A Guide to Durable Medical Equipment

What Is Considered Durable Medical Equipment?

DME includes necessary medical devices and supplies that can be used again and again at home, such as a hospital bed or a prosthetic limb. What’s not DME? Single-use medical items such as bandages or incontinence pads.

It’s important to understand what counts as DME and what doesn’t, because it affects insurance coverage. Most government and private health insurance plans will cover all or some of the expenses associated with durable medical equipment.

To qualify as DME, the item must be:

• Durable (can withstand repeated use)
• Used for a medical reason
• Typically useful only for someone who is sick or injured
• Be used in your home
• Expected to last at least three years

The most common examples of DME used outside of a hospital include:

• Mobility aids, such as wheelchairs, walkers, canes, crutches and scooters
• Personal care aids, such as bath chairs, dressing aids and commodes
• Bed equipment, such as hospital beds, lift beds, traction equipment and pressure mattresses
• Respiratory equipment, such as oxygen concentrators, monitors, ventilators, nebulizers and CPAP machines
• Other devices, such as blood sugar monitors, dialysis machines, orthotics and prosthetic devices

Are Hearing Aids Durable Medical Equipment?

You may assume that hearing aids would count as DME. After all, you wear them every day, they’re medically important, they’re worn over time and they’re needed in the home. Unfortunately, they aren’t considered DME under Original Medicare.

About one-third of people in the U.S. ages 65 to 74 experience hearing loss, and nearly half of seniors older than 75 have difficulty hearing.2 Yet Original Medicare plans view them as elective or Class I medical devices. Class I medical devices, by definition, aren’t considered medically necessary.

If you’re worried about the cost of hearing aids, watch the video below.

The good news is that most Medicare Advantage plans offer hearing aid coverage. Keep in mind, however, that they may have limitations regarding types of hearing aids covered and the maximum amount covered per year. Check your plan, because specifics vary significantly.

Durable Medical Equipment vs. Adaptive Equipment

DME consists of medically necessary devices and supplies. Adaptive or assistive equipment helps those who are elderly, ill or disabled with activities of daily living, but it may not be medically necessary.4

Here are examples of assistive devices that you’ve probably seen older adults use:

• Large print books
• Screen readers
• Closed captioning on TV
• Adaptive eating utensils
• Medication dispensers

Common Adaptive Equipment

The chart below goes into more detail about examples of adaptive equipment under three categories.

ADLs are activities of daily living, while IADLs, or instrumental activities of daily living, are activities that enable someone to live independently. Although they’re not mandatory for functional living, the ability to cook, clean, have transportation, do laundry and manage finances can significantly improve your quality of life.5

Having adaptive equipment for the sake of mobility can also greatly help older adults get around and enhance their quality of life.

What Durable Medical Equipment Is Covered by Medicare?

You’re in luck if you’re on Medicare and you need durable medical equipment. Medicare Part B will cover DME as long as your medical provider prescribes it for home use for a condition or injury you have.

DME covered by Medicare includes (but isn’t limited to): 

• Mobility aids: Walkers, wheelchairs, scooters, crutches, canes and patient lifts
• Diabetes supplies: Blood sugar meters, blood sugar test strips, lancets and lancing devices
• Breathing equipment: Nebulizers, nebulizer medications, oxygen equipment and accessories, and CPAP devices
• Continuous passive motion devices
• Commode chairs
• Hospital beds
• Pressure-reducing support surfaces
• Infusion pumps and supplies
• Suction pumps
• Traction equipment

Types of DME not covered by Medicare include:

• Equipment whose primary purpose is to help you outside of the home, such as motorized scooters
• Items designed to improve your comfort or add convenience, such as grab bars, air conditioners and toilet seats
• Single-use items, such as incontinence pads and surgical face masks
• Home modifications, such as widened doors and ramps
• Items purchased from a supplier or business that does not accept Medicare payments

How Much Does Medicare Cover for Durable Medical Equipment?

Original Medicare covers 80 percent of the cost, so you’ll pay 20 percent of the Medicare-approved amount.7 The Part B deductible also applies. Just make sure the doctor prescribing the equipment and the supplier are both enrolled in Medicare. If not, Medicare won’t pay the claims.

Medicare also covers DME in different ways. Depending on what equipment you need, Medicare may say you need to rent the equipment, you need to buy the equipment or you can choose whether to rent or to buy the equipment.

How to Find Medicare-Approved Durable Medical Equipment Suppliers Near Me

The easiest way to find local Medicare-approved DME suppliers is to use Medicare’s official Find Medical Equipment and Suppliers search tool. You can use the tool in two different ways.

• Method 1: Type in your ZIP code and a supplier’s name to check if they participate in Medicare.
• Method 2: Type in your ZIP code and the name of the equipment you need to find a local supplier.

You can also contact Medicare directly with any questions about equipment coverage or finding a supplier.

• Online: Log in to your secure Medicare account
• Phone: 1-800-MEDICARE (1-800-633-4227)
• TTY: 1-877-486-2048

Once you find a supplier, remember to ask about costs and coverage to ensure that you pay as little as possible out of pocket.

Does Medicaid Cover Durable Medical Equipment?

Medicaid programs vary from state to state, which means what Medicaid covers also varies by state. To find the most relevant information, we recommend calling your state’s Medicaid office or visiting their website.

In general, Medicaid will cover equipment that’s medically necessary and cost-effective, and that meets the state’s definition of durable medical equipment. That definition varies, but it’s often similar to the one that Medicare uses. Many state Medicaid programs cover 100 percent of the cost of any home medical equipment you need.

Receiving Medicaid coverage for durable medical equipment typically looks like this:

1. You get a medical justification letter from your medical provider that outlines why you need the item.
2. You choose a Medicaid-approved supplier and give them the letter.
3. The supplier fills out a prior approval application and sends it to the state Medicaid office.
4. The state Medicaid office either approves or denies the claim.
5. If it’s approved, the supplier sends you the DME and sends the bill to Medicaid.
6. If it’s denied, you will receive a letter outlining why, with the option to appeal.

Again, the process will vary depending on where you live. We just wanted to give you an idea of what to expect.

Other Ways to Pay for Durable Medical Equipment

Sometimes Medicare or Medicaid won’t pay for the item you need, or maybe you just don’t want to wait to find out if what you need will be approved. In either case, below are some other ways to pay for durable medical equipment.

• Private insurance: Private insurers typically cover durable medical equipment. Speak directly with your private insurer to find out details about coverage.
• Veterans health care: Veterans and their spouses can turn to the Department of Veterans Affairs for help with a Medicare copayment for DME or with the entire cost of DME. The VA offers several programs, such as CHAMPVA benefits and Tricare.
• Private pay: Paying out of pocket is an option, even if you have insurance. You may find it to be the quickest way to get the equipment you need. Be sure you understand the cost difference if you choose to pay for something privately that Medicaid, Medicare or another insurance policy normally covers. Buying DME secondhand often halves the cost, so check eBay, Facebook Marketplace, classified ads and thrift stores such as Goodwill.
• Nonprofit or state assistance: Some nonprofits, national foundations and states help older adults pay for durable medical equipment through grants, low-interest loans, assistive technology programs and financial aid programs.