Does Medicare Part A Cover DME? Part B, Rentals, and Approval

Medicare Part A does not cover durable medical equipment for use in your home. Home DME — wheelchairs, hospital beds, oxygen systems, CPAP machines, walkers, and the like — is a Part B benefit. Part A only pays for equipment indirectly, as part of the bundled payment it makes to a hospital or skilled nursing facility during a covered inpatient stay. Once you are home, Part B takes over, typically paying 80% of the Medicare-approved amount after you meet the annual Part B deductible, which is $283 in 2026.

When Part A Does Pay for Equipment

During a Part A-covered inpatient hospital stay or skilled nursing facility stay, any equipment you need is the facility’s responsibility. The cost is folded into the facility’s Medicare payment, and no separate bill goes to an outside DME supplier.¹ You will not see a separate 20% coinsurance for a wheelchair or hospital bed used inside the facility, because that equipment is not being billed to Part B.

There is one practical bridge between the two programs. A DME supplier can deliver equipment to the facility up to two days before your discharge, so staff can fit it or train you on it. The supplier cannot bill Medicare until the actual discharge date.²

If you were already renting a piece of equipment through Part B when you were admitted, the monthly rental payments pause during the stay. The continuous-use clock does not necessarily restart. If the interruption lasts fewer than 60 days (plus the days left in the last paid rental month), your rental period resumes where it left off when you return home.¹

What Part B Covers for Home Use

To qualify as DME under Medicare, an item must be durable enough for repeated use, serve a medical purpose, be the kind of thing generally only useful to someone sick or injured, be appropriate for use in your home, and be expected to last at least three years.³ A doctor or other qualified provider must prescribe it.⁴

The “home” requirement is where confusion creeps in. Medicare defines home as your regular place of residence. A hospital or a skilled nursing facility is not home. A long-term care facility can count, as long as it does not primarily provide skilled care or rehabilitation.⁴ An assisted living facility providing custodial rather than skilled care generally qualifies as home for DME purposes.⁵ You can take covered equipment out of the house — a portable oxygen concentrator to the grocery store, for example — but the item must be primarily intended for home use.

Common covered categories include:

Mobility equipment: manual and power wheelchairs, scooters, walkers, canes, and crutches.
Respiratory equipment: home oxygen systems and accessories, CPAP devices, nebulizers and certain nebulizer medications, and ventilators.
Hospital-style equipment: hospital beds, patient lifts, traction equipment, and pressure-reducing mattresses.
Monitoring and infusion devices: blood glucose monitors with test strips and lancets, infusion pumps, and self-contained pacemaker monitors.
Other items: commode chairs, suction pumps, continuous passive motion machines, and ultraviolet cabinets for severe psoriasis.

These are drawn from the CMS National Coverage Determinations reference list, which specifies each item and the conditions under which it qualifies.⁶

Part B also covers prosthetics and orthotics under the broader DMEPOS category: artificial limbs and eyes, rigid or semi-rigid braces, breast prostheses after mastectomy, ostomy supplies, urological supplies, and therapeutic shoes for people with severe diabetic foot disease. One pair of eyeglasses or contact lenses is covered after cataract surgery with an intraocular lens.⁴

Medicare draws a firm line against items it treats as comfort, convenience, or environmental. Bathtub seats, grab bars, raised toilet seats, stairway elevators, air conditioners, humidifiers, treadmills, home ramps, and widened doorways are consistently denied under Section 1862(a)(6) of the Social Security Act, which bars payment for personal comfort items.⁷⁸ Medicare also pays only for the most basic version of equipment that meets the medical need; if you want an upgraded model, you pay the difference.⁹

What You Pay Under Part B

Once you meet the annual Part B deductible of $283 in 2026, you pay 20% of the Medicare-approved amount for DME, and Medicare pays the other 80%.¹⁰ The same 80/20 split applies whether the item is rented or purchased.

That clean split only holds when your supplier accepts “assignment,” meaning it agrees to accept the Medicare-approved amount as full payment. Participating suppliers accept assignment on every claim. Non-participating suppliers can decide claim by claim, and when they do not accept assignment, there is no legal cap on what they can charge above the approved amount.¹¹ Unlike physician services, where non-participating providers are limited to 115% of the allowed amount, no such limiting charge applies to DME suppliers.¹² If a supplier charges $150 for an item with a $100 approved amount, Medicare pays $80 and you could owe as much as $70. Ask about assignment before you order.

