Medicare

Medicare Part B covers durable medical equipment that is considered medically necessary for a diagnosed condition. This includes wheelchairs, walkers, hospital beds, oxygen equipment, CPAP machines, and other mobility or assistive devices. The equipment must be prescribed by a healthcare provider and primarily used in the home setting.

Some items may require prior authorization or additional documentation to confirm medical necessity. Coverage may vary depending on Medicare guidelines, and not all medical equipment is eligible. Items that are primarily for convenience or comfort rather than medical necessity are generally not covered under Medicare.

To qualify, a doctor must determine that the equipment is medically necessary for a specific medical condition. The equipment must be durable, meaning it can withstand repeated use, and be intended for home use. Medicare requires that the equipment be obtained from a supplier that is enrolled in the Medicare program.

Some types of equipment may need additional documentation or prior approval before coverage is granted. In most cases, patients must meet their Medicare Part B deductible before coverage applies, and a coinsurance payment may be required. The process involves submitting a prescription and other necessary paperwork to confirm eligibility.

Medicare typically covers 80% of the approved amount for durable medical equipment under Part B. After meeting the annual Part B deductible, the patient is responsible for paying the remaining 20% as coinsurance. The exact cost may depend on the specific equipment and whether it is rented or purchased.

Some Medicare Advantage plans or supplemental insurance policies may help cover additional costs. If an equipment supplier does not accept Medicare assignment, the patient may be required to pay more out-of-pocket. Checking with both Medicare and the supplier in advance can help avoid unexpected expenses.

Yes, Medicare allows for certain types of durable medical equipment to be rented rather than purchased. Items such as hospital beds, oxygen equipment, and some power wheelchairs are typically provided through rental agreements rather than outright purchases.

Rental options can help reduce upfront costs and ensure access to necessary equipment without requiring a long-term commitment. Medicare determines whether an item should be rented or purchased based on specific guidelines. The rental period is usually capped, and after a certain number of payments, the patient may assume ownership of the equipment.

The length of coverage depends on the type of equipment and whether it is rented or purchased. Medicare typically covers durable medical equipment for as long as it is deemed medically necessary. If an item is rented, Medicare will continue to make monthly payments until the rental period ends.

For purchased equipment, coverage may include maintenance, repairs, or replacements if needed. Some equipment may need periodic re-evaluation by a healthcare provider to confirm ongoing medical necessity. If the patient’s condition changes and the equipment is no longer required, Medicare coverage may be discontinued.