Medicare Coverage for Durable Medical Equipment

What is durable medical equipment (DME)?

Durable medical equipment (DME) is medical equipment and supplies that are used in the home. Medicare specifies what equipment is covered and what is not. Examples of covered items are:

• crutches and walkers
• hospital beds
• oxygen tanks and nebulizers
• raised toilet seats
• wheelchairs.

Personal items, such as hearing aids and dentures, are examples of items that are not covered.

What is Medicare?

Medicare is a federal government program. It provides healthcare coverage for people age 65 or older, or for people of any age who have certain disabilities.

Medicare is divided into 2 parts: Part A and Part B. Each part covers different services. Both parts pay toward costs for services that are medically necessary. Rules about what Medicare covers can be confusing. Rules also change from time to time. Your local Social Security office can answer your questions about Medicare.

When does Medicare cover DME?

Generally, Medicare Part B helps pay for medical equipment that meets the following requirements:

• It must be prescribed by a doctor.
• It must be medically necessary and be used in the home.
• It must fill a medical need for you (not just a convenience).
• It must be able to be used over and over again (durable).

Medicare pays for different kinds of medical equipment in different ways. Some equipment must be rented, other equipment must be purchased, and for some equipment you may choose rental or purchase. Medicare pays rental for no more than 15 months.

Medicare pays 80% of the approved amount. You pay the other 20% plus your deductible. If the supplier has not agreed to accept the amount Medicare offers to pay as payment in full, you may be billed additional fees.

For additional information, call Medicare toll-free at 1-800-633-4227.

Written by Carolyn Norrgard, RNC, BA, MEd; Carol Matheis-Kraft, PhD, RNC; and Mercedes Bern-Klug, MSW, MA, for RelayHealth.
Published by RelayHealth.
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