Under Medicare, hospice DME coverage is comprehensive: the hospice agency provides, delivers, maintains, and picks up any durable medical equipment related to the terminal illness or a related condition, and the patient pays nothing. The cost is folded into the daily rate Medicare pays the agency, so families almost never deal with suppliers, prior authorizations, or billing paperwork. What’s worth knowing in advance is which items qualify, how the system handles equipment for unrelated conditions, and what to do when the hospice declines a request.
What Equipment Qualifies
Federal rules define durable medical equipment by four tests: it withstands repeated use, serves a primarily medical purpose, would not be useful to someone who isn’t sick or injured, and is appropriate for use at home.1Social Security Administration. POMS HI 00610.200 – Definition of Durable Medical Equipment Disposable items like incontinence pads, catheters, and wound dressings fail the durability test and count as medical supplies rather than DME, but hospice still covers them when they’re part of the care plan.
The hospice benefit is actually broader than Part B’s standard DME category. The regulations cover DME plus “self-help and personal comfort items related to the palliation or management of the patient’s terminal illness.”2eCFR. 42 CFR 418.202 – Covered Services The equipment has to appear in the written plan of care and be used in the patient’s home while they’re enrolled in hospice.
Items commonly provided
Hospital beds are the most frequently delivered item. A full-electric bed lets caregivers adjust the head, foot, and overall height with a remote, which matters when a patient can no longer reposition themselves. Side rails are typically included, and the hospice will usually add a pressure-relief mattress, such as a low-air-loss or alternating-pressure model, to reduce the risk of skin breakdown.
Respiratory equipment is the next big category. Oxygen concentrators and portable cylinders address shortness of breath. Hospice agencies also provide nebulizers for aerosolized medications, suction machines for clearing secretions, and CPAP or BiPAP devices when breathing support is needed overnight. High-flow oxygen therapy equipment is available for patients with significant respiratory decline.
Mobility and safety aids fill out the typical inventory:
- Wheelchairs, walkers, and canes to preserve independent movement for as long as possible.
- Patient lifts and trapeze bars for transfers between bed, chair, and commode when the patient can’t bear weight.
- Bedside commodes, shower chairs, and grab bars to reduce fall risk in the bathroom.
- Feeding pumps for patients receiving enteral nutrition related to the terminal condition.
What a specific patient receives depends on the care plan. The hospice interdisciplinary team reassesses needs as the illness progresses, so equipment that wasn’t needed at admission can become essential weeks later, and the agency is expected to respond.
How Ordering and Delivery Work
The process starts with the hospice team, not the family. During routine visits, a hospice nurse identifies an equipment need, the hospice physician or nurse practitioner orders it as part of the plan of care, and the agency coordinates directly with its contracted DME supplier.3Centers for Medicare & Medicaid Services. Hospice No one has to call a supplier, chase a prior authorization, or deal with billing.
Routine deliveries typically arrive the next business day. Urgent items, like a hospital bed when a patient can no longer safely use their own, or a suction machine for sudden difficulty managing secretions, usually come the same day. The supplier’s technician sets everything up and walks caregivers through safe use.
If a piece of equipment breaks, the hospice arranges repair or replacement. Maintenance is included. When a patient’s condition changes and an item is no longer needed, the hospice coordinates pickup. Families should never be arranging or paying for any of this on their own.
Who Pays
Medicare pays the hospice agency a flat daily rate for each day a patient is enrolled, regardless of how many services are delivered that day.3Centers for Medicare & Medicaid Services. Hospice That rate is designed to cover the full range of hospice services, DME rental, delivery, setup, maintenance, and repair included. The patient owes nothing for any equipment related to the terminal illness.
Financial risk sits with the agency. If a patient needs an expensive item, the hospice absorbs the cost within the daily rate Medicare pays. That’s why most hospices contract with specific DME suppliers at negotiated rates rather than letting patients choose any supplier. The trade-off is real: zero out-of-pocket cost, but limited choice of supplier or brand.
One small cost does fall on the patient, and only on the drug side. Outpatient prescription drugs for symptom management carry a copayment of roughly five percent of the drug’s cost to the hospice, capped at $5 per prescription.4eCFR. 42 CFR 418.400 – Coinsurance DME has no copayment at all.
