Medicare DME stands for durable medical equipment, a category of medical devices and supplies that Medicare Part B helps pay for when you need them at home. This includes items like wheelchairs, walkers, hospital beds, oxygen equipment, and blood sugar monitors. To qualify for coverage, the equipment generally must be durable enough for repeated use, serve a medical purpose, be appropriate for home use, and be ordered by your doctor.
What Counts as Durable Medical Equipment
The “durable” part of DME is key. Medicare draws a line between disposable medical supplies (like bandages) and equipment built to withstand repeated use over time. To qualify as DME, an item must be primarily medical in nature, meaning it wouldn’t be useful to someone without a medical condition. A standard mattress, for example, wouldn’t qualify, but a pressure-reducing hospital bed would.
Common categories of covered DME include:
- Mobility aids: wheelchairs, walkers, canes, crutches, and scooters
- Breathing equipment: oxygen concentrators, CPAP machines, and nebulizers
- Home medical equipment: hospital beds, patient lifts, and commode chairs
- Monitoring devices: blood glucose monitors and continuous glucose monitors
- Prosthetics and orthotics: artificial limbs, back braces, and therapeutic shoes for diabetes
The equipment must also be appropriate for use in your home. “Home” in Medicare’s definition is where you live day to day, whether that’s a house, apartment, or assisted living facility. If you’re staying in a hospital or skilled nursing facility, DME is typically bundled into the facility’s charges rather than billed separately under Part B.
What You’ll Pay Out of Pocket
DME falls under Medicare Part B, which means you’ll pay the standard Part B cost-sharing. In 2025, that starts with a $257 annual deductible. Once you’ve met that deductible, you pay 20% of the Medicare-approved amount for covered equipment. Medicare picks up the remaining 80%.
That 20% coinsurance applies whether you’re renting or purchasing. For a wheelchair with a Medicare-approved price of $1,000, your share would be $200. If you have a Medigap (Medicare Supplement) plan, it may cover part or all of that coinsurance. Medicare Advantage plans cover DME too, though copay structures vary by plan.
One important detail: your supplier must “accept assignment,” meaning they agree to charge no more than the Medicare-approved amount. If they don’t accept assignment, you could owe significantly more.
Renting vs. Buying Equipment
Medicare doesn’t handle all DME the same way. Depending on the type of equipment, you may need to rent it, buy it outright, or choose between the two. For certain rental items, ownership transfers to you automatically after you’ve made a set number of monthly rental payments (typically 13 months for items like wheelchairs and hospital beds). Once you own the equipment, Medicare stops making rental payments, and the item is yours to keep.
Oxygen equipment works differently. Medicare covers rental payments for up to 36 months, and the supplier must continue providing the equipment, supplies, and maintenance for an additional 24 months after that rental period ends. You keep paying your 20% coinsurance throughout.
Items that are less expensive or disposable in nature, like certain diabetic supplies, are purchased outright rather than rented.
Getting a Prescription and Using the Right Supplier
You can’t simply walk into a medical supply store and expect Medicare to cover the bill. Coverage requires a doctor’s order that specifies the equipment and documents why it’s medically necessary. For certain items, your doctor must complete a detailed form confirming your diagnosis and medical need. Some equipment, including power wheelchairs and continuous glucose monitors, also requires a face-to-face visit with your doctor before the order is written.
Equally important is where you get the equipment. You must use a supplier enrolled in Medicare. If your supplier isn’t enrolled, Medicare won’t pay anything, and you’ll be responsible for the full cost. You can search for enrolled suppliers through Medicare’s online supplier directory or call 1-800-MEDICARE to verify.
Medicare has historically used a competitive bidding program to set prices and select contract suppliers in certain geographic areas. As of January 2024, the program is in a temporary gap period while regulators work on the next round. During this gap, any Medicare-enrolled supplier in a former competitive bidding area can provide covered items, with prices adjusted based on previous contract rates plus inflation.
Repairs, Maintenance, and Replacement
Once you own a piece of DME, Medicare covers necessary repairs to keep it functional. You don’t need a new prescription for repairs. However, routine maintenance like basic cleaning and testing is generally not covered. The exception is more extensive servicing recommended by the manufacturer that requires a trained technician, which Medicare treats as a covered repair.
If your equipment breaks down while you’re renting it, repairs are the supplier’s responsibility and are built into the rental cost. You won’t see a separate charge for those.
Replacement follows what’s known as the five-year rule. Medicare considers most DME to have a “reasonable useful lifetime” of at least five years, calculated from the date the equipment was delivered to you. During that five-year window, Medicare will pay for repairs (up to the cost of replacement) but won’t cover a brand-new item unless the equipment is damaged beyond repair due to a specific event, was lost or stolen, or no longer fits because of a change in your medical condition. After five years of continuous use, you can request a new piece of equipment and go through the coverage process again.
Continuous Glucose Monitors and Diabetes Supplies
Diabetes-related equipment is one of the most common DME categories. Medicare covers blood glucose monitors, test strips, lancets, and continuous glucose monitors (CGMs) for beneficiaries with diabetes. CGMs have specific requirements: the device must have a standalone receiver or integrate with an insulin pump. A CGM that only displays readings on a smartphone, with no other receiver option, does not meet Medicare’s definition of DME and won’t be covered.
Coverage criteria also depend on your treatment. If you use insulin, your claims are coded differently than if you manage diabetes with oral medications alone. Your doctor and supplier handle these coding details, but it’s worth knowing that Medicare distinguishes between the two because it affects which supplies and quantities are approved.
What Happens if Coverage Is Denied
If Medicare determines that a piece of equipment isn’t medically necessary or doesn’t meet coverage criteria, your claim will be denied. Before that happens, your supplier is required to give you a written notice (called an Advance Beneficiary Notice) when they have reason to believe Medicare won’t cover an item. This notice explains why coverage may be denied and gives you the choice to receive the item anyway and pay out of pocket, or to skip it entirely.
Suppliers must also provide this notice if they’re a non-contract supplier in a competitive bidding area, or if other program rules would prevent coverage. If you receive a denial, you have the right to appeal. The first level of appeal is a redetermination by the Medicare contractor, which must be filed within 120 days of receiving the denial notice. Many denials stem from incomplete documentation rather than true ineligibility, so working with your doctor to provide additional records can often resolve the issue.