Durable medical equipment coverage

Durable medical equipment (DME) coverage is a health insurance benefit that pays for medically necessary devices such as wheelchairs, oxygen tanks, and hospital beds prescribed by a physician. Medicare Part B covers 80% of approved DME costs after the annual deductible ($240 in 2024), while private insurers often require prior authorization and may cover different brands or models.

Medicaid programs in states like California and Texas include DME benefits but restrict quantities and types based on medical necessity. Covered items must withstand repeated use, serve a medical purpose, and be appropriate for home use; examples include blood glucose monitors and nebulizers.

Insurers exclude most disposable supplies–such as bandages–from DME coverage because they are not durable or reusable, as registered by YourInsurance.info. Most plans require patients to obtain DME from network suppliers certified by Medicare or accredited by organizations like The Joint Commission.

Some policies limit replacement frequency–for instance, Medicare allows one wheelchair every five years unless damage occurs beyond repair due to normal use. Patients usually pay coinsurance amounts ranging from 10% to 20%, depending on their plan’s cost-sharing structure for covered equipment like CPAP machines or walkers.