Medicare Part B and Medicare Advantage plans cover approved durable medical equipment (DME) that is medically necessary, prescribed for use at home, and obtained from an approved supplier.

Millions of Medicare beneficiaries rely on DME every day. This includes canes, nebulizers, blood sugar monitors, and other medically necessary devices to manage health conditions and maintain independence at home.

Original Medicare and Medicare Advantage plans pay for some of the costs of approved medical equipment and devices. These items must be medically necessary and used at home to qualify for coverage. The out-of-pocket costs vary depending on the plan and whether you rent or buy the product.

Let’s look at which types of equipment and devices are covered by Medicare and go through the best way to get them.

Medicare defines DME as devices, supplies, or equipment that are used repeatedly in your home for medical purposes.

DME products are meant to help you manage a health condition, recover from an injury or illness, or recover from surgery. They should help you maintain your daily activities at home.

Medicare does not cover DME during a short-term stay at a skilled nursing facility or hospital. That said, if you live in one of these facilities long term, Medicare does consider it your home and will cover approved DME.

Medicare pays for only the basic level of DME products available for any given condition. Every time you need new equipment, your doctor must order it for you and may need to provide documentation stating its medical necessity.

Some covered products include:

Medicare also covers many orthotic and prosthetic devices.

These are just some of the products that Medicare covers. To learn whether a specific piece of equipment or device is covered, contact your State Health Insurance Assistance Program or Medicare Advantage plan provider.

If you have original Medicare, Part B will cover approved DME, prosthetics, and orthotics if the eligibility requirements are met. Medicare Advantage plans must cover at least the same products as original Medicare and sometimes offer additional benefits. Specific restrictions may apply.

Medicare generally doesn’t cover the following equipment or supplies:

  • DME that you use only outside of your home: For example, Medicare won’t cover a motorized scooter if you use it outside of your home but don’t need it to get around your home. It also won’t cover products used during a short-term stay in a skilled nursing facility or hospital.
  • DME that is not suitable for home use: Examples include certain types of beds and bath units that are designed for use in hospitals or other medical centers but not in homes.
  • Equipment or supplies that are delivered outside the United States: These include items that you purchase or order from a company in the United States to be delivered to another country.
  • Equipment or supplies that aren’t medically necessary: These include products intended for comfort, convenience, or cosmetic purposes rather than medical necessity.
  • Equipment or supplies to modify your home: Examples include grab bars, stair lifts, wheelchair ramps, and widened doors to accommodate a wheelchair or scooter.
  • Most disposable or single-use products: For example, Medicare typically doesn’t cover catheters, incontinence pads, or personal protective equipment such as gloves and face masks, although it may cover some of these supplies when they are used as part of a home healthcare service. Catheters may be covered if you use them to manage a permanent condition.
  • Eyeglasses, contact lenses, and hearing aids: These products are not typically covered under original Medicare, although there are some specific exceptions. Some Medicare Advantage plans offer extra vision or hearing benefits that may cover the costs of some of these products.
  • Orthopedic shoes. These are typically not covered, but there may be some specific exceptions, such as when the shoes are required for a leg brace or prescribed for diabetes.

Medicare also won’t cover the costs of replacing defective medical equipment or devices if they’re covered under a warranty or may be replaced for free.

There may be exceptions to some of these rules. Additional eligibility requirements may also apply. To learn whether a specific piece of equipment or supply is covered, contact your State Health Insurance Assistance Program or your Medicare Advantage plan provider.

Eligibility rules vary between original Medicare and Medicare Advantage plans.

Original Medicare rules

You’re eligible for coverage for DME, prosthetics, and orthotics if you’re enrolled in Part B of original Medicare and meet certain rules for coverage.

Medicare Part B covers DME, prosthetics, and orthotics for home use when a Medicare-approved healthcare professional determines an item is medically necessary and the item is ordered from a Medicare-approved supplier.

