Durable Medical Equipment (DME) is sometimes required to help care for yourself when facing certain medical conditions. Navigating the health insurance landscape to determine what is and isn't covered can be confusing. Knowing what equipment is covered by Medicare and how it’s covered can help alleviate stress when experiencing challenging health conditions.
DME stands for “Durable Medical Equipment” needed to care for a medical condition.
Medicare covers DME if medically necessary via prescription for use inside of your home.
Medicare will cover DME at 80%, with the patient paying 20% after the deductible (the amount you must pay each year before your Medicare plan begins paying for services).
Disposable, convenience, or comfort items and devices needed outside the home are not covered.
What is DME?
DME in healthcare stands for Durable Medical Equipment or equipment needed to care for your health. The equipment must be expected to last at least three years or more and can be reusable in the future for yourself or other patients. It is the equipment used for a medical condition inside a home by someone sick or injured. A patient may need to buy or rent DME for their healthcare needs; however, buying the equipment can be expensive, and in most cases, Medicare may only cover renting the device.
Medicare DME includes equipment like a motorized hospital bed, canes, and walkers, as well as wheelchairs and powered devices for mobility. It also provides oxygen equipment, materials for diabetes care, such as blood glucose monitor devices and test strips, and devices for sleep apnea, such as a Continuous Positive Airway Pressure, or CPAP, machine.
Medicare coverage of DME
Original Medicare covers DME under Part B as long as it’s deemed medically necessary by your health care provider via a prescription and the device is required for use inside your home, not just for convenience or to make life easier. DME is covered at a 20% copay, as Medicare covers 80% of the cost after you’ve met your deductible, which in 2023 is $226 for Medicare Part B. It’s important to note that Medicare will only cover 80% of their approved amount. If a supplier does not agree with the approved amount by Medicare, the supplier may charge more, and you may face additional costs.
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If you are in a Medicare Advantage plan, they are required to cover the same services and devices as Medicare; however, your costs or copayment depends on your plan. Call your Medicare Advantage plan for more details on DME coverage and costs.
You will only want to use suppliers enrolled and approved by Medicare, or the equipment may not be covered. You should ask the supplier ahead of time if they are Medicare enrolled and approved. They must have a Medicare supplier number. Ensure the supplier takes “assignment,” a term used to describe the approved amount by Medicare for the device. You can also check a list of approved suppliers on the Medicare website.
Renting vs Buying
For most items, Medicare will only cover rentals. If the item is inexpensive or routinely purchased, such as a cane or walker, Medicare will most likely pay for it. Your supplier will know if Medicare will pay to rent or buy. This is important when repairs may be necessary for your equipment. If you own the item, you are responsible for fixing any repairs needed, but the supplier is responsible if you rent.
How long you can rent the equipment or item depends on the type of equipment and how long the need lasts. Medicare will cover 36 months of continuous use of oxygen equipment; however, the supplier must continue to provide the oxygen and supplies for up to five years without charging you for the services. After five years and your medical need still exists, you may choose another supplier, and the new 36 payment period starts. Once again, if the need continues past the new payment period of three years, the new supplier must continue providing the oxygen equipment for an additional 24 months for a total five-year obligation period.
DME covered by Medicare
Here is a list of the most common durable medical equipment (DME) covered by Medicare:
|Adjustable hospital beds, pressure reducing beds, and mattresses.
|Diabetes related devices
|Blood glucose monitors, blood glucose test strips.
|Canes, crutches, manual wheelchairs, powered devices for mobility, walkers.
|Physical therapy and rehabilitation devices
|Bedside commodes or toilet chairs, continuous passive motion machines, patient lifts, traction equipment.
|Infusion pumps and supplies, nebulizers, oxygen equipment and accessories, prosthetics and orthotics, sleep apnea devices, suction pumps.
DME not covered by Medicare
Medicare will not cover items needed outside your home; for example, if you can get inside your house without an assistive device, Medicare will not cover using a walker, which is only necessary when leaving your home. Also, Medicare does not cover items needed for convenience or comfort to make life easier. Examples include elevators, toilet seats, and grab bars. Disposable items or items that are not used with specific equipment are also not covered by Medicare, such as face masks, compression stockings, and incontinence pads.
Here is a list of items that are not covered by Medicare, although not exhaustive:
- Air conditioners and dehumidifiers
- Disposable sheets
- Elastic stockings
- Emesis basins
- Exercise equipment
- White canes for the blind
- Heat and massage foam cushion pads
- Incontinence pads
- Face masks
- Grab bars
- Irrigation kits
- Massage devices
- Over bed tables
In general, DME should be covered if one has Medicare Part B, the equipment is deemed medically necessary by a provider enrolled in Medicare, and a Medicare-enrolled supplier provides the equipment. Items not covered include disposable or one-time use supplies not used with equipment, items only needed outside of your home, items provided by a supplier not enrolled in Medicare, or items supplied by a prescriber not enrolled in Medicare.
For additional information regarding DME and coverage, you can call 1-800-MEDICARE.
What does DME stand for in Medicare?
Durable Medical Equipment, or DME, are items needed to care for your health at your place of residence. The equipment is meant to be durable, reusable, and last 3 years or more.
Does Medicare cover DME?
Yes, if the equipment is medically necessary for use inside of your home (not something that’s only needed when you leave your house), a Medicare enrolled provider prescribes the item, and you receive the item from a Medicare enrolled supplier.
- Medicare.gov. Medicare Coverage of Durable Medical Equipment & Other Devices.
- Medicare.gov. Durable Medical Equipment (DME) Coverage.
- Centers for Medicare and Medicaid Services. Durable Medical Equipment (DME) Center.
- Centers for Medicare and Medicaid Services. Durable Medical Equipment Reference List.
- Centers for Medicare and Medicaid Services. 2023 Medicare Parts A & B Premiums and Deductibles 2023 Medicare Part D Income-Related Monthly Adjustment Amounts.