How Medicare covers medical equipment

What Medicare means by durable medical equipment

Part B covers equipment that is durable — it withstands repeated use — is used for a medical reason, is not useful to someone who is not ill or injured, is appropriate for use in the home, and is expected to last for years. Walkers, wheelchairs, hospital beds, nebulizers and CPAP machines all live under this definition.

Much of what we supply sits under neighboring benefits with the same spirit but their own rules: ostomy and catheter supplies under the prosthetic benefit, dressings under the surgical-dressings benefit, lymphedema compression under its own newer benefit. The guide for your specific supply line is the more precise place to look — this page is the map.

The chain that has to hold

1. A face-to-face encounter with your prescriber, documented in your record, that establishes the need — several categories require it within a defined window before the order.
2. A written order signed and dated by the prescriber, specific enough to identify the item.
3. Documentation that matches. The chart note has to make the need obvious to a reader who has never met you.
4. An enrolled supplier. Medicare pays claims only from enrolled DMEPOS suppliers — we are one — and some categories additionally require the plan’s approval before supply (prior authorization).

Break any link and the claim fails — usually as ‘documentation insufficient’ rather than ‘not covered’, and that distinction matters: most denials are fixable paperwork, not policy walls. What the order and the note have to say →

How paying is structured

• An annual deductible comes first. Until it is met for the year, you pay the plan-approved amount yourself; after it, you pay a share of each approved amount and Medicare pays the rest. The specific amounts change every year, which is exactly why they are not printed here.
• Purchase, rental, or capped rental. Inexpensive items are generally purchased; larger equipment typically rents month to month for a defined period, after which ownership or continued use resolves under the plan’s rules. Each rental month carries its own share.
• The approved amount is the plan’s figure, not the sticker price. An enrolled supplier that accepts assignment works from that figure — your protection against arbitrary pricing.
• Secondary coverage picks up some or all of your share, depending on the policy — the single biggest reason two neighbors with the same walker owe different amounts.

What Part B generally does not cover

Bath safety equipment, most daily living aids and absorbent incontinence products are generally not Part B benefits at all — not because of missing paperwork, but because they fall outside the benefit categories. Other doors exist: Florida Medicaid covers some of them, and many Medicare Advantage plans include an over-the-counter allowance that does too. Who covers incontinence supplies →

Medicare Advantage runs the same benefit its own way

Advantage plans must cover at least what original Medicare covers, but they administer it themselves: their own prior-authorization lists, their own supplier networks, their own cost-sharing design. The equipment answer is usually the same; the process and your share can differ meaningfully. We check the actual plan, not the general rule.

If a claim is denied

Read the denial reason. ‘Not medically necessary’ and ‘documentation insufficient’ are usually fixable with a better note or a missing document; ‘same or similar on file’ has its own routes (explained here); only ‘not a covered benefit’ is a wall. Appeals have deadlines shorter than people expect — call us and we will tell you which kind of denial you are holding and what fixing it involves.

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