Medicare and medical equipment — what's covered and how to get it
This article is for educational purposes only and does not constitute medical, legal, or financial advice. Every family situation is different, and you should consult with appropriate professionals about your specific circumstances.
Your parent's doctor says they need a walker. The hospital discharge planner says your parent needs a hospital bed. Your parent's therapist says a wheelchair would help them get around the house. Medical equipment becomes part of aging with a chronic condition or recovery from an injury. But here's what nobody explains clearly: what Medicare covers, what your parent has to pay for, and how long it actually takes to get equipment delivered when your parent needs it right now.
Medical equipment can be expensive. A decent wheelchair costs a thousand dollars or more. A hospital bed with an adjustable frame is several hundred dollars. Oxygen equipment rental costs money every month. If your parent buys these things out of pocket, it adds up quickly. The good news is that Medicare covers a lot of medical equipment. The challenging news is that getting that equipment approved and delivered sometimes involves unexpected hoops to jump through.
Understanding what Medicare covers and how the approval process works can save your parent thousands of dollars and weeks of frustration. It also means the difference between your parent getting the right equipment in time versus your parent struggling without it.
What Medicare Calls Durable Medical Equipment
Medicare has a specific category for equipment it covers. The term is durable medical equipment, abbreviated DME. Equipment qualifies as DME if it's designed to withstand extended use, serves a specific medical purpose, isn't primarily for comfort, and is typically not useful to someone without a medical condition.
Walkers, canes, and crutches are DME. Wheelchairs are DME. Hospital beds and adjustable bed frames are DME. Commodes and raised toilet seats are DME. Grab bars and shower chairs are DME. Oxygen equipment and CPAP machines are DME. Continuous positive airway pressure machines for sleep apnea treatment fall under DME. Traction equipment, certain respiratory equipment, and mobility devices all fit into the DME category.
What's not included in DME is surprisingly specific. Comfort items like cushions or padding aren't covered by themselves. A wheelchair is covered, but a wheelchair cover or specialized wheelchair cushion might not be covered by Medicare, even though the wheelchair is. Orthopedic shoes are partially covered if your parent has diabetes and meets specific criteria, but regular shoes aren't covered. Compression stockings might be covered for specific conditions but not for prevention.
This distinction matters because your parent might assume everything related to their care is covered. A doctor prescribes a wheelchair. Your parent assumes the wheelchair, the cushion, and the cover are all covered. Then the bill arrives and the wheelchair company says the cushion isn't covered. Your parent has to pay for it separately or do without.
Coverage vs. Non-Coverage: The Surprising Differences
One of the most frustrating aspects of Medicare equipment coverage is that the rules are specific and sometimes counterintuitive. Medicare will cover a hospital bed but not the mattress. Medicare will cover a walker but not the new grips if your parent finds the original grips uncomfortable. Medicare will cover a wheelchair but not the transport bag for getting it in and out of the car.
This isn't because Medicare is being difficult. It's because DME coverage is tied to medical necessity as defined in Medicare rules. A hospital bed is medically necessary for certain conditions. The mattress is assumed to be a basic component that comes with the bed. But premium pillows or specialized mattresses aren't covered because Medicare defines them as comfort items rather than medical necessity.
Similarly, oxygen equipment for someone with breathing problems is medically necessary. But the portable oxygen cart that makes it easier to carry the equipment around the house might not be covered. The oxygen concentrator itself is covered, but the accessories aren't.
These distinctions mean your parent might need to pay out of pocket for certain items even though the primary equipment is covered. Understanding this ahead of time prevents shock when the bill arrives.
Another surprise is that Medicare covers some items only for specific diagnoses. Diabetic shoes are covered for people with diabetes who meet certain criteria. But those same shoes aren't covered for someone with arthritis, even if they'd benefit from them. Prosthetic devices are covered for people with amputations. But the prosthetic isn't covered for someone who's trying to avoid an amputation.
The takeaway is this: just because a piece of equipment exists and your parent could benefit from it doesn't mean Medicare covers it. The coverage is tied to specific conditions, specific diagnoses, and specific medical necessity criteria. Before your parent's equipment is prescribed, it's worth asking the doctor what Medicare covers and what your parent would need to pay for themselves.
How Equipment Gets Prescribed and Approved
Your parent doesn't just walk into a medical equipment store and buy equipment. Equipment needs to be prescribed by a doctor or healthcare provider. Medicare won't cover equipment that your parent orders themselves.
The prescription should be specific. It's not enough for a doctor to write "wheelchair." The prescription should include the type of wheelchair, the specifications, and the reason your parent needs it. The prescription becomes part of the approval process.
Once a prescription is written, your parent can take it to any Medicare-approved DME supplier. The supplier doesn't have to be local, though local is more convenient. The supplier handles the Medicare approval process. For some equipment, Medicare approves it automatically. For other equipment, the supplier requests prior authorization from Medicare.
Prior authorization means the supplier asks Medicare, "Does my patient qualify for this equipment under Medicare rules?" Medicare reviews the prescription, the diagnosis, and the patient's health status. Medicare says yes or no. For common equipment like walkers or canes, approval is usually automatic. For expensive equipment like power wheelchairs or specialized beds, Medicare might need more information.
The prior authorization process can add days or weeks to equipment delivery. If your parent needs a wheelchair urgently, the authorization delay is frustrating. If your parent is planning ahead, the delay is manageable.
