Your Medicare Coverage
Is my test, item, or service covered?
Durable medical equipment (DME) coverage
How often is it covered?
Medicare Part B (Medical Insurance) covers durable medical equipment (DME) that your doctor prescribes for use in your home. Only your doctor can prescribe medical equipment for you. DME meets these criteria:
- Durable (long-lasting)
- Used for a medical reason
- Not usually useful to someone who isn't sick or injured
- Used in your home
In certain circumstances, the DME that Medicare covers includes, but isn't limited to:
- Air-fluidized beds
- Blood sugar monitors
- Blood sugar (glucose) test strips
- Braces (arm, leg, back, and neck)
- Canes (however, white canes for the blind aren't covered)
- Commode chairs
- Continuous passive motion (CPM) machine
- Enteral nutrition supplies and equipment (feeding pump)
- Glucose control solutions
- Home oxygen equipment and supplies
- Hospital beds
- Infusion pumps
- Lancet devices and lancets
- Nebulizers and nebulizer medications
- Orthotics and artificial limbs
- Ostomy supplies
- Oxygen therapy
- Patient lifts (to lift patients from bed or wheelchair by hydraulic operation)
- Prosthetic devices
- Sleep apnea and Continuous Positive Airway Pressure (CPAP) therapy
- Suction pumps
- Therapeutic shoes or inserts
- Traction equipment
- Wheelchairs and power mobility devices
All people with Medicare are covered.
Your costs in Original Medicare
You pay 20% of the Medicare-approved amount. Medicare pays for different kinds of DME in different ways. Depending on the type of equipment, you may need to rent the equipment, you may need to buy the equipment, or you may be able to choose whether to rent or buy the equipment.
Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them. It’s also important to ask your suppliers if they participate in Medicare before you get DME. If suppliers are participating suppliers, they must accept assignment. If suppliers are enrolled in Medicare but aren’t “participating,” they may choose not to accept assignment. If suppliers don't accept assignment, there’s no limit on the amount they can charge you.
Competitive Bidding Program
If you live in or visit certain areas, you may be affected by Medicare's Competitive Bidding Program. In most cases, if you have Original Medicare and get competitively bid equipment and supplies in competitive bidding areas, Medicare will only help pay for these equipment and supplies if they're provided by contract suppliers. Contract suppliers can't charge you more than the 20% coinsurance and any unmet yearly deductible for any equipment or supplies included in the Competitive Bidding Program.
To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like other insurance you may have, how much your doctor charges, whether your doctor accepts assignment, the type of facility, and the location where you get your test, item, or service.
If you live in an area that's been declared a disaster or emergency, the usual rules for your medical care may change for a short time. Learn more about how to replace lost or damaged equipment or supplies in a disaster or emergency.