade/special features options in your DME prescription, Medicare may cover the costs. But your doctor will have to go into detail about why you need an upgrade. Even so, Medicare may reject the upgrade.
Your supplier may require you to sign an advance beneficiary notice, or ABN, if it thinks Medicare will not cover the special features. By signing an ABN, you agree to pay the difference for the upgraded features if Medicare rejects them.
Medicare will pay to replace your DME at any time if it’s lost, stolen or declared a total loss in a natural disaster or accident. This is covered whether you rent or own the equipment, but you must provide proof of the loss or theft.
Medicare will only pay to replace DME you lost with equipment of an equal type. In other words, you can’t upgrade to a more expensive or advanced piece of equipment.
Medicare will only replace worn-out equipment if you have had the DME in your possession for its entire lifetime — at least five years since you began using it. Medicare will only pay to replace it if the damage is from routine, day-to-day wear and tear that has left it beyond repair. In other words, excessive damage beyond what is normal wear and tear may not be covered by Medicare.
Opt-Out Providers and Suppliers
Certain doctors, suppliers and other health care providers who don’t want to work with Medicare can choose to opt out of Medicare.
If they opt out, Medicare will not pay for any items or services you receive from those suppliers and providers. You will have to pay the full amount for their items or services. Medicare will not reimburse you.
It is important that you check to see if a DME supplier has opted out of Medicare before signing any agreement to purchase or rent durable medical equipment. You can use Medicare’s search tool to check on a supplier’s status.
What Is the Medicare DME Competitive Bidding Program?
Medicare has a competitive bidding program in which suppliers submit bids to provide certain durable medical devices in specific competitive bidding areas around the country. Medicare then uses these bids to determine how much it will pay for each item.
The program is called the Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program. Medicare screens suppliers based on financial, quality and accreditation standards before they receive contracts.
As of January 1, 2021, the program only includes off-the-shelf knee and back braces. If you have Original Medicare and require such a brace, you are required to obtain it exclusively through the contract supplier in the bidding area in which you live unless you qualify for an exception.
Frequently Asked Questions About Durable Medical Equipment
Medicare only covers durable medical equipment from suppliers enrolled in Medicare. You can use the Medicare.gov finder tool to locate participating providers near you.
A stair lift is a chair used to carry people up and down a staircase. Medicare doesn’t typically cover the purchase or installation of a stair lift, even with a doctor’s order.
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.
Medicare Advantage, or Part C, plans must cover the same items and services as Original Medicare (Part A and Part B). However, your costs depend on the plan you select. If you’re enrolled in a Medicare Advantage plan and need durable medical equipment, contact your plan provider to see if the equipment is covered and how much you’ll pay.
11 Cited Research Articles
- Medicare Interactive. (n.d.). DME repairs and maintenance. Retrieved from https://www.medicareinteractive.org/get-answers/medicare-covered-services/durable-medical-equipment-dme/dme-repairs-and-maintenance
- Medicare Interactive. (n.d.). Original Medicare DME costs. Retrieved from https://www.medicareinteractive.org/get-answers/medicare-covered-services/durable-medical-equipment-dme/dme-costs-when-you-are-not-affected-by-competitive-bidding
- Medicare Interactive. (n.d.). Upgrades and special features for DME. Retrieved from https://www.medicareinteractive.org/get-answers/medicare-covered-services/durable-medical-equipment-dme/upgrades-and-special-features-for-dme
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Competitive Bidding Program. Retrieved from https://www.medicare.gov/what-medicare-covers/what-part-b-covers/competitive-bidding-program
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Find providers who’ve opted out of Medicare. Retrieved from https://www.medicare.gov/forms-help-resources/find-providers-whove-opted-out-of-medicare
- 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