Does Medicare Cover 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.

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.

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.

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.

The Medicare Part B deductible applies for diabetes supplies. You will owe a 20 percent coinsurance payment.

Medicare Part B generally covers the rental of oxygen equipment and related accessories, but you must meet certain criteria to qualify.

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.

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.

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.

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.

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 2022, 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.