HME insurance refers to insurance coverage for home medical equipment, the devices and supplies you use at home to manage a medical condition. If you’ve seen “HME” on a bill, an explanation of benefits, or a supplier’s website, it’s shorthand for the same category Medicare officially calls durable medical equipment, or DME. This coverage falls under Medicare Part B, and most private health insurance plans include similar benefits. Understanding how it works can save you hundreds or thousands of dollars on equipment you need.
What HME Insurance Actually Covers
HME coverage applies to medical equipment prescribed by a doctor for use in your home. The key requirement is medical necessity: the equipment must be needed to diagnose or treat an illness, injury, or condition, and it must meet accepted standards of medicine. Your doctor, nurse practitioner, physician assistant, or clinical nurse specialist fills out a prescription order specifying the type of equipment you need. For certain items, Medicare may require additional documentation proving your medical need before approving coverage.
The range of covered items is broad. Common categories include:
- Mobility aids: canes, crutches, walkers, manual wheelchairs, power wheelchairs, and scooters
- Respiratory equipment: oxygen concentrators, portable oxygen systems, nebulizers, and ventilator accessories
- Hospital beds and accessories
- Blood sugar monitors and supplies
- Patient lifts
- Braces for the back, knee, and other joints
For power wheelchairs and scooters specifically, your doctor must document that your medical condition requires one. A simple preference for convenience isn’t enough.
How Much You Pay Out of Pocket
Under Medicare Part B in 2025, you pay 20% of the Medicare-approved amount for covered equipment after meeting the annual deductible of $257. So if Medicare approves a hospital bed at $1,000, you’d owe $200 plus any remaining deductible. If you have a Medicare Supplement (Medigap) policy, it may cover part or all of that 20% coinsurance.
Private insurance plans vary, but most follow a similar structure: a deductible, then a coinsurance or copay percentage. Check your plan’s summary of benefits under “durable medical equipment” or “DME” to find your specific cost share. Some plans cap the total you’ll spend on DME per year.
Rental vs. Purchase: The 13-Month Rule
Many people assume they’re buying their equipment outright, but Medicare treats most HME as a rental. For what’s called “capped rental” items, Medicare pays a monthly rental fee for as long as you have a medical need, up to 13 consecutive months. After you’ve rented for 13 months, the supplier must transfer ownership to you. At that point, the equipment is yours to keep.
This matters for your budget. During those 13 months, you pay your 20% coinsurance on each monthly rental charge. Once you own the item, the monthly payments stop. If your medical need ends before 13 months, so do the payments, and the equipment goes back to the supplier.
Power wheelchairs follow slightly different rules. For complex rehabilitative power wheelchairs, the supplier must offer you the option to purchase outright when you first receive the equipment. If you choose this route, Medicare pays a lump sum instead of monthly rentals, and you pay your 20% of that lump sum.
What Happens After You Own It
At least two months before ownership transfers to you, the supplier is required to tell you whether they’ll continue maintaining and servicing the equipment after you take title. This is worth paying attention to, because once the item is yours, you need to know who handles repairs. Some suppliers continue servicing equipment they’ve transferred; others do not, leaving you to find a different provider for maintenance.
Using a Medicare-Enrolled Supplier
You can’t just buy equipment from any retailer and expect Medicare to cover it. The supplier must be enrolled in Medicare. If you get equipment from a non-enrolled supplier, Medicare won’t pay, and you’ll be responsible for the full cost.
Medicare previously ran a competitive bidding program that required patients in certain areas to use specific contract suppliers for items like back braces and knee braces. Those contracts expired at the end of 2023, and as of 2024, the program is in a temporary gap period while CMS develops a new round of bidding. During this gap, Medicare-enrolled suppliers in former competitive bidding areas are paid adjusted rates based on prior contract amounts plus inflation. For you as a patient, the practical effect is that you currently have more flexibility in choosing a supplier, but you should still confirm enrollment before placing an order.
When Your Needs Change
If your condition changes or you need different equipment, your doctor must complete and submit a new, updated order. You can’t simply swap out a standard wheelchair for a power wheelchair on your own. The new equipment goes through the same approval process: a fresh prescription, documentation of medical necessity, and in some cases additional paperwork your supplier will coordinate with your doctor.
This also applies if you move. HME coverage is specifically for equipment used in your home. If your living situation changes in a way that affects your equipment needs, an updated order ensures continued coverage.
Private Insurance and HME
While the research above focuses on Medicare, most private health plans cover HME under their DME benefit. The general framework is similar: you need a doctor’s prescription, the equipment must be medically necessary, and you’ll pay a deductible plus coinsurance or a copay. Where private plans differ most is in their approved supplier networks, prior authorization requirements, and annual or lifetime caps on DME spending.
Some private plans require prior authorization before you receive equipment, meaning the insurance company must approve the item in advance. Skipping this step can result in a denial, leaving you with the full bill. If your plan requires prior authorization, your supplier or doctor’s office typically handles the paperwork, but it’s worth confirming the approval is in place before the equipment arrives at your door.
Tips for Avoiding Unexpected Costs
The most common reason people end up paying more than expected for HME is using a supplier that isn’t in their insurance network or isn’t enrolled in Medicare. Before ordering any equipment, call your insurance plan and confirm the supplier is covered. Ask whether prior authorization is needed and whether the specific item has any coverage limitations.
Keep copies of your doctor’s prescription and any supporting documentation. If a claim is denied, you have the right to appeal. Denials often happen because of missing paperwork rather than a true lack of medical necessity, and resubmitting the correct documentation frequently resolves the issue. Your supplier should be able to help navigate the appeals process, since they don’t get paid until the claim is approved either.