Does Medicare cover my durable medical equipment?

Dear Rose,

Yes, Medicare Part B covers durable medical equipment (DME). DME is equipment that serves a medical purpose, can withstand repeated use, and is appropriate for use in the home. Examples of DME include wheelchairs, walkers, and oxygen equipment. Medicare also covers prosthetics, orthotics, and some medical supplies. Here is an overview of the Medicare coverage rules for these products:

Eligible equipment:

• Medicare’s DME benefit does not cover all medical equipment. Medicare covered DME:
  • Is durable, meaning it can be used many times
  • Serves a medical purpose
  • Is for use in the home, although you can also use it outside the home
  • And is likely to last for three years or more
• Medicare does not cover:
  • Equipment mainly for outside the home
  • Most items intended only to make things more convenient or comfortable, like air conditioners or grab bars
  • Items that get thrown away after use or that aren’t used with equipment in most cases, like incontinence pads or surgical facemasks
  • Modifications to your home, such as ramps or widened doors for improving wheelchair access
  • Equipment that is not for use in the home, like some specialized hospital beds

Whether you have Original Medicare or a Medicare Advantage Plan, the types of equipment covered are the same

Coverage requirements:

• Covered DME must:
  • Be ordered by a provider who says it’s medically necessary for use in the home
  • Be obtained from suppliers who contract with Original Medicare or your Medicare Advantage Plan
    • Medicare Advantage Plans may have additional requirements and different cost sharing rules

Coverage method:

• Depending on the type of equipment you need, you may need to either rent or buy the DME.
• Medicare typically only pays for standard equipment that meets your health needs. If you want special features or upgrades, you may have to pay more.

Maintenance:

• Whether Medicare covers the cost of maintenance and repair for your DME will depend on whether or not you rent or bought the equipment.
• Medicare may also cover replacement of the equipment in some circumstances.

To find out if Medicare covers the equipment or supplies you need, or to find a Medicare approved DME supplier in your area, call 1-800-MEDICARE or visit www.medicare.gov. You can also learn about Medicare coverage of DME by calling your State Health Insurance Assistance Program (SHIP).

Hope this helps!

-Marci