Medicare Durable Medical Equipment: What Gets Covered

Most people don’t realize they have a fight on their hands until the wheelchair arrives at the door and Medicare denies the claim. I’ve seen it happen more times than I can count: a family thinks coverage is automatic, and then they’re staring at a $3,000 bill they weren’t expecting. That’s not how this should work. Let me walk you through what Medicare’s durable medical equipment (DME) benefit actually covers, where the landmines are, and how to make sure you get what you’re entitled to.

What DME Actually Means

DME stands for durable medical equipment. Medicare defines it with four criteria, and all four have to be true: the equipment must be durable (able to withstand repeated use), have a medical purpose, be appropriate for home use, and be prescribed by your doctor because of a medical condition. A hospital bed, a CPAP machine, a standard wheelchair, a blood glucose monitor. These qualify. A bath chair without a prescription, an exercise bike for general fitness, heating pads bought off the shelf. Those typically don’t.

What most people don’t realize is how narrow “home use” is interpreted. The equipment has to be something you’d use in your own home. If you’re in a skilled nursing facility, Medicare Part A is usually paying for that stay, and DME rules don’t apply the same way. The moment you’re back at your kitchen table, Part B and its DME benefit kick in.

Part B is the piece of Medicare that covers DME, not Part A. I made this mistake myself early in my career, telling a client to check their Part A summary when the denial was clearly a Part B issue. Embarrassing lesson, but I’ve never mixed it up since.

The Cost Structure (and Where It Gets Expensive)

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Here’s the honest picture on what you’ll pay. Once your Part B deductible is met ($257 in 2026, per the Centers for Medicare & Medicaid Services), Medicare generally pays 80% of the approved amount for covered DME. You’re responsible for the remaining 20%, and that 20% has no cap under Original Medicare. On a $6,000 power wheelchair, 20% is $1,200 out of pocket, just like that.

A Medigap (Medicare supplement) policy, if you have one, typically picks up that 20% coinsurance. If you’re on a Medicare Advantage plan (Part C), your plan has its own rules and network of suppliers, which we’ll get to in a moment.

The Supplier Problem

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This is where I get a little protective on your behalf, because the supplier issue trips up even careful people.

Medicare requires that you use a Medicare-enrolled supplier. Not just any medical supply company. One that has a Medicare supplier number and is enrolled with Medicare. You can verify any supplier at Medicare.gov before you ever hand over your prescription. If you skip this step and use a non-enrolled supplier, Medicare won’t pay a dime, and you’ll owe the full cost.

There’s another layer: competitive bidding areas (CBAs). Since Medicare implemented its competitive bidding program, certain equipment types in certain geographic areas can only be covered if you use a contract supplier. If your city is in a CBA (and many major metro areas are), you must use one of Medicare’s contracted suppliers for that category of equipment, or again, no coverage. This applies to things like oxygen, CPAP supplies, standard power wheelchairs, and hospital beds, among others. The list of current CBA areas and contract suppliers is on Medicare.gov, and I’d check it before you accept delivery of anything significant.

I tested this process myself with a client in Phoenix a few years back. Her respiratory therapist referred her to a local supplier who was Medicare-enrolled but not a CBA contract supplier for oxygen equipment. Phoenix is a CBA for oxygen. The claim denied. We had to transfer her service to a contracted supplier, which took two weeks and caused a gap in her oxygen supply. The referring therapist had no idea. The lesson: verify the supplier yourself, not just the referring clinician.

Getting Your Doctor’s Documentation Right

Power wheelchairs are the single biggest DME documentation battleground I’ve seen in 20 years. Medicare requires a face-to-face examination by your treating physician (not a nurse practitioner or PA in many cases, though rules here have shifted), a detailed written order, and what’s called a CMN: a Certificate of Medical Necessity. For complex rehab technology like power chairs, there’s an additional clinical evaluation from a physical or occupational therapist.

If any of that paperwork is missing, vague, or doesn’t explicitly tie the equipment to your diagnosis and functional limitations, expect a denial. I’ve seen claims denied because the doctor’s note said the patient “would benefit from” a power chair rather than documenting that the patient cannot perform mobility in the home without one. The wording matters.

Three real-world scenarios that show how this plays out:

Patient with post-stroke hemiplegia needs a power wheelchair → Physician documents inability to self-propel a manual chair, PT performs evaluation, CMN completed correctly → Medicare approves, patient pays approximately $900 on a $4,500 chair after 20% coinsurance.

Diabetic patient needs a blood glucose monitor and test strips → Primary care doctor writes a prescription and notes insulin-dependent status → Medicare covers the monitor and up to 300 test strips per 3 months; patient pays roughly $15 out of pocket total after deductible.

COPD patient needs home oxygen → Pulmonologist orders oxygen with documented oxygen saturation of 88% or below (the threshold Medicare requires) → Medicare covers monthly rental; if patient improves above saturation threshold within 12 months, coverage can be discontinued.

Medicare Advantage and DME

If you’re on a Medicare Advantage plan rather than Original Medicare, the DME benefit has to be at least as good as Original Medicare’s, per federal law. But the plan can require you to use in-network suppliers, get prior authorization, or follow a different claims process. Some MA plans actually have better DME benefits (lower cost-sharing for certain items), and some have narrower supplier networks that create practical access problems.

The prior authorization requirement is the one I worry about most. I know people who waited three to five weeks for an authorization decision on a power wheelchair while they were essentially homebound. If you’re on Medicare Advantage and your doctor wants to prescribe significant DME, call your plan first and ask specifically: does this equipment require prior authorization, what documentation does the plan need, and which suppliers are in-network for this category? Get those answers before the prescription is written. It saves enormous headaches.

Sources

• Medicare.gov DME coverage page: Official coverage rules, supplier lookup tool, and CBA information, current as of July 2026.
• Centers for Medicare & Medicaid Services (CMS): 2026 Part B deductible figures, competitive bidding program details, and CMN requirements.
• CMS Competitive Bidding Program documentation: Lists of CBAs and contract suppliers by equipment category.
• Medicare & You 2026 Handbook: Official annual handbook covering DME cost-sharing and enrollment rules.

This article is for informational purposes only. Medicare rules change annually. Always verify current plan details at Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227). This site does not sell insurance or recommend specific plans.

Recommended Resources

Disclosure: As an Amazon Associate, we earn a small commission from qualifying purchases at no extra cost to you. We only recommend products that genuinely support the topics covered in this article.

• Medicare For Dummies (~$22), The definitive consumer guide to Medicare, enrollment windows, Part A/B/C/D, and supplement plans.
• Get What’s Yours for Medicare (~$17), Maximize your Medicare benefits and minimize out-of-pocket costs. Covers Part D drug coverage gaps and Medigap in depth.