Medicare will cover many pieces of Durable Medical Equipment. Part B will include most medical equipment you may need. Coverage can include prescriptions that may accompany equipment, like medications with a nebulizer. Equipment is essential for so many because it can help with daily tasks. Let’s take a look at the Durable Medical Equipment Medicare will cover and discuss the guidelines for coverage. Then, we can answer some common questions on the topic.
Medicare Guidelines for Durable Medical Equipment
Part B will cover Durable Medical Equipment you’ll use at your home if your doctor decides you need it. Medicare won’t cover all devices, but it does include a good majority. You’ll be able to use the Durable Medical Equipment in your home or a long-term care facility. If you have to stay in a skilled nursing facility, the facility will provide you with your equipment. Part A covers skilled nursing facilities, so your devices will be covered, inpatient too.
Eligibility Criteria for Medicare to Cover Durable Medical Equipment
- Endure repeated use
- Serve a medical purpose
- Must be appropriate for home use
What Equipment Does Medicare Pay For?
- Glucose monitors and strips
- Prosthetics
- Hospital beds
- Lancet devices & lancets
- Canes
- Wheelchairs & scooters
- Commode chairs
- Oxygen equipment & accessories
- Suction pumps
- Continuous Positive Airway Pressure (CPAP) devices
What DME is Not Covered By Medicare?
While Medicare covers a wide range of medical equipment, it doesn’t cover everything.
Some supplies and equipment that aren’t covered can include:
- Equipment to help you outside your home
- Equipment intended only to make things convenient and comfortable—for example, stairway elevators, air conditioners, and toilet seats
- Disposable items. For example, Medicare won’t cover incontinence pads, catheters, facemasks, or compression stockings
- Changes to your home. Modifications may include ramps or broader doors for wheelchair access
- Equipment not suitable for use in your home
Purchasing vs. Renting Durable Medical Equipment Through Medicare
Durable Medical Equipment can end up being quite expensive. You may find equipment available for purchase or rental. In most cases, Medicare pays to rent medical equipment. But Medicare will buy some equipment that’s inexpensive like a walker or cane.
Medicare usually will help with any repairs or replacements you may need for your device. Sometimes you need the equipment longer than a few months. Medicare may buy equipment rather than renting for situations like these.
Criteria for Medicare to Cover a Replacement for Durable Medical Equipment
- Lost
- Stolen
- There’s extensive damage.
- If it’s more than five years old
To ensure coverage, you’ll need to order from an equipment supplier who’s Medicare-approved.
Durable Medical Equipment Suppliers Approved by Medicare
To get coverage for equipment, you’ll need to get your supplies from a Medicare-approved supplier. You can check Medicare’s website to be sure that you find a qualifying supplier.
Does Medicare Advantage Cover Durable Medical Equipment?
Medicare Advantage plans must offer the same level of coverage through Medicare. But, often, you’ll find many more perks with an Advantage plan such as extra coverage. Advantage plans come from private insurance companies. You’ll want to confirm with your plan to ensure your equipment has coverage.
FAQs
How to Find Medicare Coverage for Durable Medicare Equipment
You may have questions or concerns about your Medicare coverage for Durable Medical Equipment. Medigap policies can help you with the costs of DME items you may need. Our agents can answer any coverage questions you may have. We can also look at different plans that may better suit your needs. Call us today for a quote. Our services are free to you! You can also compare rates online today.
Hi, a good friend of mine has a rare muscular progressive disease. He has a prescription from his Dr. for a tube bench or transfer tub bench next to shower and hand rail for shower. I am wondering if Medicare will cover that? And how to find a Medicare approved DME provider. So far, I cannot find anything.
