Many Medicare beneficiaries use equipment to treat or maintain their health. This equipment comes in many shapes and sizes. Medicare Part B covers medical equipment as Durable Medical Equipment, sometimes referred to as DME.

What is Durable Medical Equipment?

To be classified as Durable Medical Equipment, the device must meet specific criteria. The equipment must withstand repeated use, be used for a medical reason, and have lifetime use of at least three years. It’s also not generally valuable for someone who isn’t sick or injured for use in your home.

Since the equipment is intended for repeated use, single-use items are generally not covered under Durable Medical Equipment. There are a few exceptions, such as blood sugar test strips.

Items Medicare Covers Under Durable Medical Equipment

There is a variety of equipment covered by Medicare. Most medical equipment covered by Medicare can be described as Safety Devices, Therapy Equipment, or Mobility Devices.

Safety Devices

Household safety equipment can be covered under Durable Medical Equipment. Items include lift bars, shower chairs, bumpers for sharp edges, commode chairs, and guard rails. These items are necessary for the beneficiary to avoid further injury.

Therapy Equipment

Therapy equipment helps beneficiaries recover after injury, illness, or improve medical conditions. Orthopedic shoes, hospital beds, CPAP, and oxygen machines are examples of therapy equipment. Therapeutic equipment can also include monitoring devices such as blood sugar test strips and meters.

Mobility Devices

Mobility devices are designed to help beneficiaries around their home generally. If the device’s primary use is outside the patient’s house, it may not be covered. Canes, crutches, walkers, wheelchairs, and motorized scooters are all examples of mobility devices. Sometimes leg and back braces are covered as mobility devices.

How Does Medicare Coverage Work for DME?

Durable Medical Equipment is covered under Medicare’s doctor and medical services side, Medicare Part B. You must get your medical device, and both the authorizing doctor and medical supply company must participate in Medicare.

If you buy the equipment on your own, Medicare will not cover it. Ensure that you consult with your doctor and follow Medicare’s process if you need medical equipment.

If the doctors or suppliers do not participate in Medicare, Medicare won’t pay the claim. Part B covers Durable Medical Equipment if the doctor prescribes it for use in your home.

You are subject to Part B costs for the equipment. Once you have met the Part B deductible, Medicare pays 80%, and you’re generally required to pay 20% of the cost. If the cost is $100, you’d be responsible for $20 in most cases.

Depending on the type of equipment, it may be a rental or purchase. At times you may have the option to choose. Sometimes the devices have a rental period before you can purchase them, which can vary depending on the equipment. If it’s a long-term condition, purchasing is usually the best option.

Do Medicare Advantage Plans Cover Durable Medical Equipment?

Medicare Advantage plans are required to cover everything that Original Medicare does. Medicare Advantage covers Durable Medical Equipment.

The majority of Medicare Advantage plans pay 80% of the cost for Durable Medical Equipment for most items. Depending on the plan, some Items could be less or have a fixed copay.

Remember, on Medicare Advantage plans, you’re subject to networks in most cases. Make sure you verify your healthcare provider and medical supply company are in-network. If they’re out of network, the plan won’t play.

Any cost you pay towards your medical and hospital expenses go towards your Maximum-Out-Of-Pocket. You may reach the maximum if you have a year of expensive equipment or procedures. The good news is that when you get that threshold, you will pay no more out of pocket for hospital or medical services for the remainder of the year.

Do Medigap Plans Cover Durable Medical Equipment?

Medicare Supplement plans supplement Medicare. If Medicare pays, the Medigap will kick in and pay part or all your portion of the Medicare costs. This can vary depending on which plan letter you choose, and some plans will leave you with no cost on your approved medical equipment.

With a Medigap plan, there is no need to check with the plan for networks. As long as the healthcare provider and the equipment provider accept Medicare, your Medicare supplement will help cover the costs.

How to Get Help with DME Coverage with Medicare

We understand that figuring out which plan best fits your individual needs with so many options. Choosing the right Medicare plan for your needs is a crucial decision, and we’re here to make sure you don’t have to do it alone.

For more information on how Medicare plans cover medical equipment, give us a call or fill out our online request form. Our licensed and knowledgeable insurance agents are standing by to help you. We’re here to make Medicare as easy as possible for you.

Picture of the author
by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.