Key takeaways:
Durable medical equipment (DME) is a term for medically necessary items designed for long-term use at home.
People with a medical condition, disability, or injury usually use DME.
Medicare and Medicaid will cover many kinds of DME. But they may not cover items deemed to be home improvements.
Durable medical equipment (DME) refers to medically necessary items for people with medical conditions, disabilities, or injuries. Depending on your insurance coverage, DME may include mobility gear and healthcare devices that treat conditions. But it may or may not apply to medical supplies such as incontinence products. Your insurance plan may not cover some DME that are considered home improvements.
A Centers for Medicare & Medicaid Services final rule expanding coverage for certain DME took effect in 2022. This includes coverage for continuous glucose monitors (CGMs), orthotics, and prosthetic equipment. The change aimed to create better accessibility and affordability in the healthcare system.
Below are some examples of DME and how they’re covered by Medicare and other insurance plans.
What is durable medical equipment?
DME includes items needed to function at home with a medical condition, disability, or injury. DME recognized by Medicare must meet these criteria:
Durable (can be used repeatedly)
Used for a medical reason
Useful to someone who is sick or injured
Used in your home
Generally has an expected lifetime of 3 years or more
Examples of durable medical equipment covered by Medicare
Medicare considers prosthetics, orthotics, and other supplies to be DME. Certain DME items must be ordered by a Medicare-enrolled healthcare professional to be covered by Medicare. DME includes the following (this list is not complete):
Blood glucose (sugar) meters (glucometers)
Commode chairs
Continuous passive motion devices following knee replacements
Home infusion services
Infusion pumps and supplies
Pressure-reducing support surfaces
Prosthetic equipment
Suction pumps
Traction equipment
Wheelchairs and scooters
Examples of home improvements not considered durable medical equipment
Not all medically necessary equipment used at home is considered DME by Medicare and Medicaid. For instance, stair lifts are not DME under original Medicare. But they may be covered by a Medicare Advantage plan or other insurance.
Other home improvements that are not covered as DME under original Medicare include:
Grab bars
Ramps
Walk-in showers
Durable medical equipment (DME) includes mobility devices. Your manual wheelchair, power wheelchair, or mobility scooter can be considered Medicare-covered DME.
You can get some Medicare-covered DME at the pharmacy. You may be able to buy canes and other DME at a drugstore.
If it’s considered a home improvement, it’s not DME. Equipment such as stair lifts and ramps are considered home improvements and are not covered by Medicare.
What is the difference between durable medical equipment and medical supplies?
DME typically includes items that can be used for a long time. Medical supplies are disposable and are used once or short term. Sometimes, these items are included in DME and may be considered DME by your insurance plan. Examples of medical supplies include:
Bandages
Gloves
Will Medicare cover durable medical equipment?
Medicare Part B and Medicare Advantage plans will cover DME if your Medicare-enrolled healthcare professional deems the item medically necessary. Your supplier must be enrolled in Medicare. Depending on the DME you need, Medicare may require you to rent or buy it.
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Medicare typically pays for standard equipment to meet your health needs. You may have to pay more for upgrades or special features. If your Medicare request for DME is denied, you can appeal the coverage decision.
Will Medicaid cover durable medical equipment?
Medicaid covers DME under the mandatory home health benefit. Prosthetics may be covered, but they fall under an optional benefit that varies by state and territory. Medicaid also may cover medical supplies that Medicare doesn’t. These include specialized equipment for independent living outside the home.
If you have commercial insurance, check your summary of benefits and coverage to see what DME is covered. This includes plans from employers or an Affordable Care Act marketplace.
Where can I find medical supplies and equipment near me?
You can find medical equipment and supplies at medical-supply stores, pharmacies, and other retailers. You can search for a Medicare-approved supplier by using the Medicare DME supplier search tool or by calling 1-800-633-4227 for help. Common DME, such as canes, may be covered and available at your local pharmacy. You may not need to visit a medical-supply store. Also, you may find that incontinence supplies sold by manufacturers or DME suppliers perform better than retail products.
Frequently asked questions
Contact lenses and eyeglasses may be considered DME by commercial insurance plans. But they’re not covered by Medicare because they’re not just for use at home. Medicare will cover certain contacts and glasses only if they are needed to replace a missing lens in the eye or after an approved cataract surgery that replaces a lens in your eye.
Indoor air humidifiers are not considered DME by Medicare. But your commercial insurance or other healthcare coverage may cover them. Medicare considers oxygen humidifiers as DME if used with certain other DME. Examples include CPAP devices, oxygen equipment, and respiratory-assist devices.
Original Medicare doesn’t cover shower chairs for use at home. But your Medicare Advantage plan may cover them as an over-the-counter allowance.
Yes, Medicare Part B covers orthotics. Specifically, it covers therapeutic shoes and inserts for enrollees with diabetes or severe diabetes-related foot conditions. Medicare Advantage plans meet or exceed what’s covered by original Medicare.
Contact lenses and eyeglasses may be considered DME by commercial insurance plans. But they’re not covered by Medicare because they’re not just for use at home. Medicare will cover certain contacts and glasses only if they are needed to replace a missing lens in the eye or after an approved cataract surgery that replaces a lens in your eye.
Indoor air humidifiers are not considered DME by Medicare. But your commercial insurance or other healthcare coverage may cover them. Medicare considers oxygen humidifiers as DME if used with certain other DME. Examples include CPAP devices, oxygen equipment, and respiratory-assist devices.
Original Medicare doesn’t cover shower chairs for use at home. But your Medicare Advantage plan may cover them as an over-the-counter allowance.
Yes, Medicare Part B covers orthotics. Specifically, it covers therapeutic shoes and inserts for enrollees with diabetes or severe diabetes-related foot conditions. Medicare Advantage plans meet or exceed what’s covered by original Medicare.
The bottom line
Durable medical equipment (DME) can improve quality of life for people with medical conditions, disabilities, and injuries. DME can include mobility gear such as canes, walkers, wheelchairs, and scooters. The term also may refer to continuous glucose monitors and continuous positive airway pressure devices, as well as prosthetics, orthotics, and other supplies. Many types of DME are covered by insurance plans.
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References
Centers for Medicare & Medicaid Services. (2020). Patient lifts - policy article.
Centers for Medicare & Medicaid Services. (2020). Refractive lenses - policy article.
Federal Register. (2021). Medicare program; durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) policy issues, and level II of the Healthcare Common Procedure Coding System (HCPCS); DME interim pricing in the CARES act; durable medical equipment fee schedule adjustments to resume the transitional 50/50 blended rates to provide relief in rural areas and non-contiguous areas. Centers for Medicare & Medicaid Services.
Mayhew, M. C., et al. (2019). CMCS informational bulletin. Centers for Medicare & Medicaid Services.
Medicaid.gov. (n.d.). Mandatory & optional Medicaid benefits.
Medicare.gov. (n.d.). Durable medical equipment (DME) coverage.
Medicare.gov. (n.d.). Eyeglasses & contact lenses.
Medicare.gov. (n.d.). Humidifiers.
Medicare.gov. (n.d.). Search for medical equipment & suppliers.
Medicare.gov. (n.d.). Therapeutic shoes & inserts.
Medicare.org. (n.d.). Does Medicare cover shower chairs?
National Association of Boards of Pharmacy. (n.d.). DMEPOS Pharmacy.