Hi Lori! We have some information on bathroom safety devices, but normally Medicare does not cover those types of items even though they are medically necessary. However, Medicare is always updating these guidelines and could cover them under certain circumstances. I’ve also heard of some Medicare Advantage plans covering them. Your best option is to call an agent, they will have the resources to determine if it will be covered. Your friends doctor should also be able to tell them as well as provide information on a DME provider.
hi my mother has medicare and medical and she is home having ihss and us kids take care of her around the clock she has a wound that has to fistula that one has opened up from the small bowel and is coming into the wound and everything she eats and drinks comes out these wounds. she has no stomach do to her stomach turning gangrene and killed it with some of her intestines. im trying to get wound bags and supplies but a lot of places say they don’t have wound bags that are 6in x 9 in to cover both sights I feel like we have been put out to fend for are selfs but are having a hard time.
Hi Kari! So sorry you’re going through this with your mother. It sounds like she needs skilled nursing care, she may need to be in a Skilled Nursing Facility. If she has Medicaid, they will cover the costs. I would contact your local Medicaid office for more information.
On 7-21-2020 CVS Pharmacy filled a DME prescription for me for test strips. They offer delivery of prescriptions but declined delivery of this prescription (#1792800). I offered to pay extra. The pharmacy tech and the pharmacist both stated Medicare would not allow the pharmacy to deliver my prescription. I am unable to determine if the pharmacy acted correctly and believe I have been wronged – either by CVS or Medicare. (DME prescriptions are Medicare Part B).
I would think this is an error on the pharmacy’s part. I would recommend contacting the manufacturer that makes the test strips directly to see if they will deliver them. Or, you can contact Medicare directly to get this issue cleared up.
Hello. Medicare paid for a rollator in September for my elderly mother. Since then she has fell twice and has limited mobility and uses a wheel chair at Rehab. Will Medicare allow a wheelchair since they just bought the walker?
Hi Karen! It’s really a case by case scenario. However, I would think that as long as your doctor finds it medically necessary, Medicare should help cover the cost of a wheelchair. We have great FAQ content on Medicare-approved wheelchairs and mobility scooters that should help you understand the approval process. If covered, it would fall under Part B, leaving your mom responsible for the 20% coinsurance. However, if she has a Medigap plan, that coinsurance will be covered. The only out of pocket expense she might have to pay is the Part B deductible of $198 unless she has Plan F. If she has Plan F, that deductible would also be covered. Hopefully, this helps! Don’t hesitate to reach out with any more questions.
The walker that I’ve been approved for sits too low and has small wheels. The supplier said I have no choices but that one !! Is there any way to chose and pay the difference ?
Hi Donna! This is a tough one. If you’re renting the equipment, Medicare makes monthly payments for use of the equipment to the supplier. So, that may be why they don’t want to take the walker back. Ideally, if they do not have the appropriate size walker for you, they should take it back. Then you and/or your doctor would find another supplier near you that does have the appropriate size walker for your needs. Have you talked to your doctor about this issue? I would recommend you call your doctor that prescribed your walker. You can also call 1-800-MEDICARE to find out how to replace your walker. Between Medicare & your doctor, you should be able to get this issue resolved.
Hello, I have a patient here that have a medicare health insurance part A and part B. Asking if she have any DME coverage. What are the steps she needs to do to get all information and process to get DME?
Hi Lady! Yes, if your patient has Part B, then she has coverage for DME. Part B will cover 80% of her DME costs. The other 20% will be her responsibility to pay unless she has a Medigap plan to cover it. To get the process started for DME, she would need to speak to her doctor to get a prescription for the DME.
My mother in law who has Alzheimer’s is currently in a long term care facility in Norfolk, VA, and is being charged $2700.00 per month for a wound vac. Can this be right? My husband is being stonewalled by the facility and Medicare says he needs a Guardianship to speak to them. He is the caregiver, has POA, and is trustee over her financial decisions. Please help!! My mother in law has Medicare Part A, Part B, and Federal BCBS as 2ndary! Need advice!
Hi Cindy! I’m so sorry you’re going through this with your mother-in-law. There is a difference between POA & Guardianship. If Medicare is stating you need guardianship, then that’s what I would recommend you do. A wound vac is considered Durable Medicare Equipment and should be covered 80% under Part B as long as her doctor deems it’s medically necessary. The remaining would be billed to her Federal BCBS plan.