Some equipment doesn't require prior authorization. A cane, walker, or standard wheelchair can be dispensed quickly. More specialized equipment might need authorization. Asking the DME supplier about authorization requirements before ordering saves time.
Your Role in Timing and Equipment Selection
Here's something that catches many adult children off guard: the time between a prescription and equipment delivery can be weeks. Your parent's doctor says your parent needs a walker. You call a DME supplier. The supplier says it'll be two to three weeks before the walker arrives. Two to three weeks while your parent is using a cane and at risk of falling.
This timing issue is why planning ahead matters. If your parent is recovering from surgery and the doctor mentions they might need a wheelchair at discharge, ordering the wheelchair weeks before discharge means it's ready when your parent comes home. If your parent is recovering well and the wheelchair becomes unnecessary, the wheelchair can be returned. But if your parent didn't order it, the wheelchair might not be available for weeks after discharge.
Discharge planners at hospitals sometimes feel rushed. They want your parent out of the hospital and home. They might order equipment quickly without fully thinking through whether it's the best choice for your parent. You can slow this process down. Take a day or two to think about what your parent actually needs. Ask whether there are alternatives. Make sure the equipment makes sense before ordering.
The same goes for choosing equipment. Your parent might need a wheelchair, but should it be a manual wheelchair or a power wheelchair? A manual wheelchair is lighter and more portable but requires upper body strength to operate. A power wheelchair is heavier but easier for someone with limited strength. This choice should be based on your parent's capabilities, not on rushing the decision.
Your parent might resist getting equipment they feel signals dependence or decline. A parent who's always been independent might resist using a walker or wheelchair. Understanding your parent's feelings and giving them time to adjust to the idea can help. Equipment that sits unused because your parent wouldn't accept it is wasted money.
Before equipment is ordered, talk with your parent about what they actually need and what they're willing to use. A mobility aid that your parent uses is far better than the perfect equipment your parent refuses to use.
Understanding Your Parent's Cost Responsibility
Medicare covers eighty percent of approved DME costs after your parent has met the Part B deductible. Your parent pays the remaining twenty percent coinsurance. If approved equipment costs a thousand dollars, Medicare pays eight hundred dollars. Your parent pays two hundred dollars.
The specific amount your parent owes depends on whether they have supplemental insurance. If your parent has a Medigap policy, the Medigap policy might cover the twenty percent coinsurance. If your parent has a Medicare Advantage plan, the plan might cap your parent's coinsurance at a specific dollar amount. If your parent has neither, they pay the full twenty percent.
Some DME suppliers offer payment plans for your parent's out-of-pocket costs. If a wheelchair costs a thousand dollars and your parent owes two hundred dollars coinsurance, some suppliers will let your parent pay twenty dollars per month instead of a lump sum. It's worth asking.
Another option is finding used equipment. Medicare doesn't require new equipment. Used equipment that's in good condition can work just as well and costs much less. Your parent might pay significantly less out of pocket for used equipment because the base cost is lower. Ask the DME supplier about used options.
Some nonprofits and community organizations provide used medical equipment at no cost or low cost. If your parent qualifies based on income or need, these organizations can provide equipment without your parent paying anything. The equipment might be older or basic, but it's functional.
Common Surprises and How to Prevent Them
The biggest surprise people encounter is that Medicare approves equipment but the approval has restrictions your parent didn't expect. Your parent's Medicare Advantage plan might approve equipment that your parent assumed would be free but actually requires a specialist authorization. Your parent's Original Medicare might cover a hospital bed but not the specific type the doctor recommended.
Another surprise is discovering that your parent is responsible for the physical logistics of getting equipment delivered and set up. If your parent orders a hospital bed, who moves the old furniture to make space? Who assembles the bed if it comes in pieces? Some DME suppliers include delivery and setup. Others drop equipment at the door and leave. If your parent is paying out of pocket for these logistics, the total cost rises.
A third surprise is that equipment prescribed in a hospital or rehabilitation facility might work differently when your parent is at home. A wheelchair your parent used successfully in physical therapy might not fit through doorways at home. A walker prescribed at the hospital might be too wide for your parent's kitchen. Thinking about your parent's actual living space before ordering equipment prevents mismatch.
Yet another surprise happens with ongoing costs. Some equipment requires maintenance, batteries, or replacement parts. A CPAP machine requires replacement masks regularly. A power wheelchair requires battery replacement. An oxygen concentrator requires servicing. These ongoing costs aren't covered by the initial DME benefit. Your parent needs to budget for these separately.
The final surprise is that some Medicare-covered equipment becomes outdated quickly, and newer versions aren't covered. Your parent's wheelchair works fine, but newer wheelchair models have better wheels and more comfortable seating. Medicare won't cover the upgrade because your parent's current wheelchair still functions. Your parent can pay out of pocket for the upgrade, but it won't be covered.
Planning ahead prevents some of these surprises. Thinking about your parent's living space, the type of equipment they're willing to use, and the ongoing costs of equipment ownership makes the difference between equipment that's helpful and equipment that creates problems.
How To Help Your Elders is an educational resource. We do not provide medical, legal, or financial advice. The information in this article is general in nature and may not apply to your specific situation. If you are concerned about a loved one's medical equipment needs or coverage, consult with their healthcare provider, contact your state SHIP program, or call 1-800-MEDICARE.