A Medigap policy can reduce or eliminate the 20% coinsurance. All ten standardized Medigap plan types are designed to help cover Part B cost sharing, including DME coinsurance.¹³ If you are enrolled in a Medicare Advantage plan instead, the plan must cover the same categories of DME as Original Medicare, but it can require prior authorization, limit you to in-network suppliers, and set its own cost-sharing amounts; the specifics appear in each plan’s Evidence of Coverage.⁴

Renting Versus Buying

Medicare pays for DME on one of three tracks.

Inexpensive or Routinely Purchased Items

Items like canes, walkers, and blood glucose monitors are purchased outright. Medicare pays 80% of the approved purchase price; you pay 20%.⁴

Capped Rental Items

More expensive items — standard wheelchairs, hospital beds, nebulizers — are rented month by month. After 13 months of continuous rental, the supplier must transfer ownership to you at no additional cost.⁴ The supplier must offer you the option to buy starting in the 10th month; if you decline or do not respond, rental payments can continue for up to 15 months, after which the supplier retains ownership.¹⁴ While you rent, the supplier handles all maintenance and repairs at no extra charge.

Oxygen Equipment

Oxygen has its own rules. Medicare pays to rent oxygen equipment for up to 36 months of continuous use. After those 36 months, rental payments stop, but the supplier must keep providing the equipment, supplies, and maintenance for another 24 months, for a total of five years. If you still need oxygen past five years, you can choose a new supplier, which starts a fresh 36-month cycle.⁴

For equipment you own, Medicare covers necessary repairs once the warranty expires, with the usual 20% coinsurance.¹⁵ Medicare sets a reasonable useful lifetime of at least five years, measured from the delivery date; during that window, replacement for normal wear is generally not covered, but replacement is covered if the item is lost, stolen, or irreparably damaged.¹⁶

Getting It Approved

A prescription for DME has to meet Medicare’s written-order standard: your name, a description of the equipment, the prescribing provider’s signature and National Provider Identifier, and the date of the order.¹⁷

For certain items, including power wheelchairs, hospital beds, oxygen systems, and specific orthotics, Medicare also requires a face-to-face encounter with your treating provider within the six months before the order. As of April 2026, 83 items are on the required face-to-face list.¹⁷ These encounters can be conducted via telehealth if they meet Medicare’s telehealth requirements. Congress extended many pandemic-era telehealth flexibilities through December 31, 2027, under the Consolidated Appropriations Act of 2026.¹⁸

Some items require prior authorization before Medicare will pay. The supplier submits your medical documentation to the DME Medicare Administrative Contractor, which decides before the item is delivered. Standard review takes up to seven calendar days; expedited review takes two business days.¹⁹ Items currently on the list include all power mobility devices, certain pressure-reducing support surfaces, specific lower limb prostheses, and several categories of orthotics; seven new codes covering certain orthoses and pneumatic compression devices were added April 13, 2026.²⁰

You must get your DME from a supplier enrolled in Medicare with a valid supplier number. If the supplier is not enrolled, Medicare will not pay the claim at all.⁴ Before delivering an item that may not be covered, a supplier must give you an Advance Beneficiary Notice of Noncoverage on form CMS-R-131, explaining why Medicare may deny the claim and letting you decide whether to accept financial responsibility. If the supplier does not provide a valid ABN when one is required, it cannot bill you for the item.²¹ A vague statement like “Medicare may not pay” does not satisfy the rule — the notice has to name the specific item and give a concrete reason for the expected denial.²²

If a Claim Is Denied

Medicare’s appeals process has five levels, starting with a redetermination filed with the Medicare contractor within 120 days of the initial denial, then a reconsideration by a Qualified Independent Contractor, an Administrative Law Judge hearing, a Medicare Appeals Council review, and finally federal district court, which requires a minimum amount in controversy of $1,960 in 2026. Each decision letter explains how to move to the next step.²³ Medicare Advantage denials follow a parallel track: the plan handles the first level, and if it upholds the denial, the case is sent automatically to an independent review entity before entering the standard appeals process.²⁴ Free personalized counseling is available through the State Health Insurance Assistance Program (SHIP).

1
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24
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