Getting durable medical equipment (DME) through insurance follows a specific process: you need a face-to-face medical visit, a written prescription, and an enrolled supplier. Most people with Medicare pay 20% of the approved amount after meeting their annual Part B deductible ($257 in 2025, $283 in 2026), but the steps between needing equipment and actually receiving it involve several requirements that can trip you up if you don’t know about them in advance.
What Counts as Durable Medical Equipment
Not everything medical qualifies as DME. To be classified as durable medical equipment under Medicare’s definition, an item must meet four criteria: it can withstand repeated use, it serves a medical purpose, it wouldn’t be useful to someone without an illness or injury, and it’s appropriate for use in your home. This covers things like hospital beds, wheelchairs, oxygen equipment, CPAP machines, walkers, and certain braces.
Items that are disposable, purely for comfort, or mainly used outside the home generally don’t qualify. If an item falls into a gray area, your regional Medicare contractor makes the call based on whether the FDA has approved it, whether it’s considered safe and effective, and whether it’s reasonable and necessary for your specific situation.
The Face-to-Face Visit Requirement
Before you can get a prescription for DME, you need a face-to-face encounter with a physician, physician assistant, nurse practitioner, or clinical nurse specialist. This visit must happen within six months before the written order is created, and the date on the prescription cannot be earlier than the date of your visit. Telehealth visits count.
If a PA, NP, or CNS orders your equipment, a physician (MD or DO) still needs to co-sign the relevant portion of your medical record confirming the encounter took place. This is a documentation step that happens behind the scenes, but if it’s missing, the claim gets denied. You can help by confirming with your provider’s office that the paperwork is complete before you contact a supplier.
What the Prescription Must Include
Your provider writes what’s called a Detailed Written Order. It must include your name, a description of the specific DME item, the prescribing practitioner’s National Provider Identifier (NPI), their signature, and the date. Missing any of these elements results in a denied claim. If your provider’s office gives you a copy, check that all five elements are present before moving forward.
Choosing the Right Supplier
Where you get your equipment matters as much as what you get. Medicare requires you to use an enrolled DMEPOS supplier. In certain geographic areas, Medicare runs a competitive bidding program that designates specific contract suppliers for certain items. If you live in one of these areas and use a non-contract supplier, Medicare will likely not pay, and you could be responsible for the full cost. The supplier may ask you to sign an Advance Beneficiary Notice warning you of this before completing the transaction.
There are a few exceptions. Your doctor or therapist can give you an off-the-shelf brace during an appointment as part of clinical care, even without being a contract supplier. The same applies if you receive a brace while admitted to the hospital or on discharge day. If you’re traveling outside a competitive bidding area, you can use any enrolled supplier in that location.
As of January 2024, the competitive bidding program is in a temporary gap period after the most recent contracts for off-the-shelf back and knee braces expired. Medicare is adjusting fees in former competitive bidding areas using consumer price index calculations while it prepares the next round. For now, this means the contract supplier requirement is relaxed for those items, but the enrolled supplier requirement still applies to all DME.
Rental vs. Purchase
Many DME items aren’t purchased outright. Instead, Medicare uses a capped rental system. You pay monthly rental fees (your 20% share) for up to 13 continuous months of use. After that 13th month, the supplier must transfer ownership of the equipment to you at no additional charge. From that point, it’s yours.
Power wheelchairs work slightly differently. The supplier is required to offer you a purchase option upfront when they first provide the chair. If you choose to buy, payment still processes as monthly rental payments for up to 13 months, after which ownership transfers to you. If you’d rather not commit to a purchase immediately, you can rent month to month during your period of medical need.
Special Rules for Oxygen Equipment
Oxygen concentrators, tanks, and related equipment follow their own timeline. Medicare pays rental fees for 36 months. After that, your supplier keeps providing the equipment, accessories, maintenance, and repairs through month 60 (the five-year “reasonable useful lifetime”) at no additional rental cost to you or Medicare. If you relocate during this period, your original supplier is responsible for either continuing service or arranging another supplier to take over.
After the five-year mark, you have a choice. You can start fresh with new equipment, which begins a new 36-month rental cycle. Or you can keep using the existing equipment. If you keep it and the supplier retains ownership, they continue covering maintenance and repairs under the same terms. But if the supplier transfers the title to you, Medicare no longer covers accessories, maintenance, or repairs for that equipment. Oxygen contents (the actual gas or liquid oxygen) remain separately payable if you own a gaseous or liquid system.
Power Wheelchairs and Scooters
Getting a power wheelchair or scooter approved requires meeting a specific set of medical necessity criteria. You must have a mobility limitation that significantly impairs your ability to do at least one mobility-related activity of daily living in your home, like getting to the bathroom, kitchen, or bedroom. Beyond that, Medicare needs to see that a cane or walker wouldn’t safely solve the problem, and that you don’t have enough upper body strength or function to propel a manual wheelchair through your home during a typical day.
All three conditions must be met. If a manual wheelchair would work, that’s what Medicare covers. The evaluation typically involves your physician documenting your functional limitations in detail, and in many cases a specialized assessment is part of the process.
Repairs, Maintenance, and Replacement
Once you own a piece of DME, Medicare covers necessary repairs to keep it functional. This includes both parts and labor, with two important limits: repairs covered under a manufacturer’s or supplier’s warranty aren’t eligible for Medicare payment, and if the repair cost exceeds what it would cost to rent or buy a replacement for your remaining period of medical need, Medicare won’t pay the difference.
Routine upkeep is your responsibility as the owner. Testing, cleaning, and basic adjustments aren’t covered. However, more complex maintenance that the manufacturer recommends be performed by an authorized technician does qualify. Think of it this way: if the task requires opening sealed components or using specialized testing tools you wouldn’t have at home, Medicare treats it as a covered repair.
One notable exception: equipment in the “frequent and substantial servicing” category, along with oxygen equipment still in its rental period, isn’t eligible for separate repair or maintenance payments. Those costs are built into the rental fees.
Steps to Get DME
- Schedule a qualifying visit. See your physician, NP, PA, or CNS in person or via telehealth. Discuss your functional needs and why you need the equipment.
- Get a complete written order. Confirm it includes your name, the specific item, the provider’s NPI, their signature, and the date.
- Find an enrolled supplier. Use Medicare’s supplier directory to locate one in your area. If you’re in a competitive bidding area, verify the supplier holds a contract for your item category.
- Confirm coverage before you commit. Ask the supplier to verify your Medicare eligibility and confirm the item is covered. If there’s any doubt, request that they submit a prior authorization or predetermination.
- Understand your cost share. You’ll owe 20% of the Medicare-approved amount after your Part B deductible is met. For rental items, this is a monthly payment. Ask the supplier for a written estimate.
- Keep your documentation. Hold onto copies of your prescription, supplier receipts, and any correspondence. If a claim is denied, these records are essential for an appeal.
Private Insurance and Medicaid
Most private insurers follow a similar framework to Medicare: you need a prescription, medical necessity documentation, and an in-network or approved supplier. The specifics vary by plan. Some require prior authorization before you receive the equipment, and skipping that step can mean paying full price. Call the number on your insurance card and ask about DME benefits before ordering anything.
Medicaid covers DME in every state, but the approved items, supplier networks, and cost-sharing rules differ significantly. Some state Medicaid programs require prior authorization for nearly all DME, while others have streamlined processes for common items like walkers and nebulizers. Your provider’s office or a local Medicaid office can clarify what applies in your state.
If you have both Medicare and Medicaid (dual eligibility), Medicaid often picks up the 20% coinsurance and deductible that Medicare doesn’t cover, potentially reducing your out-of-pocket cost to zero.