Medicare Guide FAQs

Anyone who has Medicare Part B can get durable medical equipment as long as the equipment is medically necessary.

If you have Part B, Original Medicare covers durable medical equipment when your doctor or treating practitioner (such as a nurse practitioner, physician assistant, or clinical nurse specialist) prescribes it for you to use in your home. A hospital or nursing home that is providing you with Medicare-covered care can’t qualify as your “home” in this situation. However, a long-term care facility can qualify as your home. Note: If you are in a skilled nursing facility and the facility provides you with durable medical equipment, the facility is responsible for this equipment.

Medicare Advantage Plans (like an HMO or PPO) must cover the same items and services as Original Medicare. Your costs will depend on which plan you choose, and may be lower than Original Medicare. If you are in a Medicare Advantage Plan and you need durable medical equipment, call your plan to find out if the equipment is covered and how much you will have to pay.If you are getting home care or using medical equipment and you choose to join a new Medicare Advantage Plan, you should call the new plan as soon as possible and ask for Utilization Management. They can tell if your equipment is covered and how much it will cost. If you return to Original Medicare, you should tell your supplier to bill Medicare directly after the date your coverage in the Medicare Advantage Plan ends. Note: If your plan leaves the Medicare Program and you are using medical equipment such as oxygen or a wheelchair, call the telephone number on your Medicare Advantage Plan card. Ask for Utilization Management. They will tell you how you can get care under Original Medicare or under a new Medicare Advantage Plan.

If you need durable medical equipment in your home, your doctor or treating practitioner (such as a nurse practitioner, physician assistant, or clinical nurse specialist) must prescribe the type of equipment you need. For some equipment, Medicare also requires your doctor or one of the doctor’s office staff to fill out a special form and send it to Medicare to get approval for the equipment. This is called a Certificate of Medical Necessity. Your supplier will work with your doctor to see that all required information is submitted to Medicare. If your prescription and/or condition changes, your doctor must complete and submit a new, updated certificate.Medicare only covers durable medical equipment if you get it from a supplier enrolled in the Medicare Program. This means that the supplier has been approved by Medicare and has a Medicare supplier number.

For Medicare to cover a power wheelchair or scooter, your doctor must state that you need it because of your medical condition. Medicare won’t cover a power wheelchair or scooter that is only needed and used outside of the home.

Assignment is an agreement between you (the person with Medicare), Medicare, and doctors or other health care providers, and suppliers of health care equipment and supplies (like durable medical equipment and prosthetic or orthotic devices). Doctors, providers, and suppliers who agree to accept assignment accept the Medicare-approved amount as full payment. After you have paid the Part B deductible ($135 in 2009), you pay the doctor or supplier the coinsurance (usually 20% of the approved amount). Medicare pays the other 80%.

If your supplier is a Medicare-enrolled supplier, they will know whether Medicare allows you to buy a particular kind of durable medical equipment, or just pays for you to rent it. Medicare pays for most durable medical equipment on a rental basis. Medicare only purchases inexpensive or routinely purchased items, such as canes; power wheelchairs; and, in rare cases, items that must be made specifically for you.

If you own Medicare-covered durable medical equipment and other devices, Medicare may also cover repairs and replacement parts. Medicare will pay 80% of the Medicare-approved amount for purchase of the item. Medicare will also pay 80% of the Medicare-approved amount (up to the cost of replacing the item) for repairs. You pay the other 20%. Your costs may be higher if the supplier doesn’t accept assignment. Note: The equipment you buy may be replaced if it’s lost, stolen, damaged beyond repair, or used for more than the reasonable useful lifetime of the equipment.

If you rent durable medical equipment and other devices, Medicare makes monthly payments for use of the equipment. The rules for how long monthly payments continue vary based on the type of equipment. Total rental payments for inexpensive or routinely purchased items are limited to the fee Medicare sets to purchase the item. If you will need these items for more than a few months, you may decide to purchase these items rather than rent them. Monthly payments for frequently serviced items, such as ventilators, are made as long as the equipment is medically necessary. The payment rules for other types of rented equipment, called “capped rental items,” are on page 10. Medicare will pay 80% of the Medicare-approved amount each month for use of these items. You pay the other 20% after you pay the Medicare Part B deductible ($135 in 2009). The supplier will pick up the equipment when you no longer need it. Any costs for repairs or replacement parts for the rented equipment are the supplier’s responsibility. The supplier will also pick up the rented equipment if it needs repairs. You don’t have to bring the rented equipment back to the supplier.