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Medicare Coverage for Durable Medical Equipment

If you or a loved one needs durable medical equipment (DME), Medicare can help pay for it.

Here’s a clear, practical guide to what counts as DME, which parts of Medicare cover it, how to qualify, what you’ll pay, and how to avoid common pitfalls.

What counts as durable medical equipment (DME)?

Medicare defines DME as reusable medical equipment ordered by your doctor for use at home when it’s medically necessary. Think items like wheelchairs, walkers, hospital beds, or oxygen systems. You can see the official overview at Medicare’s DME coverage page.

Items used mainly for convenience (like grab bars or most air purifiers), disposable supplies that aren’t used with DME, and home modifications generally aren’t covered. When in doubt, ask your doctor and check the specific item’s page on Medicare.gov or your plan’s coverage rules.

Which parts of Medicare pay for DME?

Medicare Part B (Medical Insurance)

Most DME is covered under Part B when it’s medically necessary and ordered by your treating practitioner. After you meet the Part B deductible, you typically pay 20% of the Medicare-approved amount, and Medicare pays 80%. Coverage may be for a rental, a purchase, or a rental that converts to ownership, depending on the item.

Medicare Part A (Hospital/SNF stays)

When you’re a hospital inpatient or in a skilled nursing facility (SNF), medically necessary equipment is usually included in the facility’s bundled payment. Part A doesn’t typically pay separately for DME you take home—once you’re home, Part B rules usually apply.

Medicare Advantage (Part C)

Medicare Advantage plans must cover at least what Original Medicare covers, but they can have different supplier networks, prior authorization rules, and cost-sharing. Use in-network, Medicare-enrolled DME suppliers and follow your plan’s approvals to avoid denials.

Medigap and other secondary insurance

A Medigap (Medicare Supplement) policy can help pay your Part B coinsurance for DME. If you have Medicaid or employer/retiree coverage as secondary, it may also reduce out-of-pocket costs—check those plan rules.

How to qualify and get your DME covered

Follow these steps to improve your chances of approval and minimize costs.

  • See your doctor and document medical necessity. Your practitioner must evaluate your condition and write a detailed order. For some items, a face-to-face visit and a written order before delivery are required.
  • Choose a Medicare-enrolled supplier. Verify status with the Medicare supplier directory. If you’re in a Medicare Advantage plan, confirm the supplier is in-network.
  • Ask whether prior authorization is required. Certain items (like many power wheelchairs and some prosthetics) need approval before delivery. See the CMS list for providers: DME Prior Authorization Program.
  • Confirm the supplier “accepts assignment.” This means they accept Medicare’s approved amount as full payment. If they don’t, you could pay much more. Learn more about assignment: What is assignment?
  • Keep your paperwork. Save the prescription/order, delivery receipts, and any prior authorization or medical notes. These help with service, repairs, or appeals.
  • Understand rental vs. purchase. Some items are capped rentals (you rent up to 13 months, then own); others are always rentals (like most oxygen) or purchases (like some inexpensive items).

What will you pay? Rentals, purchases, and savings

Standard costs: With Original Medicare, you generally pay 20% of the Medicare-approved amount after the Part B deductible, and Medicare pays 80%. If your supplier accepts assignment, your cost is based on the lower Medicare-approved rate. If not, suppliers can charge more than the approved amount—making your share unpredictable.

Rental vs. purchase: Many DME items are rented first. For capped rental items, after 13 continuous rental months, you own the equipment, and Medicare covers certain repairs and maintenance when needed. Some items are always rental (notably most oxygen equipment), while others are typically purchased outright when inexpensive.

Oxygen and related equipment: Oxygen has special timelines. Under Part B, suppliers generally must provide oxygen equipment and related maintenance for set periods; see details on oxygen equipment coverage.

CPAP trial periods: CPAP devices for sleep apnea often start with a 12-week trial to confirm improvement; continued coverage requires documentation of benefit. See CPAP coverage rules.

Competitive bidding areas: In times and areas where Medicare’s DME competitive bidding program is active, you generally must use contract suppliers for certain items to get full coverage. Your supplier or plan can confirm whether competitive bidding affects you.

Repairs, replacements, and supplies: Medicare may cover repairs or replacement when equipment is worn out or damaged beyond repair from normal use. Consumable supplies used with covered DME (like CPAP masks or wheelchair cushions) are often covered on a set schedule—check frequency limits.

What’s not covered (and common pitfalls)

  • Convenience or comfort items: Grab bars, shower chairs (in many cases), air purifiers, and most home modifications aren’t DME.
  • Deluxe or nonstandard features: Upgrades (like a power chair with enhanced features not medically necessary) may leave you paying the difference.
  • Duplicates: Medicare typically won’t cover two of the same/similar items at once unless clearly justified.
  • Supplies not used with DME: Some disposable medical supplies aren’t Part B DME, though other benefits might apply. For diabetes, see what Part B covers (meters, strips, lancets) on diabetes supplies & services. Insulin not used with a pump is generally under Part D (your drug plan).
  • Missing approvals or wrong supplier: Skipping a required prior authorization or using a non-enrolled/out-of-network supplier can trigger denials.

Quick, real-world examples

Example 1: New need for a walker. Your doctor documents impaired mobility and writes an order. You choose a Medicare-enrolled supplier that accepts assignment, pick an appropriate standard walker (no luxury upgrades), and pay 20% after your Part B deductible. If you have Medigap, it may cover your 20% coinsurance.

Example 2: Power wheelchair. Your clinician evaluates you, showing you can’t use a cane/walker/manual chair safely at home. Because many power wheelchairs need prior authorization, your supplier submits the paperwork first. Once approved, Medicare covers it under Part B and you owe 20% of the approved amount (less if you have Medigap or secondary coverage). If you’re in Medicare Advantage, you follow plan network and approval rules.

Example 3: CPAP for obstructive sleep apnea. After a sleep study, your doctor orders CPAP. Medicare covers a 12-week trial; if you meet compliance and benefit criteria, coverage continues. Supplies like masks and tubing are replaced on a schedule when medically necessary.

Appeals and where to get help

If your claim is denied, you have rights. Read Medicare’s step-by-step guide to filing an appeal. You can also get free, unbiased counseling from your State Health Insurance Assistance Program (SHIP): SHIP help.

Key takeaways

  • Most home-use DME is covered by Medicare Part B when medically necessary and ordered by your doctor.
  • Use Medicare-enrolled (and in-network, if on Medicare Advantage) suppliers—prefer those that accept assignment.
  • Know whether your item is a rental or purchase, watch for prior authorization, and keep your documentation.
  • Expect 20% coinsurance after the Part B deductible unless Medigap or other secondary coverage applies.