Understanding Medicare & Durable Medical Equipment (DME)

by Vince Baiera December 16, 2025

What Medicare Really Covers—and What It Doesn’t—When It Comes to DME

Navigating Medicare can feel overwhelming, especially when you or a loved one needs durable medical equipment (DME) to stay safe, mobile, and independent at home. Questions like “Is this covered?”, “Do I need a prescription?”, or “Why was my claim denied?” are common—and completely understandable.

This guide breaks down how Medicare works with DME, what qualifies, what doesn’t, and how to make smarter decisions so you avoid costly mistakes. Whether you’re a caregiver, a senior planning ahead, or a patient recently discharged from the hospital, understanding these rules can make a meaningful difference in your quality of life and financial peace of mind.

What Is Durable Medical Equipment (DME)?

Durable Medical Equipment refers to medical-grade equipment designed for repeated use that helps manage a medical condition or improve daily function. Under Medicare, DME must meet five core criteria:

Durable – Able to withstand repeated use (not disposable)
Medical purpose – Primarily used for a medical reason
Not useful to someone without illness or injury
Used in the home – Including assisted living or a private residence
Prescribed by a Medicare-enrolled provider

Common examples include:

Walkers and canes
Wheelchairs and scooters
Hospital beds
Oxygen equipment
Commodes and transfer aids

However, not every helpful or safety-related product automatically qualifies—even if it improves daily living.

Medicare at a Glance: Parts That Affect DME

Understanding which part of Medicare applies is critical before purchasing or ordering equipment.

Medicare Part A (Hospital Insurance)

Part A may cover DME only during an inpatient hospital stay or short-term skilled nursing facility stay. Once you’re discharged home, Part A generally stops paying for equipment.

Medicare Part B (Medical Insurance)

This is the primary Medicare coverage for DME used at home.

Under Part B:

Medicare typically pays 80% of the approved amount
You pay 20% coinsurance (after meeting your deductible)
Equipment must be obtained from a Medicare-enrolled supplier

Medicare Advantage (Part C)

Part C plans are offered by private insurers and must cover at least what Parts A and B cover—but rules can differ.

Important differences may include:

Prior authorization requirements
Limited supplier networks
Different replacement schedules

Always check your plan details before ordering equipment.

What DME Does Medicare Commonly Cover?

Medicare Part B covers a wide range of equipment—but only when medical necessity is clearly documented.

Mobility Equipment

Walkers (standard, rolling)
Canes (limited types)
Manual and power wheelchairs
Mobility scooters

Coverage depends on your ability to move inside your home, not outside or recreational use.

Beds and Support Surfaces

Hospital beds (manual, semi-electric)
Pressure-reducing mattresses (with qualifying diagnoses)

Standard home beds or adjustable beds are not covered.

Respiratory Equipment

Oxygen concentrators
CPAP machines (for sleep apnea)
Nebulizers

Strict testing and compliance documentation is required.

Other Covered Equipment

Patient lifts
Commodes (bedside only)
Diabetic testing supplies

What Medicare Does Not Cover (And Why)

Many people are surprised to learn that Medicare does not cover convenience or preventive items, even if they clearly improve safety.

Examples of typically non-covered items include:

Bathroom safety equipment (most grab bars, shower steps)
Home modifications (ramps, stair lifts)
Over-the-counter supplies
Items primarily for comfort or convenience

That doesn’t mean these products lack value—it simply means Medicare classifies them differently.

In fact, many families choose to invest out-of-pocket in safety-focused solutions because they reduce fall risk and hospital readmissions.

Medical Necessity: The Key to Coverage

Medicare coverage hinges on medical necessity, which must be supported by:

A face-to-face visit with your provider
A written prescription (order)
Clinical notes explaining why the equipment is required

If documentation is incomplete or vague, claims are often denied.

Tip: Always ask your provider to clearly state how the equipment helps you function safely inside your home.

