This article was updated on January 4, 2021.
Medicare may provide some patients with Durable Medical Equipment coverage (DME) in certain circumstances. However, you should be aware of the different types of Medicare coverage before you talk to your doctor about it, as the benefits differ based on one’s type of coverage.
Medicare coverage
Part A covers medical equipment for individuals who are in a skilled nursing facility or in the hospital. If the equipment is medically necessary and purchased from an approved supplier, Medicare Part A will pay for 80 percent of the allowable amount for any specific item. The individual or their supplemental insurance is responsible for paying for the remaining 20 percent and any amount over the allowable limit.
Part B pays for medical equipment to be used in your home for most Medicare beneficiaries, even if they are not confined to their home. A nursing home does not qualify as a home. Home medical equipment must be medically necessary, prescribed by your physician, and purchased from a Medicare-approved supplier. Medicare Part B pays for 80 percent of the allowable purchase price. The individual or their supplemental insurance is responsible for the remaining 20 percent and any amount over the allowable limit.
Part C, also known as Medicare Advantage, is required by law to provide, at a minimum, the same coverage as Part A and Part B. Therefore, if you have Medicare Part C, your plan will pay at least 80 percent of the allowable limit for durable medical equipment.
Durable medical equipment covered
Durable medical equipment must be able to withstand extended use, must be used for a medical reason, must not be useful to someone who is in good health, must be used in your home, and must have a lifetime of at least 3 years.
It’s best to think of Medicare’s durable medical equipment coverage as having 2 levels:
- DME is covered when determined to be medically necessary.
- DME that is never covered despite being medically necessary.
For example, grab bar rails may be completely necessary for an individual, but Medicare does not consider them to be medical equipment and therefore will not cover the cost.
Examples of covered DME include:
- Blood sugar monitors
- Blood sugar test strips
- CPAP machines
- Crutches
- Wheelchairs
- Walkers
- Prosthetics
- Oxygen tanks
- Hospital beds
- Patient lifts
Examples of non-covered items include:
- Grab bars
- Air conditioners
- Wheelchair ramps
- Motorized scooters for use outside the home
Renting vs. buying
Typically, the decision to rent versus buy is not made by you. Instead, Medicare makes this decision. In most cases, Medicare will rent the equipment and will only purchase inexpensive DME or equipment that must be custom made. Once you have rented the equipment for 13 months, you may keep it.
In many cases, renting works to your benefit, because you don’t have to spend additional money should an item break or require repairs. The Medicare-approved supplier will inform you if the item you require is available for rent or purchase.
