Introduction

Navigating Medicare can feel overwhelming — especially when you need home medical equipment and aren’t sure what’s covered or how the process works. The good news? Medicare Part B does help pay for many essential devices, from a Standard Manual Wheelchair to a Stationary Oxygen Concentrator, through its Durable Medical Equipment (DME) benefit.

That said, Medicare has specific rules you need to understand — including rental periods, cost-sharing, and doctor documentation requirements. Knowing these upfront can save you time, frustration, and unexpected delays.

In this guide, we break down how Medicare covers DME in plain, easy-to-follow language. We’ll explain:

• What equipment Medicare typically covers
• How much Medicare pays (and what you’re responsible for)
• The steps required to get equipment approved

This is a high-level overview designed to help you or your loved one confidently use Medicare benefits for home medical equipment. Let’s demystify Medicare and DME.

What Equipment Does Medicare Cover?

Medicare Part B covers “medically necessary” durable medical equipment — meaning devices your doctor prescribes for use at home to treat or manage a medical condition. Common examples include:

Mobility Aids

Medicare covers walkers, canes, crutches, and wheelchairs (both manual and power).
For example, if you have severe arthritis and need a Standard Walker or a Group 2 Power Wheelchair, Medicare can help pay for it when properly prescribed.

Home Hospital Equipment

Items like a Hospital Bed (Total Electric), patient lifts, or commode chairs may be covered if your doctor orders them based on your medical needs — such as being bed-bound or requiring special positioning.

Respiratory Equipment

Medicare covers:

• Portable Oxygen Concentrators (POCs)
• Stationary oxygen machines
• CPAP machines for sleep apnea
• Ventilators
• Nebulizer machines

Coverage requires proper documentation, including a qualifying diagnosis and, in many cases, supporting test results (such as oxygen saturation levels for oxygen therapy).

Prosthetics & Orthotics

Medicare may cover artificial limbs, braces, and support devices.
For example, a Hinged Knee Orthosis (Off-The-Shelf) or a Vinyl Lace-Up Ankle Brace may be covered after an injury or surgery if prescribed to support joint stability during recovery.

Certain Medical Supplies

Medicare Part B covers some reusable or semi-durable supplies, including:

• Blood glucose monitors
• Test strips and lancets (for diabetes management)
• Straight tip urine catheters for long-term catheterization

However, Medicare does not cover most disposable supplies such as gloves, adult diapers (incontinence products), or routine wound dressings for home use. These items are typically paid out-of-pocket or may be covered by Medicaid or another insurance plan.

Medicare also generally does not cover home modifications or convenience items like shower chairs, as they’re not considered primarily medical equipment.

Bottom line: The item must be durable, used repeatedly, and medically necessary to treat or manage a condition. If you’re unsure whether something is covered, your equipment supplier can help clarify — but the categories above include most commonly used home medical equipment, from rollator walkers to oxygen systems and hospital beds.

The Doctor’s Order and Medical Necessity

Being on Medicare isn’t enough by itself — coverage starts with your doctor. To qualify for DME, Medicare requires proper documentation showing medical necessity.

Here’s how that works:

Face-to-Face Appointment

Medicare requires a recent visit with a doctor (or certain qualified providers) who determines that you need the equipment.
For some items — especially power wheelchairs — this must include a documented, face-to-face mobility evaluation.

Detailed Written Order

Your doctor must complete a detailed order describing:

• The specific equipment
• Why it’s medically necessary
• Relevant diagnoses, measurements, or test results

For example:

• Oxygen equipment requires documented oxygen levels and diagnoses like COPD
• A Gel Overlay Pad (Pressure Relief Surface) requires documentation of pressure ulcers or risk factors

Medical Necessity Rules

Medicare only covers items that are “reasonable and necessary.” Documentation must clearly connect your condition to the equipment.

Some items require minimal explanation. Others — like hospital beds or power wheelchairs — have very specific criteria.
For example:

• Hospital beds often require proof that positioning needs cannot be met with a standard bed
• Group 3 power wheelchairs have strict requirements related to in-home mobility and functional ability

Your doctor and DME supplier usually know these requirements and work together to ensure documentation meets Medicare’s standards.