Renting vs. Buying DME

Medicare often decides whether equipment is rented or purchased, not the patient.

Rental Equipment

Common rental items include:

Oxygen equipment
Hospital beds
Wheelchairs (initial period)

Monthly rental fees apply, and Medicare pays its share each month.

Purchased Equipment

Items like walkers or commodes are typically purchased outright.

Ownership usually transfers to you after Medicare pays its portion.

Choosing a Medicare-Enrolled Supplier

Medicare will only pay if the supplier:

Is enrolled in Medicare
Accepts assignment (agrees to Medicare-approved pricing)

Using a non-participating supplier can result in significantly higher out-of-pocket costs—or no coverage at all.

Why Safety Equipment Still Matters—Even Without Coverage

While Medicare rules are strict, safety doesn’t wait for approval.

Many caregivers discover that preventing falls and injuries at home often requires tools Medicare doesn’t classify as DME.

For example, products that assist with getting in and out of bed safely can dramatically reduce nighttime falls—even though Medicare may not cover them.

One such solution is the Step2Bed, a bedside safety step designed to provide stable support and motion-activated lighting for safer nighttime mobility. Families often choose it as a proactive safety measure rather than waiting for an injury to occur.

Similarly, bathroom-related falls remain one of the leading causes of injury among older adults. A product like the Step2Tub, which adds a stable intermediate step for entering and exiting the bathtub, can significantly reduce risk during daily routines.

While these products may not fall under Medicare’s DME definition, they often align perfectly with what Medicare intends: helping people remain safe and independent at home.

How DME Fits Into Aging in Place

Aging in place is about maintaining independence without sacrificing safety.

DME plays a critical role by:

Reducing fall risk
Supporting mobility limitations
Preventing hospital readmissions
Supporting caregivers

In our related article, Seasonal Home-Safety Checklist, we discuss how small changes—especially during colder or darker months—can prevent injuries before they happen.

Common Reasons Medicare DME Claims Are Denied

Understanding denial reasons can save time and frustration.

Top causes include:

Missing or unclear documentation
Equipment deemed “not medically necessary”
Supplier not enrolled in Medicare
Diagnosis doesn’t match coverage criteria
Item classified as convenience or preventive

Appeals are possible, but prevention is easier than correction.

Tips for Maximizing Your Medicare DME Benefits

Prepare before appointments – Know what equipment you’re requesting
Ask direct questions – “Is this covered under Part B?”
Use enrolled suppliers only
Keep copies of prescriptions and clinical notes
Plan ahead – Don’t wait until a crisis

Medicare, Caregivers, and Family Decision-Making

Caregivers often juggle medical, financial, and emotional responsibilities.

Understanding DME rules helps caregivers:

Advocate effectively
Budget realistically
Reduce stress during transitions of care

Education is one of the most powerful tools caregivers can have.

Frequently Asked Questions (FAQs)

Does Medicare cover all durable medical equipment?

No. Medicare only covers equipment that meets its strict definition of DME and is deemed medically necessary for use in the home.

Do I need a prescription for DME?

Yes. Most DME requires a written order from a Medicare-enrolled provider.

Will Medicare pay for bathroom safety equipment?

Generally no. Items like tub steps or grab bars are usually considered preventive or convenience items.

Can I buy DME online and get reimbursed?

Only if the supplier is Medicare-enrolled and accepts assignment. Otherwise, reimbursement is unlikely.

What if my Medicare Advantage plan says no?

You can appeal, but coverage rules vary by plan. Always review your plan’s evidence of coverage.

Is DME coverage the same in assisted living?

Yes, as long as the equipment is used in your personal living space—not a shared facility area.

Recommendations: Making Smart, Safe Choices

Understand Medicare—but don’t rely on it alone for safety
Invest early in fall-prevention solutions
Balance coverage rules with real-world needs
Choose products designed for long-term use and stability

Sometimes the most valuable equipment is the kind that prevents the need for Medicare coverage in the first place.