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Does Medicare cover medical equipment and supplies?


| Yes. Medicare Part B covers doctor and outpatient services as well as prescribed equipment and supplies for home use that are deemed medically necessary.

It must be considered durable. The federal government calls this category durable medical equipment (DME). This equipment must withstand repeated use and includes blood sugar meters and test strips, commode chairs, continuous positive airway pressure (CPAP) machines and accessories, hospital beds, infusion pumps and supplies, oxygen equipment and accessories, walkers, wheelchairs and scooters, and other devices.

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Medicare also covers prosthetic and orthotic items such as:

  • Arm, back, leg and neck braces
  • Artificial eyes and limbs 
  • Breast prostheses following a mastectomy
  • Ostomy bags and related supplies for those who have had operations to control digestive or urinary tract diseases
  • Therapeutic devices, such as shoes or inserts for diabetics with foot problems
  • Urological supplies

What may be denied. What won’t be covered are other items that you may need medically but are considered disposable, such as catheters, compression socks, incontinence pads, rolled elastic bandages and surgical face masks. Also likely to be rejected because they’re considered as being for your convenience and not medically necessary are items such as an air purifier, a bathtub lift and a raised toilet seat.

How does the equipment qualify for coverage?

To pass Medicare’s test for coverage, the equipment or supplies must be:

  • Considered medically necessary, not just convenient 
  • Deemed appropriate for use within the home
  • Determined to be reusable and likely last for three years or more
  • Identified as essential to help you and your condition, not those who don’t have the illness or injury
  • Prescribed by a doctor, nurse practitioner, physician assistant or other primary care professional
  • Provided by Medicare-approved suppliers

Some items, such as oxygen equipment and wheelchairs, have additional requirements before Medicare will cover them. That could include getting prior approval or renting instead of buying.

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How much will I pay for the medical equipment?

If a medical equipment supplier accepts assignment, which means it agrees to take the Medicare-approved amount as payment in full, then Medicare Part B pays 80 percent of the cost of the equipment and supplies. You’ll pay the remaining 20 percent coinsurance.

If a supplier doesn’t accept assignment, it can charge whatever it wants for the equipment. Durable medical equipment doesn’t have a 15 percent limit on excess charges as it does for doctors and other health care providers who don’t accept assignment but have not opted out of Medicare. 

Medigap helps. You can buy a private Medicare supplement policy to help cover Medicare’s deductibles, copayments and coinsurance. All of these Medigap policies cover the 20 percent Part B coinsurance in part or full.  

Keep in mind

Medical equipment is often rented, but you can purchase some items. Requirements vary based on the equipment type.

Either way, you must get the equipment from a Medicare-approved supplier. Check out Medicare’s medical equipment supplier directory for approved suppliers in your area.

Beware of unsolicited calls or other communications offering "free" medical equipment, especially if they request your Medicare or Social Security number. It's almost certainly a scam to steal your identity or bill Medicare for devices that aren’t medically necessary or never delivered.

Updated September 15, 2022  

        

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