Medicare DME Coverage
Written by: Rachel Nall, MSN, CRNA, APRN
Reviewed by: Brett Braithwaite, Licensed Insurance Agent
Medicare will pay for a portion of durable medical equipment (DME), including wheelchairs, canes and hospital beds.
Medicare defines what qualifies as DME, including items used repeatedly, needed for a medical reason, and will usually last at least three years.
You’ll usually need a doctor’s “prescription” and must purchase the items from a Medicare-approved supplier to get reimbursement.
Medicare will typically pay 80 percent for renting or purchasing DME, and you’ll pay the remaining 20 percent.
What is DME Medicare?
Durable medical equipment or DME is the equipment you need to use in your home to support your health and keep you safe. Examples of DME include walkers, oxygen, blood sugar monitors, patient lifts, sleep apnea devices, and more. Medicare has a long list of DME it will cover, but you have to go through a Medicare-approved provider (such as your primary care doctor) and supply manufacturer to make sure Medicare will reimburse you.
As a general rule, Medicare DME must meet the following criteria: [i]
- Durable (used frequently)
- Is used in the home
- Medically needed
- Not useful to a person who isn’t injured or has a chronic medical condition
- Will usually last at least three years
Medicare Part B (the part that pays for doctor’s visits) pays for DME.
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What DME Does Medicare Cover?
Medicare covers DME that will usually last longer than three years, can be used in your home, and is something you need for a medical reason. While some people with Medicare may buy DME, you can also rent DME. Renting is usually reserved for higher-cost items, such as a hospital bed.
Some of the common DME categories that Medicare covers include:
- assistive walking devices: canes, crutches, and walkers.
- diabetes care items: blood sugar monitors, blood sugar testing strips, and lancets.
- mobility devices: wheelchairs, patient lifts, and power wheelchairs or scooters.
- oxygen and breathing equipment: oxygen tanks, nebulizers, masks, and sleep apnea devices, such as a continuous positive airway pressure (CPAP) mask.
- prosthetic and orthotic items: braces, artificial limbs/eyes, ostomy bags, therapeutic shoe inserts.
- supplies for medication administration: including infusion pumps, tubing, and other supplies.
- supplies for surgery or injury recovery: pressure-reducing beds, hospital beds, suction pumps, traction equipment, and continuous passive motion machines.
Will Medicare Pay for Medical Supplies?
Medicare will usually pay 80 percent of the Medicare-approved amount for DME, and you’ll pay the remaining 20 percent. This means Medicare pays for DME much like it reimburses your doctor under Medicare Part B.
Buying or renting DME and getting Medicare to pay for it isn’t a two-step process. You’ll have to follow a specific set of steps to make sure Medicare will pay its share for your equipment. While these can vary somewhat based on the medical equipment, the general process is:
- Doctor’s prescription: A doctor or other healthcare provider must certify you need the equipment. Your doctor must participate in Medicare and provide written confirmation the item is medically necessary for you.
- Purchase/rental: You must purchase or rent the item from a Medicare-approved supplier. Your doctor can often recommend a Medicare-approved supplier. You can also find Medicare-approved suppliers online through the “Find Medical Equipment & Supplies ” portion on Medicare’s website.
- Pay your portion: You will typically pay 20 percent of the Medicare-approved amount for DME. If you are renting an item, you’ll usually make a monthly rental payment. Sometimes, you may also have periodic maintenance or service fees, such as to fill portable oxygen tanks.
Medicare requires you to go through these steps to keep costs low. There is a lot of medical equipment out there, and by requiring providers to accept assignment and using certain Medicare-approved suppliers, Medicare ensures they (and you) do not pay excessive amounts for equipment.
What medical supplies are covered by Medicare?
Medicare covers durable medical equipment (DME) as well as supplies that go along with it. For example, when you get a blood sugar meter (glucometer), you also need test strips and lancets as supplies to use the glucometer. Medicare will usually cover these supplies as DME.
Other examples of supplies that Medicare considers as DME include supplies for infusion pumps, such as tubing, and nebulizer medications that go along with a nebulizer used to treat breathing problems.
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How Much Does Medicare Pay for DME?
Medicare will usually pay 80 percent of the cost for DME while you will pay the remaining 20 percent. When a company that sells medical equipment is a Medicare supplier, they’ve agreed to charge Medicare-approved prices for an item. This means if you are purchasing a cane from a certain medical supplier, the price should be similar to that of other suppliers.
Some suppliers will bill Medicare directly for you. If the supplier won’t bill Medicare directly, you may have to purchase or rent the item and submit the receipt to Medicare for reimbursement.
If I have Medicare Advantage, is my DME covered?
Medicare Advantage plans are when you choose a private insurance company to fulfill your Medicare benefits. Medicare requires all Medicare Advantage plans to cover DME at the same level as Original Medicare plans. However, the specific costs and suppliers may depend on your plan. A good place to start to find out more is your “Evidence of Coverage” document. This can tell you what cost-sharing you’ll have when you purchase or rent DME through Medicare Advantage.
What DME is Not Covered by Medicare?
Medicare simply doesn’t cover some types of medical equipment, and it also doesn’t cover every product in a DME category. Notable examples of DME that Medicare doesn’t cover include shower grab bars, compression socks, catheters, or many home modifications, such as wheelchair ramps. [i] Medicare doesn’t cover equipment that is more for convenience or isn’t necessarily medical.
It’s important to also keep in mind that just because Medicare covers a certain category of supplies doesn’t mean all supplies in that category are covered. A notable example is blood glucose monitors. Companies have invented continuous glucose monitors that don’t require you to prick your finger to check your blood sugar. Medicare has approved some systems for coverage (such as the FreeStyle Libre Flash), but not all systems on the market.
For this reason, it’s vital to ensure Medicare covers the specific DME you want to purchase or rent. Medicare has a resource called “
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How Do I Order Medical Supplies From Medicare?
You can get Medicare-approved DME in several ways: from your doctor, in-person at a supplier, or online.
First, your doctor may supply it, such as a knee or ankle brace they keep on-site. Second, your doctor may give you a list of Medicare suppliers in your area. Third, you can obtain a list of Medicare-approved suppliers from Medicare’s website. Medicare has a page called “Find medical equipment & suppliers.” There, you provide your zip code and a brief description of what equipment type you need. The search tool may ask further questions, such as if you need the item custom-fitted before giving you a list of suppliers.
Once you find a supplier, you can contact them to find out pricing information. You’ll usually need your doctor’s prescription to get the most accurate estimate. If you need or want a particular brand or model of DME, your doctor must specify this in the prescription.