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Medicare Coverage of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

October 6, 2016

Beneficiaries with Medicare Part B may have Medicare coverage for some types of durable medical equipment (DME). The durable medical equipment must be long-lasting, primarily used for a medical reason, and prescribed by a doctor to be used in your home. This can include medical equipment like wheelchairs, walkers, blood glucose monitors, and ostomy bags.

Medicare Part B also covers certain prosthetic and orthotic devices needed for partial or total replacement of an internal organ or to support an injured body part (such as a neck brace). This coverage doesn’t include dental appliances.

Medicare coverage of durable medical equipment and other supplies

Medicare Part B covers certain DME, prosthetics, orthotic items, and other supplies. Below is a list of some of the equipment and devices covered by the Medicare program.

Durable medical equipment:

  • Air fluidized beds
  • Blood glucose monitors and test strips
  • Canes
  • Crutches
  • Home oxygen equipment and supplies
  • Hospital beds
  • Infusion pumps
  • Ostomy supplies
  • Oxygen therapy equipment
  • Patient lifts
  • Ventilators or respiratory assist devices
  • Walkers
  • Wheelchairs

Prosthetic and orthotic supplies

  • Arm, leg, back, and neck braces
  • Prostheses, including artificial limbs, eyes, and breast prostheses
  • Prosthetic devices for internal body parts
  • Therapeutic shoes or inserts prescribed for those with diabetes
  • Intraocular lenses (IOLs)
  • Corrective glasses and contact lenses after cataract surgery that implants an intraocular lens

Medicare costs for durable medical equipment

Under Original Medicare, you pay 20% of the Medicare-approved amount for durable medical equipment, prosthetics, and orthotic supplies, after paying the Medicare Part B annual deductible.

Individuals can either rent or own equipment, depending on their needs and the type of DME. If you decide to purchase, Medicare will cover 80% of the Medicare-approved amount for the item, as well as the cost of repairs and replacement parts. If you rent, Medicare will make a monthly payment for the use of the equipment, and any cost for repairs or replacements will be covered by the supplier. You may have different costs, depending on the type of equipment.

Medicare Competitive Bidding Program

In 2011, Medicare launched the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program in an effort to lower government and beneficiary costs for medical equipment. Under this program, DMEPOS suppliers must compete for Medicare contracts by submitting bids. Suppliers with winning bids become Medicare contract suppliers, and, with a few exceptions, Medicare beneficiaries must get durable medical equipment and other supplies from Medicare contract suppliers to be covered. Medicare is required to reopen the bidding process at least once every three years.

In general, if you have Original Medicare and live in an area affected by the program, Medicare won’t cover your DMEPOS costs unless you purchase or rent equipment from one of its contract suppliers. There may be exceptions if you get your medical equipment directly from a hospital or if your DMEPOS supplier is a “grandfathered” supplier. Grandfathered suppliers are suppliers that didn’t win a Medicare contract, but can continue renting equipment to Medicare beneficiaries who were already renting from them when the program began in their area. If your supplier is grandfathered, you may only rent the same items you were renting when the program started and only until the rental period ends. If you rent additional equipment, Medicare won’t cover the cost for those items unless you use a Medicare contracted supplier.

If your supplier decides not to be grandfathered, you will have to switch to a Medicare contract supplier, although there are exceptions for some types of rented equipment, such as oxygen equipment.

Medicare’s Competitive Bidding Program is currently only available in certain regions. To see if your area is affected and/or to find a Medicare supplier, visit Medicare.gov.  If you live in a region that is part of Medicare’s Competitive Bidding Program, it’s advisable to make sure that your supplier is a Medicare contracted supplier for the Medicare Competitive Bidding program, or Medicare may not pay your claim.

For additional information on Medicare-covered equipment and supplies in your area, you may also call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users can dial 1-877-486-2048.

If you live in an area not yet affected by the Competitive Bidding Program, costs may depend on the type of equipment and whether your supplier accepts Medicare assignment. DMEPOS suppliers that accept assignment agree not to charge more than the Medicare-approved amount for equipment, and you will not be billed more than your Part B annual deductible and coinsurance. Keep in mind that if you live in an area that isn’t part of the program, but travel to a participating area and need equipment there, you will need to use a Medicare contract supplier, or Medicare may not cover the medical equipment or supply.

For individuals enrolled in Medicare Advantage plans, Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) costs will vary depending on the plan and may be lower than Original Medicare. Medicare Advantage plans are offered by private insurance companies that contract with Medicare.  Medicare Advantage plans must offer the same coverage as Medicare Part A and B (except hospice care), and many Medicare Advantage plans offer additional benefits, such as routine vision, hearing or prescription drug coverage.  If you are enrolled in a Medicare Advantage plan and need medical equipment, you may want to call your plan’s Customer Service for specific cost and coverage information.