Prior Authorization (Limited in Original Medicare)

Original Medicare rarely requires prior authorization. Instead:

• Your supplier submits the claim after delivery
• Medicare reviews it and either pays or denies based on documentation

If something is missing, the claim may be denied and corrected through additional documentation or appeal.

Important: Medicare Advantage plans often do require prior authorization before equipment is delivered. Always check your specific plan rules.

Pro Tip: Work with an experienced, Medicare-enrolled DME supplier from the start. At Kinxo Medical Supplies, we routinely communicate directly with physicians to ensure documentation is complete before submission — reducing delays and denials. Medicare documentation can be very specific, but experienced providers navigate it every day.

How Payment Works: Medicare’s 80/20 and Rental Rules

Medicare Part B typically pays 80% of the approved amount, and you (or your secondary insurance) are responsible for the remaining 20%, after your Part B deductible is met.

Here’s what that looks like:

Your Share (Coinsurance)

You usually pay 20% of Medicare’s approved amount.

• Medigap plans often cover this 20%
• Medicaid may cover it for dual-eligible patients

Example:
If Medicare allows $50 for a cane, Medicare pays $40 and you pay $10.

Rental vs. Purchase

Many DME items are rented rather than purchased upfront.

• Capped Rental (Usually 13 Months):
  Items like a Hospital Bed (Total Electric) or Standard Manual Wheelchair are rented monthly. After 13 months, ownership typically transfers to you.
• Purchased Items:
  Low-cost items like canes or crutches are usually purchased outright.
• Oxygen Equipment:
  Oxygen is treated differently. Medicare pays monthly for up to 36 months, followed by additional service periods — totaling 5 years. The equipment generally remains the supplier’s property during this time, and maintenance is included.

Maintenance and Replacements

Once you own equipment:

• Medicare may cover repairs or replacement parts
• Equipment typically has a 5-year “useful lifetime”
• Replacement may be approved if equipment is worn out, damaged, or lost due to disaster

If you’re renting, maintenance is included — you should not be billed for repairs during the rental period.

Real-World Example:
If you receive a Group 1 Power Wheelchair as a capped rental, you pay your portion monthly for 13 months. After that, you own it. If a motor fails later, Medicare may cover 80% of the repair cost, just like the original equipment.

Assignment and Approved Suppliers

To receive coverage, you must use a Medicare-enrolled DME supplier. In many areas, Medicare also requires the use of contracted suppliers through its competitive bidding program.

To avoid surprise costs:

• Confirm the supplier accepts Medicare assignment
• This ensures pricing is capped and predictable

Steps to Take

1. Doctor Order: Ensure your doctor sends the order and documentation to the supplier
2. Supplier Confirmation: Choose a Medicare-approved supplier and provide your Medicare information
3. Sign Required Forms: You may sign an Assignment of Benefits or, in rare cases, an Advance Beneficiary Notice (ABN)
4. Use Equipment as Prescribed: Some equipment requires periodic follow-up documentation

A reputable supplier will guide you through each step and flag issues early.

What About Medicare Advantage or Other Insurance?

Medicare Advantage plans must cover at least what Original Medicare covers — but rules vary. These plans often:

• Require prior authorization
• Limit coverage to in-network suppliers
• Use different cost-sharing structures

If you’re dual-eligible (Medicare + Medicaid), Medicaid may cover coinsurance or items Medicare doesn’t cover, such as incontinence supplies.

Private insurance plans vary widely. Many follow Medicare-like rules but have different approval processes or copays. Always confirm coverage directly with your plan.

Conclusion

Medicare can be a powerful resource for obtaining home medical equipment — covering 80% of the cost for many medically necessary items. But success depends on following the right steps: getting a proper doctor’s order, working with a Medicare-participating supplier, and understanding rental and cost-sharing rules.

The process may feel bureaucratic, but it exists to ensure appropriate care. Stay engaged, ask questions, and keep communication open with your doctor and supplier. With the right knowledge, Medicare becomes far less intimidating — and much more useful.

With this foundation, you’re better equipped to get the equipment you need and focus on what matters most: living safely and comfortably at home.