Medicare and DME

In addition to covering a wide range of services, Medicare also covers certain medical devices, items and supplies often referred to as durable medical equipment (DME).

The Centers for Medicare & Medicaid Services (CMS) defines durable medical equipment as special medical equipment, such as wheelchairs or hospital beds, that are prescribed by your medical provider for use in your home.

Use this guide to learn more about durable medical equipment, including a list of some of the DME that Medicare covers and the estimated costs you can expect to pay.

Woman outside using a walker

What durable medical equipment does Medicare cover?

Medicare covers a range of items, supplies and equipment as durable medical equipment. The list of DME that is covered by Medicare includes (but is not limited to):

The classification of DME extends to DMEPOS, or durable medical equipment, prosthetics, orthotics and supplies. Items in this classification include prosthetics such as artificial limbs or other body parts, along with things like braces and wound dressings.

When does Medicare pay for DME?

In order for durable medical equipment to be covered by Medicare, the item in question must be:

  • Durable, meaning it can withstand repeated use
  • Used for a medical reason
  • Not typically used by anyone who is not sick or injured
  • Used in the home
  • Expected to last for at least three years of use

How does Medicare cover DME?

Durable medical equipment is covered by Medicare Part B (medical insurance). Once you meet your Part B deductible ($185 per year in 2019), you are typically required to pay a 20 percent coinsurance for the Medicare-approved cost for your qualified DME.

The following criteria must be met before Medicare will pay for your DME:

  • The equipment must be considered medically necessary and prescribed for use in the home by a primary care physician. Most items will require your doctor to submit a Certificate of Medical Necessity (CMN).

  • Your doctor must be approved by and accept Medicare. If your doctor accepts Medicare but does not accept Medicare assignment, they may be allowed to charge more than the Medicare-approved amount for your DME.

  • The DME supplier must also be enrolled in Medicare.

Depending on the type of durable medical equipment, you may have to purchase or rent the item.

What is the Medicare Competitive Bidding Program?

Depending on where you live, the cost of your DME may be affected by the Competitive Bidding Program.

Under the program, DME suppliers submit a bid to Medicare to supply certain products to Medicare beneficiaries. Medicare then sets the amount it will pay for each item based on these bids.

The federal Medicare website provides a list of areas that utilize competitive bidding, as well as the types of DME that are affected.

DME and Medicare Advantage plans

By law, Medicare Advantage plans are required to provide at least the same benefits as Medicare Part A and Part B (known together as Original Medicare). This means that Medicare Advantage plans provide the same coverage for qualified DME as Original Medicare.

Many Medicare Advantage plans also offer a number of benefits not covered by Original Medicare. This includes providing coverage for certain items that can help make it easier for people to age in place at home, some of which are not currently classified as DME.

In 2019, some Medicare Advantage plans may now provide coverage for equipment like bathroom grab bars, wheelchair ramps and air conditioners for people with asthma. Ask a licensed insurance agent what additional benefits may be covered by the plans you are considering.

Find a Medicare Advantage plan that covers the DME you need

Are you looking for Medicare coverage for your approved DME? Do you want to find a plan that may also cover additional medical equipment that isn’t covered by Original Medicare? You may be able to find a Medicare Advantage plan that offers the benefits you need.

Speak with a licensed insurance agent who can help you compare Medicare Advantage plans that are available where you live. Get started by calling TTY Users: 711 24 hours a day, 7 days a week.

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MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.