Durable medical equipment (DME) coverage


Medicare Part B (Medical Insurance) covers durable medical equipment (DME) that your doctor prescribes for use in your home. Only your doctor can prescribe medical equipment for you. DME meets these criteria:

• Durable (long-lasting)

• Used for a medical reason

• Not usually useful to someone who isn’t sick or injured

• Used in your home
In certain circumstances, the DME that Medicare covers includes, but isn’t limited to:

• Air-fluidized beds

• Blood sugar monitors and diabetic testing strips

• Canes (however, white canes for the blind aren’t covered)

• Commode chairs

• Crutches

• Home oxygen equipment and supplies

• Hospital beds

• Infusion pumps (and some medicines used in infusion pumps if considered reasonable and necessary)

• Nebulizers (and some medicines used in nebulizers if considered reasonable and necessary)

• Patient lifts (to lift patients from bed or wheelchair by hydraulic operation)

• Suction pumps

• Traction equipment

• Walkers

• Wheelchairs

Who’s eligible?

All people with Medicare are covered.

Your costs in Original Medicare

You pay 20% of the Medicare-approved amount. Medicare pays for different kinds of DME in different ways: some equipment may be rented, other equipment may be purchased, and you may choose to rent or buy some equipment.
Medicare will only cover your DME if your doctor or supplier is enrolled in Medicare. If a DME supplier doesn’t accept assignment, Medicare doesn’t limit how much the supplier can charge you. You may also have to pay the entire bill (your share and Medicare’s share) at the time you get the DME.

Competitive Bidding Program
If you live in certain areas of California, Florida, Indiana, Kansas, Kentucky, Missouri, North Carolina, Ohio, Pennsylvania, South Carolina, or Texas, you may be affected by Medicare’s Competitive Bidding Program. In most cases, if you have Original Medicare and get program items in program areas, Medicare will only help pay for these items if they’re provided by contract suppliers. More areas will be added in 2013.