Durable medical equipment (DME) coverage
Medicare Part B (Medical Insurance) covers medically necessary DME.
Description
DME is defined as equipment that is:
- Durable (can withstand repeated use)
- Used for a medical reason
- Typically only useful to someone who is sick or injured
- Used in your home
- Expected to last at least 3 years
Coverage details
Medicare-covered DME includes, but isn't limited to:
- Canes
- Commode chairs
- Continuous passive motion machines, devices & accessories
- Continuous Positive Airway Pressure (CPAP) machines
- Crutches
- Diabetes supplies
- Hospital beds
- Infusion pumps & supplies
- Nebulizers & nebulizer medications
- Oxygen equipment & accessories
- Patient lifts
- Pressure-reducing support surfaces
- Suction pumps
- Traction equipment
- Walkers
- Wheelchairs & scooters
Medicare covers 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.
- You may be able to choose whether to rent or buy the equipment.
- Some items become your property after you’ve made a certain number of rental payments.
Where can I get covered DME items?
Who's eligible
Part B covers medically necessary DME if your doctor or other health care provider prescribes it for use in your home.
Provider requirements
Make sure your doctors and DME suppliers are enrolled in Medicare. It’s also important to ask a supplier if they participate in Medicare or will accept assignment before you get DME.
Costs
After you meet the Part B deductible , you pay 20% of the Medicare-approved amount (if your supplier accepts assignment ).
If suppliers are participating in Medicare, they must accept assignment (which means, they can charge you only the coinsurance and Part B deductible for the Medicare-approved amount). A non-participating provider doesn't have to accept assignment of your claims, but may choose to do so in your case. If DME suppliers aren't participating suppliers or won't accept assignment of your claims, you may be charged more. For rented DME, make sure the supplier is willing to accept assignment of your claims for all rental months. If the claim isn't assigned, you must pay for the full cost upfront. If this happens, Medicare will pay you later for the amount it covers after your claims have been processed.