Your doctor may need to conduct a face-to-face visit and fill out a certificate of medical necessity for certain products to be covered. The in-person visit must occur within 6 months of the product order.

Approved products are not covered unless you’ve been injured or have a medical condition that requires therapeutic equipment or supplies. Specific exceptions may apply.

Medicare Advantage rules

Medicare Advantage (Part C) plans have many of the same eligibility requirements as original Medicare, but there are some differences.

Depending on the specific plan, Medicare Advantage plans may:

  • have higher costs
  • cover more products
  • require the use of in-network providers
  • use separate suppliers for different types of equipment

You can contact your plan provider for a list of approved DME, prosthetics, or orthotics suppliers in your area. Your plan provider can also help you learn more about the coverage, costs, and requirements for specific products.

Most DME is rented. After you meet your plan’s deductible, original Medicare pays 80% of the monthly costs for 13 months of rental. If you still need the equipment after that time, you may be allowed to own it, depending on the specific product. Your supplier will let you know whether the equipment needs to be returned.

If equipment is made specifically to fit you, like a prosthetic, Medicare requires you to buy rather than rent it.

In some cases, Medicare lets you decide whether to rent or buy equipment. This includes items that cost less than $150. If you choose to purchase equipment, you may need to pay the full amount and seek reimbursement from Medicare.

There are special rules for oxygen equipment. You can only rent this equipment, not buy it. Supplier agreements cover a 5-year time frame. Medicare pays 80% of the rental fees for the oxygen and related supplies for 36 months.

If you still need oxygen therapy after 36 months, you no longer have to pay rental fees. But you must continue to pay coinsurance for the oxygen itself and for any maintenance services on the equipment.

How to rent equipment

In most cases, you must rent rather than purchase DME, unless the product is made specifically for you.

The eligibility rules for renting DME are the same as for buying. After visiting your doctor to get an order for DME, you can take your prescription to an approved supplier to rent it.

Keep in mind that Medicare Advantage plans may have specific rental requirements, such as using an in-network supplier or renting a specific brand of device. You can check with your plan provider to learn about the specific rules you must follow.

How to buy equipment

Most DME products are rented rather than purchased, but there are some types of DME, prosthetics, and orthotics that you can buy up front.

To purchase eligible equipment:

  • Schedule an in-person visit with your doctor. During the visit, your doctor will write an order for the DME, prosthetic, or orthotics if they deem it medically necessary.
  • Find out whether Medicare requires prior authorization for the item. Your doctor can help you learn more about this process.
  • Take the order to a Medicare-approved supplier. Depending on the specific item, ask whether the supplier will deliver it to your home.

Medicare Advantage plans may have additional requirements. For example, some plans may require you to:

  • visit in-network suppliers for equipment
  • buy specific brands of DME
  • get prior authorization

Contact your Medicare Advantage plan directly to ask about your coverage and associated costs.

Deciding whether to rent or buy

In some cases, you might have a choice to rent or buy DME. Here are a few points to consider when making this decision:

  • How long will you need the equipment?
  • What is the upfront cost of buying versus monthly rental fees?
  • What are the costs of repair if you buy?
  • Can you easily sell the item after use?

Considering the upfront costs, repair costs, and how useful the product will be in the long term can help you make the decision of whether to buy or rent.

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The costs of DME, prosthetics, or orthotics depend on multiple factors, such as:

  • the specific plan you have, including whether you’re enrolled in original Medicare or Medicare Advantage
  • whether you decide to buy or rent the item, and how long you rent it for if you decide to rent it
  • which supplier you rent or purchase the item from
  • the brand or manufacturer

Costs can also vary from one region to another.

Medicare requires you to rent or purchase all DME products, prosthetics, or orthotics from suppliers that accept assignment for Medicare. This means the supplier has signed an agreement that they’ll accept rates set by Medicare. This keeps costs low, both for you and for Medicare.

