DME overview

Medicare Part B covers durable medical equipment (DME), which is equipment that serves a medical purpose, is able to withstand repeated use, and is appropriate for use in the home. There are many important things to know about Medicare’s coverage rules for DME. Use the information below to learn whether/how you are covered.

• Eligible equipment: Medicare’s DME benefit does not cover all medical equipment. Learn the types of DME that Medicare pays for and about equipment and supplies excluded from Medicare coverage.
• Eligibility requirements: Medicare only covers DME if your provider provider See Health Care Provider. says it is medically necessary for use in the home. You also must order your DME from suppliers who contract with Original Medicare Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. or your Medicare Advantage Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs).  Plan. Medicare Advantage Plans may have additional requirements you need to meet before your DME is covered.
• DME coverage: Depending on the type of equipment you need, Medicare requires that you either rent or buy DME. There are also special rules when you need oxygen equipment. 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: The costs for maintenance and repair of your DME will depend on whether or not you rent or bought the equipment. Medicare may also cover replacement of the equipment.

Note: If Medicare denies coverage for your DME, you have the right to appeal the decision.