What’s DME and How Is It Covered?

DME stands for durable medical equipment used at home to help people with daily activities, including: 

• Mobility aids: Walkers, manual wheelchairs, scooters, crutches, and canes
• Home hospital equipment: Hospital beds, commode chairs, and patient lifts
• Respiratory equipment: Oxygen equipment, CPAP machines, and nebulizers
• Diabetes supplies: Blood sugar meters and test strips
• Other medical devices: Infusion pumps, traction equipment, and suction pumps

How does Medicare cover DME?

If you are enrolled in Medicare Parts A and B and are enrolled in the HOP Medical Plan or the HOP Value Medical Plan, Medicare Part B covers DME if a doctor prescribes it for home use (that includes an assisted living or long-term care facility). The DME must come from a Medicare-approved supplier that accepts payment from Medicare.  

You usually pay a percentage of the Medicare-approved amount after paying your Part B deductible. For example, after the deductible, under the HOP Medical plan, you’ll pay 10% up to $100 per item, and under the Value Medical Plan, you’ll pay 20%.

You should know that Medicare pays for different kinds of DME in different ways. Depending on the type of equipment, you may need to rent or buy the equipment. For example, if you need a hospital bed at home, you can often rent to own the bed through your Medicare supplier.

Other items such as back braces and support stockings that aren’t necessarily considered DME but enhance quality of life can be covered with a doctor’s prescription for treating specific conditions.

DME must be purchased from a Medicare supplier.

If you need DME items, make sure your supplier is enrolled in Medicare and accepts payment from Medicare to ensure coverage. To search for medical equipment and suppliers, go to medicare.gov/medical-equipment-suppliers.

What if you’re in a Medicare Advantage plan? These plans are required by law to provide at least the same benefits as Original Medicare (Part A and Part B). This means that Medicare Advantage plans cover DME in the same way as Original Medicare. However, you should check with your plan for the details of your coverage, including any network restrictions, costs, and prior authorization requirements.