Medicare covers most repairs and maintenance on durable medical equipment. How it covers these depends on whether the supplier owns the equipment or you do.
To learn about how you long you can keep DME before you own it, click on the link in the GO TO box.
When the supplier owns the equipment, the supplier is responsible for maintenance, repairs and replacement parts.
If you rented your DME before January 1, 2011 and you live in a place where you must use a contract supplier you should find out if your supplier is the contract supplier for that area. If your supplier is not the contract supplier, in order to continue using that supplier the supplier must agree to be “grandfathered” by Medicare. If the supplier does not agree to be “grandfathered” you must switch to another supplier in order for Medicare to keep paying for your DME.
- While Medicare is paying the supplier a rental fee, the supplier cannot charge a separate fee for repairs and maintenance. Repairs and maintenance are included in the rental fee.
- For all DME except oxygen equipment (see below), if Medicare is no longer paying the supplier a rental fee but you still have the equipment (you began renting your DME before January 1, 2006 and have chosen not to own the item), the supplier can bill Medicare a maintenance and service fee equal to one month's rent every six months. You will be responsible for the 20 percent coinsurance plus any allowable excess charges. If you see a provider who accepts Medicare’s payment in full (takes assignment) you should not have to pay more than 20 percent for your DME repairs.
When you own the equipment, you are responsible for getting maintenance, repairs and replacement parts.
- Medicare will not pay anything for “routine” maintenance and servicing of the equipment. Routine maintenance refers to anything that you can be “reasonably" expected to take care of using the operating manual, like cleaning and checking the equipment.
Medicare will pay 80 percent of the Medicare-approved amount for “non-routine” maintenance (minus any unmet portion of your Part B deductible) and repairs and you will pay the balance if the repairs are not covered by a warranty. You can save money by going to any Medicare-enrolled supplier who takes assignment. If you live in an area where you must use a contract supplier and you own equipment that is on the list of items you must get from a contract supplier, Medicare will cover “non-routine” maintenance (and replacement parts needed for the repair) from any Medicare-approved supplier. However, it is best to get repairs done by contract suppliers because they must accept assignment for the repair.
For information on how to keep your durable medical equipment (DME) costs down if you have Original Medicare, click on the link in the GO TO box.
For oxygen equipment, after your 36-month (three year) rental period ends, you will no longer have to pay a rental fee, but you will not own the equipment. The supplier will continue to own the equipment; you will be able to keep it for two additional years as long as it is medically necessary for you. (Five years is about the useful lifetime of oxygen equipment). During this time, your supplier must keep your equipment in good working condition and provide you supplies, parts and maintenance free of charge in most cases.
You may be charged a fee in the following instances:
- If you use oxygen tanks or cylinders, you will be charged for liquid or gaseous oxygen that the supplier delivers to you on a monthly basis.
- If you use a stationary or portable oxygen concentrator or transfilling equipment (a machine that fills your portable tanks in your home), your supplier can bill you for general in-home maintenance visits every six months after the end of the three-year rental period in many cases. You will be responsible for a 20 percent coinsurance (plus additional costs) if your supplier does not take assignment.
At the end of the five-year period, you will have to choose whether to get new oxygen equipment from your supplier or switch suppliers. A new 36-month rental period will begin.
To find out when Medicare will replace broken DME, click on the link in the GO TO box.