Durable medical equipment is essential for so many Medicare beneficiaries because it can help with many daily tasks. In this article, we will look at the durable medical equipment Medicare will cover and discuss the guidelines for coverage. Then, we will answer some common questions on whether Medicare helps cover durable medical equipment costs.
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Medicare Guidelines for Durable Medical Equipment
Durable medical equipment may be covered under Original Medicare, which comprises of Medicare Part A and Medicare Part B.
Common examples of durable medical equipment include:
- Wheelchair
- Crutches
- Walker
- Nebulizer
- Ventilators
- Heart rate monitor
Medicare Part A covers skilled nursing facilities and inpatient care. So, inpatient devices are covered by Medicare Part A. Medicare Part B will cover Durable Medical Equipment you use at your home if your doctor decides it is medically necessary for you. The durable medical equipment must come with a prescription from a licensed health professional to be covered.
Medicare won’t cover all durable medical equipment, but it does include several items.
You’ll be able to use durable medical equipment in your home or a long-term care facility. If you must stay in a skilled nursing facility, the facility will provide you with your equipment. Medicare Part A covers skilled nursing facilities, so inpatient devices are covered.
Eligibility Criteria for Medicare to Cover Durable Medical Equipment
To qualify for Medicare coverage of durable medical equipment, there is specific criteria Medicare requires you to meet in addition to being ordered by a Medicare-approved doctor and using a Medicare accepting supplier.
To be covered by Medicare Part B, a durable medical equipment device must be:
- Used because of illness or injury
- Used at home
- Likely to last for at least three years
- Endure repeated use
- Serve a medical purpose
What Durable Medical Equipment Does Medicare Cover?
Original Medicare does not cover all durable medical equipment. Beneficiaries only receive coverage if the device is medically necessary. If you require a durable medical equipment that is not covered by Medicare, you may have to pay the full cost of the device.
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Original Medicare covers the following durable medical equipment:
- Glucose monitors and strips
- Prosthetics
- Hospital beds
- Lancet devices and lancets
- Canes
- Wheelchairs and scooters
- Commode chairs
- Oxygen equipment & accessories
- Suction pumps
- Continuous Positive Airway Pressure (CPAP) devices
The list above is not all-encompassing. So, it is important to speak with your doctor before purchasing a device.
What Durable Medical Equipment is Not Covered By Medicare?
While Original 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, 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. Often, Medicare pays to rent medical equipment and buy equipment when necessary.
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
To ensure Medicare coverage for replacement medical equipment, you need to order from an equipment supplier who’s Medicare-approved. Medicare will not cover a replacement just because you wish to have a new device. There are certain criteria that will warrant a replacement device to be covered by Medicare. These include:
- Lost
- Stolen
- There’s extensive damage.
- If it’s more than five years old
Durable Medical Equipment Suppliers Approved by Medicare
When you need access to durable medical equipment, you may find it hard to know where to start and what durable medical equipment supplies are available to help you with your needs.
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You’ll need to get your supplies from a Medicare-approved supplier to get coverage for equipment. Medicare.gov has a durable medical equipment supplier directory to help Medicare beneficiaries search for suppliers that carry Medicare-covered equipment and supplies.
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 a Medicare Advantage plan, such as extra coverage.
Medicare Advantage plans come from private insurance companies. You’ll want to confirm with your plan to ensure your equipment has coverage.
Medicare Durable Medical Equipment FAQs
How to Find Medicare Coverage for Durable Medicare Equipment
You may have questions or concerns about your Medicare coverage for Durable Medical Equipment. Medicare Supplement plans can help you with the costs of durable medical equipment items you may need. Our licensed insurance agents can help answer any questions you may have regarding Medicare coverage of durable medical equipment. We can also look at different coverage options that may better suit your needs. Call us today for a quote. Our services are free to you with no obligation to enroll. You can also compare rates online today.
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Sources:
MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.
- Durable Medical Equipment Coverage, Medicare.gov. Accessed May 2022.
https://www.medicare.gov/coverage/durable-medical-equipment-dme-coverage - Medicare Coverage of DME and Other Services, CMS. Accessed May 2022.
https://www.medicare.gov/media/publication/11045-medicare-coverage-of-dme-and-other-devices.pdf?linkit_matcher=1
Hi Jagger, my mother received a new hoyer lift that was billed to Medicare. It is only two weeks old. Compare to other models my mother previously own, this model is longer in length and wheels are very stiff. The home aides are having great difficulty operating this particular model by themselves, which a hoyer lift should be a one man’s job. This can potentially put my mother in danger during the transfer. Since the supplier only carry this model, we have no choice but to return it. I was told by the supplier that we can request for a return but they might deny it. I put in a request for a return a week and still waiting for approval. Now the question is, can the supplier deny a return and is my mother obligated to keep this hoyer lift?
Denise, since the lift has been used, they can deny the return. However, it will be reviewed on a case by case basis by the company.
Hi
For a Medigap Plan F policy, prior to 2020 — does the Plan F insurer need to cover the excess amount due when the DME provider billed Medicare as non-participating? I am not able to find anything in writing about what the Plan F policy has to pay when services are billed as non-participating. The DME carrier is saying the Plan F insurer needs to pay the excess but the insurer is saying they do not pay that only the co-insurance.
Val, if the provider is non-participating, then your Plan F will not cover the additional costs. Plan F only covers carriers who accept Original Medicare.
HI Jagger,
Can a DPT order DME for Medicare Advantage plans without a MD Script.
Sandra, for the DME to be covered by your advantage plan, it must be prescribed by your physician. Meaning, they must write the script.
Hello, is it possible for me get a DME prescription from my doctor via Telehealth and still be covered by Medicare Part B? Assuming my doctor deems it medically necessary, does Medicare allow 80% coverage even if I live in a big city and not a rural area? I read somewhere telehealth coverage has been expanded during Covid. Was there Telehealth coverage for Part B DME prior to Covid and will it go back to being that way?
Hi Sam! Yes, you can do a telehealth appointment with your doctor and they can provide you with a prescription for DME that the supplier will accept. Telehealth appointments have always been treated the same as a face to face doctor’s appointments. I hope this helps!
Thanks Lindsay! do you know any online companies doing telehealth for DME currently?
Hi Sam! You would need to do a telehealth appointment with your doctor who would then write you a prescription for the DME equipment and send that prescription over to the DME provider.
Hi; I work in healthcare and I have a hard time finding dme suppliers / supplies for Medicare patients. How would a doctor submit an order for dme through CVS or Walgreens?
Hi Gaby. Is CVS or Walgreens the actual provider of the equipment? I would recommend using the Medicare DME provider tool and ask the provider directly if they are partners with CVS or Walgreens.
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.