Equipment for Unrelated Conditions
When a patient elects hospice, they waive Medicare coverage for services related to the terminal illness and related conditions, except through the designated hospice.5eCFR. 42 CFR 418.24 – Election of Hospice Care Conditions that have nothing to do with the terminal diagnosis stay under regular Medicare, and that distinction matters for DME.
A patient with terminal lung cancer who also has a long-standing knee condition requiring a brace can keep receiving that brace through Medicare Part B. The DME supplier bills Part B using a GW modifier, which flags the item as unrelated to the hospice diagnosis. Without the modifier, Medicare denies the claim on the assumption that any DME billed during a hospice period is the hospice’s responsibility.6Centers for Medicare & Medicaid Services. 0114-Durable Medical Equipment Billed during Hospice Period – Unbundling
If a patient was renting DME through Part B before electing hospice and that equipment relates to the terminal condition, Part B stops paying. The hospice takes over. In practice, the hospice often continues the rental through the existing supplier under its own account, or swaps in equipment from its contracted supplier. If the pre-existing item is genuinely unrelated to the terminal illness, Part B rental continues with the GW modifier.
The gray area is where things get complicated. A patient with congestive heart failure on hospice who also has COPD might use oxygen for both. Whether that oxygen is “related” to the terminal diagnosis is a judgment call that affects billing. Ask the hospice team directly if a specific item’s status is unclear.
What Happens to Equipment If You Leave Hospice
Patients can revoke hospice at any time, for any reason. They can also be discharged if their condition stabilizes or they no longer meet eligibility. Either way, the hospice picks up every piece of equipment it provided.
After revocation or discharge, the patient returns to standard Medicare. Any DME they still need would come through Medicare Part B under the regular benefit, which typically involves a 20 percent coinsurance after the Part B deductible. The transition can leave a gap: the hospice retrieves its equipment, and the patient then needs a new prescription, a Part B supplier, and a delivery window. If a discharge is planned, ask the hospice team to start coordinating replacement equipment before the discharge date, not after.
For patients who re-elect hospice after revoking, the new hospice (or the same one) resumes DME responsibility from the new election date forward.
If the Hospice Declines to Provide Something
If the hospice team won’t provide an item the patient or family believes is necessary, there is a right to appeal. Medicare’s process lets beneficiaries challenge a refusal to cover any health care service, supply, or item, and hospice patients also have a right to a fast appeal when services are being reduced or ended.7Medicare.gov. Filing an Appeal
Before anything formal, raise the concern with the hospice medical director. Equipment decisions are clinical calls, and a direct conversation about why the item is needed often resolves the issue. If that doesn’t work, a formal claim with Medicare starts an appeals process that moves through redetermination by a Medicare Administrative Contractor and, if needed, independent review and administrative law judges.
Be realistic: appealing a hospice equipment denial is harder than appealing a standard Medicare denial. The hospice controls the plan of care, and the daily rate gives the agency a financial reason to limit expensive items. Document the medical need in writing, and if the attending physician is not employed by the hospice, ask that physician to back up the request.
What Hospice Won’t Provide
The benefit covers equipment and supplies tied to the terminal illness and related conditions. Anything outside that scope is on the family. Medicare also won’t pay room and board, whether the patient is at home, in a nursing facility, or in a hospice inpatient unit for routine care.8Medicare.gov. Hospice Care
Families typically pay out of pocket for non-medical comfort items like special pillows or blankets, personal care products, over-the-counter items the hospice hasn’t prescribed, and home modifications beyond what the hospice supplies as DME. Permanent bathroom renovations or a stair lift fall outside the benefit even when they serve a medical purpose. A portable grab bar or shower chair the hospice delivers is a different category from a contractor-installed renovation.
Curative treatment is also excluded once hospice is elected, including curative drugs and therapies and any services equivalent to hospice care provided by a non-designated provider.8Medicare.gov. Hospice Care Pursuing curative treatment means revoking the hospice election and returning to standard Medicare, which changes the DME arrangement entirely.