Medical equipment

Durable medical equipment (DME) is equipment that holds up to repeated use, serves a medical purpose, is mostly useful to someone who is sick or injured, is used at home, and is expected to last at least 3 years. Medicare’s examples include canes, walkers, crutches, commode chairs, hospital beds, wheelchairs and scooters, oxygen equipment, CPAP machines, infusion pumps, and blood sugar monitors and supplies.

Medicare Part B covers DME that is medically necessary and ordered by a doctor or other provider for use in the home. Both the provider who orders it and the supplier must be enrolled in Medicare. If either one isn’t, Medicare won’t pay.

With Original Medicare, your loved one pays 20% of the Medicare-approved amount after the Part B deductible, which is $283 in 2026, as long as the supplier accepts assignment. A Medigap policy, Medicaid or other coverage may pay some or all of that 20%. If the supplier doesn’t accept assignment, the bill can be higher.

Yes. A doctor or other treating provider has to order the equipment, and may need to document why your loved one needs it. The supplier usually helps make sure the right paperwork is sent. If equipment is denied, ask the supplier and the doctor whether more information would help.

During a Medicare-covered skilled nursing facility stay, the facility itself must provide the equipment your loved one needs. A long-term care setting can count as “home” for Part B equipment coverage, but a hospital or a nursing home that is giving Medicare-covered care does not. Ask the facility and the supplier before ordering so you know who is responsible.

Use Medicare’s supplier finder at Medicare.gov/medical-equipment-suppliers or call 1-800-MEDICARE. Medicare only pays suppliers that are enrolled in Medicare. Before you agree to anything, ask whether the supplier is enrolled and whether it accepts assignment.

A supplier that accepts assignment agrees to take the Medicare-approved amount as full payment and bills Medicare directly, so your share is just the deductible and coinsurance. Participating suppliers must always accept assignment. Non-participating suppliers can choose not to, and may charge more than the Medicare-approved amount.

Yes. For rentals, the supplier must accept assignment for every month of the rental. If it doesn’t, you may have to pay the full cost up front and wait for Medicare to pay back its share. Ask this question directly before the equipment is delivered.

Competitive bidding is a Medicare program in which suppliers bid to provide certain items in certain areas. CMS says no bidding round has been in effect since January 1, 2024, and the next round is set to start no later than January 1, 2028. That round is planned to cover continuous glucose monitors and insulin pumps, urological and ostomy supplies, catheters, and off-the-shelf braces, with a transition period for people who need to switch suppliers.

It depends on the item. Medicare pays for most equipment as a rental, while it usually buys inexpensive or routinely purchased items such as canes, walkers and blood sugar monitors, and complex rehab power wheelchairs. For wheelchairs and hospital beds, Medicare pays rent for up to 13 months of continuous use, and then the supplier must transfer ownership to your loved one.

For rented equipment, the supplier is responsible for maintenance, repairs and replacement, and picks it up when it’s no longer needed. For equipment your loved one owns, the original seller doesn’t have to repair it, but Medicare pays 80% of the approved repair cost and you pay 20%. You can take it to another Medicare-enrolled supplier for the repair.

Medicare may replace owned equipment that is lost, stolen, damaged beyond repair, or used past its reasonable useful life, which is generally 5 years from when your loved one started using it. In a declared disaster or emergency, Medicare may cover replacements and, in general, loaner equipment while repairs are made.

Your loved one’s doctor must find that they aren’t getting enough oxygen, that oxygen therapy may help, and that their blood oxygen test results fall in a set range. The equipment is rented from a Medicare-enrolled supplier, and the monthly payment covers the equipment, refills, tubing and other supplies, and needed maintenance. You pay 20% after the Part B deductible.

Medicare stops paying rent after 36 months, but the supplier must keep providing the equipment and supplies for as long as your loved one needs them, up to 5 years from the start. After 5 years, they can get new equipment from any Medicare-enrolled supplier and a new rental period begins. A supplier can’t change the equipment or refills without a doctor’s order, and Medicare doesn’t pay for oxygen used on airplanes.

There can be. After the 36-month rental period, people using an oxygen concentrator or equipment that fills portable tanks may owe coinsurance for maintenance every 6 months. The supplier can only charge this if it actually comes to the home to inspect and service the equipment.

Ask the oxygen supplier for portable oxygen several weeks before the trip so there is time to arrange it. Medicare doesn’t pay for oxygen used on an airplane, so check with the airline about its own rules. The doctor can tell you whether travel is safe for your loved one.

Part B may cover a hospital bed when it is medically necessary and a doctor or other provider orders it for use at home. Your loved one pays 20% of the Medicare-approved amount after the Part B deductible if the supplier accepts assignment. Hospital beds are usually rented, with ownership passing to your loved one after 13 months of continuous rental.

Medicare requires an in-person exam with a treating provider and a written order, and the chair or scooter must be medically necessary. Some power wheelchairs need approval from Medicare before it will pay, and the supplier usually sends that request. Medicare can deny it if it decides the device isn’t medically needed or doesn’t get enough information, so make sure the doctor’s notes describe your loved one’s mobility needs at home.

Read the denial notice for the reason and the appeal deadline. Ask the doctor whether more documentation would help, and ask the supplier what was missing. Utah SHIP counselors can help you understand the notice and file an appeal at no cost.

Medicare Advantage plans must cover the same kinds of medically necessary equipment as Original Medicare, but each plan has its own supplier network and costs, and some items may need the plan’s approval first. Call the number on the plan card before ordering to find an in-network supplier. If the plan denies something, your loved one can appeal and ask for an independent review.

Yes. Utah Medicaid covers medically necessary medical supplies and equipment with an order from a doctor or other qualified provider. Some items need approval first, including oxygen systems, most wheelchairs, and repairs. Members enrolled in a Medicaid health plan should follow that plan’s rules, so call the plan or the supplier to confirm before ordering.

Both, depending on the item. For many items Utah Medicaid pays rent, and the member owns the equipment after 12 months in a row; a break of 60 days or more starts the count over if it is ordered again. Some specialized equipment is rented for as long as it is needed. Repairs are covered when needed to make the equipment work, need approval first, and can’t cost more than replacing it.

Choose a supplier that is enrolled with both programs and ask it to bill both. Depending on your loved one’s Medicaid coverage, Medicaid may help with costs Medicare doesn’t pay. Utah SHIP counselors can explain how the two programs work together for your family member.

Medicare’s hospice benefit covers medical equipment such as wheelchairs and walkers, and supplies such as bandages and catheters, when they are related to the terminal illness. The hospice team arranges it, so call them first, because equipment from someone else may not be covered. For conditions unrelated to the terminal illness, Original Medicare still pays with the usual deductible and coinsurance.

Call 1-800-MEDICARE about rental suppliers that don’t respond, suppliers that don’t follow Medicare rules, or problems with an oxygen supplier. If an oxygen supplier says it will stop providing service, ask it to put that in writing. People with Medicare Advantage should also call their plan.