December 2021: Medicare Coverage of Durable Medical Equipment

Medicare Coverage of Durable Medical Equipment

Medicare Part B covers durable medical equipment (DME), which is equipment that serves a medical purpose, can withstand repeated use, and is appropriate for use in the home.

 What kind of DME does Medicare cover?

Medicare usually covers DME if the equipment:

  • Is durable, meaning it is able to withstand repeated use
  • Serves a medical purpose
  • Is appropriate for use in the home, although you can use outside the home
  • And, is likely to last for three years or more

Examples: wheelchairs, walkers, hospital beds, power scooters, portable oxygen equipment, orthotics, prosthetics, certain diabetes supplies

 What kind of equipment does Medicare not cover?

There are certain kinds of equipment and supplies that Medicare does not cover, such as:

  • Equipment mainly intended to help you outside of the home
  • Most items intended only to make things more convenient or comfortable
  • Items that get thrown away after use or that are not used with equipment
  • Modifications to your home
  • Equipment that is not suitable for use in the home

Examples: air conditioners, incontinence pads, surgical facemasks, wheelchair ramps, medical equipment from a hospital or skilled nursing facility like an oscillating bed, a wheelchair or scooter that is only intended for use outside the home

Note: Some Medicare Advantage Plans may cover minor home modifications or other items as a supplemental benefit.

How can I get my DME covered?

Your doctor must sign an order, prescription, or certificate after a face-to-face office visit. In this document, your doctor must state that the required office visit occurred, that you need the requested DME to help a medical condition or injury, and that the equipment is for home use. Your face-to-face office visit must take place no more than six months before the prescription is written. You then must take the prescription to the right kind of supplier.

Note that the process is different if you need coverage for a manual or power wheelchair or scooter.

What kind of supplier should I go to?

If you have Original Medicare, you should get your DME from a Medicare-approved supplier that takes assignment.

  • Avoid suppliers who have not signed up to bill Medicare for DME (also known as opt-out providers). Medicare will not pay for services you receive from opt-out providers. This means you are responsible for the entire cost.
  • Be aware that many suppliers are Medicare-approved but do not take assignment. These suppliers may charge you more than Medicare’s approved amount for the cost of services. Medicare will still only pay 80% of its approved amount for services, so you will be responsible for any additional costs.