Durable medical equipment (DME) coverage

13 May.,2024


Durable medical equipment (DME) coverage

After you meet the Part B deductible you pay 20% of the Medicare-approved amount (if your supplier accepts assignment). Medicare pays for different kinds of DME in different ways. Depending on the type of equipment:

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  • You may need to rent the equipment.
  • You may need to buy the equipment.
  • You may be able to choose whether to rent or buy the equipment.

Make sure your doctors and DME suppliers are enrolled in Medicare. It’s also important to ask a supplier if they participate in Medicare before you get DME. If suppliers are participating in Medicare, they must accept assignment (which means, they can charge you only the coinsurance and Part B deductible for the Medicare‑approved amount). If suppliers aren’t participating and don’t accept assignment, there’s no limit on the amount they can charge you.

Replacing DME

Medicare will pay to replace equipment that you rent or own at any time if it is lost, stolen, or damaged beyond repair in an accident or a natural disaster, so long as you have proof of the damage or theft.

Replacing equipment means substituting one item for an identical or nearly identical item. For example, Medicare will pay for you to switch from one manual wheelchair to another, but it will not pay for you to replace a manual wheelchair with an electric wheelchair or a motorized scooter.

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If your equipment is worn out, Medicare will only replace it if you have had the item in your possession for its whole lifetime. An item’s lifetime depends on the type of equipment but, in the context of getting a replacement, it is never less than five years from the date that you began using the equipment. This five-year timeframe differs from the three-year minimum lifetime requirement that most medical equipment and items must meet in order to be considered DME by Medicare. The item must also be so worn from day-to-day use that it can no longer be fixed.

Note: Medicare covers repairs for worn DME if the equipment has not reached the end of its lifetime. Medicare will pay for repairs up to the cost of replacement.

To be eligible for a DME replacement, your primary care provider must write you a new order or prescription that explains your medical need. It is most cost-effective to use a Medicare-approved supplier who takes assignment.

To find out if Medicare covers the equipment or supplies you need, or to find DME suppliers in your area, call 1-800-MEDICARE or visit www.medicare.gov. You can also learn about Medicare coverage of DME by contacting your State Health Insurance Assistance Program (SHIP).

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