Medicare’s Durable Medical Equipment (DME) Benefits

The short answer is, Yes, Medicare does pay for Durable Medical Equipment (DME)! However, prior to a thorough discussion of the details, it is important to be aware of the different types of Medicare coverage, as the benefits differ based on one’s type of coverage. Medicare Part A is hospital insurance and Part B is for medical outpatient services. (Part A and Part B is sometimes referred to as Original Medicare). Part C (also called Medicare Advantage or MA) combines Part A and Part B and generally offers additional benefits, such as vision and dental. Part C is sold by private companies, rather than provided by the government. Medicare Part D is for prescription drugs and is not relevant to the discussion on DME.

Part A covers medical equipment for individuals who are in a skilled nursing facility or in the hospital. If the equipment is medically necessary and purchased from an approved supplier, Medicare Part A will pay for 80% (if one’s annual deductible has been met) of the allowable amount for any specific item. The individual or their supplemental insurance is responsible for paying for the remaining 20% and any amount over the allowable limit.

Part B pays for medical equipment to be used in one’s home for most Medicare recipients, even if they are not confined to their home. In addition to one’s private home, a personal care residence, such as an assisted living facility, can be considered one’s “home”. A nursing home does not qualify as one’s “home”. Home medical equipment must be medically necessary, prescribed by one’s physician, and purchased from a Medicare-approved supplier. Medicare Part B pays for 80% (if one’s annual deductible has been met) of the allowable purchase price. The individual or their supplemental insurance is responsible for the remaining 20% and any amount over the allowable limit.

Part C, which as mentioned previously, is also known as Medicare Advantage Plans, is required by law to provide, at a minimum, the same coverage as Part A and Part B. Therefore, if one has Medicare Part C, their plan will pay at least 80% of the allowable limit for durable medical equipment.

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