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 medically necessary 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

DME that Medicare covers includes, but isn't limited to:

Who's eligible?

All people with Medicare Part B are covered.

Your costs in Original Medicare

If your supplier accepts assignment, you pay 20% of the Medicare-approved amount, and the Part B deductible applies. 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. If you have Original Medicare and get competitively bid equipment and supplies in competitive bidding areas, Medicare may 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.

Note

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.

Note

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.

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