What Is Durable Medical Equipment (DME) and How Does Medicare Cover It?

What Is DME (Durable Medical Equipment) and How Does Medicare Cover It?

Many older adults rely on Durable Medical Equipment (DME) like wheelchairs, walkers, hospital beds, or oxygen machines to manage health conditions safely at home. Knowing how Medicare covers DME can help you avoid unexpected costs and delays.

What Qualifies as Durable Medical Equipment?

DME refers to reusable medical devices prescribed by a doctor for home use. Medicare defines DME by these criteria:

Durable (can withstand repeated use)
Used for a medical reason
Not usually helpful for someone without illness or injury
Intended for use in the home
Expected to last at least 3 years

Common examples include:

Wheelchairs and walkers
Canes and crutches
Hospital beds and commode chairs
Oxygen equipment
Nebulizers and infusion pumps
Blood sugar monitors and patient lifts

⚠️ Note: Items like shower chairs, grab bars, or air conditioners are not considered DME under Medicare.

How Medicare Covers DME

Medicare Part B covers 80% of the cost of medically necessary DME after you meet your deductible. You are responsible for the remaining 20%, unless you have a Medigap policy that covers it.

To qualify for coverage:

Your doctor must prescribe the equipment and be enrolled in Medicare.
The DME supplier must also be Medicare-approved and accept assignment (agreeing to Medicare’s set payment rate).

If the supplier does not accept assignment, they can charge more, and you’ll be responsible for the difference. Always confirm this in advance.

Coverage Breakdown Example

If a walker costs $200:

Medicare pays $160
You pay $40 (plus any deductible if not met)

Rental vs. Purchase

Medicare may either rent or purchase the equipment depending on the item:

Rental: Medicare pays monthly fees (e.g., hospital beds, oxygen). Ownership typically transfers to you after 13 months.
Purchase: Inexpensive items like canes or glucose monitors are usually bought outright.
Maintenance: If rented, the supplier handles repairs. If purchased, Medicare may cover necessary repairs or replacement.

What’s Not Covered as DME

Not covered under Part B DME:

Disposable supplies (e.g., bandages, incontinence pads)
Hearing aids and eyeglasses (unless after cataract surgery)
Bathroom safety items
Home modifications (e.g., stair lifts)

🧠 Orthotics and prosthetics are covered under a different Medicare benefit, though they follow similar 80/20 cost-sharing.

Steps to Get Your DME

Talk to your doctor: They will write a prescription for the needed equipment.
Choose a Medicare-approved supplier: Use the Supplier Directory.
Check for competitive bidding: Some items may require you to use specific contracted suppliers.
Ask about rental vs. purchase options: Understand long-term costs and maintenance responsibilities.
Confirm plan requirements: If you have a Medicare Advantage plan, you may need pre-authorization and must use in-network suppliers.

Special Situations

Skilled Nursing Facilities (SNF): Equipment is provided during Medicare-covered stays. Part B kicks in once you’re home.
Home health patients: Some supplies may be covered under your home health benefit.
Emergencies: If equipment is lost or damaged in a disaster, Medicare can help replace it.

Your Rights and Appeals

If Medicare denies your claim:

You can file an appeal.
Suppliers should notify you with an Advance Beneficiary Notice (ABN) if they expect Medicare won't pay.
Don’t sign without understanding your responsibility — and seek a second opinion if unsure.

Advocacy Support

Services like Breezly can help you coordinate doctor prescriptions, supplier selection, and delivery logistics—especially during hospital discharges or after surgery. This support can reduce delays and help prevent billing issues.

Bottom line: Medicare Part B covers medically necessary DME, but you must use enrolled providers, follow documentation rules, and understand what is and isn’t included. With the right process, DME can help you stay safe, mobile, and independent at home.