If you rent or buy supplies from a nonapproved supplier, you may need to pay a higher amount that Medicare will not reimburse. Avoid using nonapproved suppliers, except in special circumstances, such as an emergency. Always check to make sure that a supplier accepts assignments before renting or buying any items.

Part A

Medicare Part A covers hospital stays, hospice care, and limited home health and skilled nursing facility care. If DME supplies are required during your stay at any of these facilities, Medicare expects the facility to pay for the costs based on your Part A benefits.

You must meet your deductible before Medicare starts to pay for inpatient costs. Copayment fees may also apply.

The monthly premium for Medicare Part A in 2024 is $0 for most people, but some may need to pay $278 or $505 per month, depending on their family’s work and tax history. The deductible for Medicare Part A in 2024 is $1,632 for each inpatient hospital benefit period. It’s possible to have multiple benefit periods in a single year.

Part B

Eligible DME, prosthetics, and orthotics costs are covered under Medicare Part B when you meet the eligibility criteria and obtain the item from an approved supplier that accepts assignment.

Regardless of whether you rent or buy DME, prosthetics, or orthotics, Medicare pays 80% of approved costs after you meet your deductible. Unless you have supplemental insurance such as Medigap, you will need to pay the remaining 20% in coinsurance, as well as monthly premium costs.

The monthly premium for Part B in 2024 is $174.70 for most people. The deductible in 2024 is $240.

Medicare Advantage

Medicare Advantage plans cover at least the same DME products, prosthetics, and orthotics as original Medicare. However, there may be differences in costs and restrictions on providers or supplies. These plans may offer coverage for more products, but your options for buying vs renting may be different based on specific plan rules.

Reach out to your plan provider to discuss your needs related to DME, prosthetics, or orthotics and learn about the available coverage and associated costs. If you live in multiple states during the year, ask about product servicing and delivery options to avoid gaps or higher costs with service. If you switch plans, check to make sure your equipment will be covered under the new plan.

Medigap

Medigap is supplemental insurance that you can buy to help cover coinsurance and copayment costs not covered by original Medicare. Medicare Part B pays only 80% of the costs for approved DME, prosthetics, and orthotics. A Medigap plan may be a good option to help pay some or all of the remaining 20% in coinsurance costs.

There are 10 Medigap plans available, and the coverage and costs vary by plan.

Choose the best plan for you, based on your medical needs and budget.

Medigap plans do not start paying for coinsurance or copayment benefits until after you meet your original Medicare (Part A and Part B) premiums and deductibles.

You rarely need to file a claim yourself for DME products, prosthetics, or orthotics. The supplier of your equipment or device will typically file the claim on your behalf.

All claims must be filed within 1 year of rental or purchase for Medicare to reimburse it. It may be helpful to read more about the process of filing a claim.

Check your Medicare Summary Notice statements to make sure the supplier has filed the claim. If the supplier has not filed a claim, you can call and ask them to file. If time is running out on your 1-year limit, you can file a claim using the Patient Request for Medical Payment form.

You can also call 800-MEDICARE (800-633-4227) or visit Medicare.gov to learn more about filing a claim.

Original Medicare and Medicare Advantage plans pay for covered DME products, prosthetics, and orthotics, as long as you meet all of the eligibility requirements. Medicare Advantage plans may offer more options or coverage for certain products, but the exact coverage and costs vary by plan and region.

If a medical device or supply is covered, Medicare won’t start paying until after you’ve met your deductible. You will also need to pay the applicable coinsurance or copayment fees, as well as monthly premiums to maintain your coverage. A Medigap plan can help offset the costs of coinsurance and copayment fees from original Medicare.

Although a majority of DME products are rented, you may have the option to buy certain equipment based on the specific product and your insurance plan.

You can reach out to your local State Health Insurance Assistance Program for more information on what is covered and how to get a DME, prosthetic, or orthotic product from an approved supplier in your area.