Medicare and medical equipment — what's covered and the approval process

This article provides general information about Medicare coverage and approval processes. Coverage details and eligibility vary by individual circumstances, plan type, and location. Always verify current coverage with Medicare directly or consult your parent's insurance specialist before making equipment purchases.

I remember the moment my mother's doctor handed her a prescription for a walker. We both stared at it like we were deciphering instructions in a foreign language. How much would this cost? Would Medicare pay for it? And how long would the whole approval process take?

These are the questions that keep adult children awake at night. The good news is that Medicare does cover many of the medical devices and equipment that help older adults stay independent. The less good news is that understanding what's covered and how to get approval requires patience and some bureaucratic navigation.

Let me walk you through what I've learned from helping my mother through this process.

What Medicare Part B Actually Covers

Medicare Part B covers durable medical equipment, or DME. The term itself is dry and uninspiring, but what it represents is significant: wheelchairs, walkers, canes, crutches, hospital beds, oxygen equipment, CPAP machines, compression stockings, and many other items that genuinely make daily life more manageable.

The key word here is "durable." Medicare wants equipment that can withstand repeated use and isn't considered disposable. So splints, elastic bandages, surgical supplies, and other consumables typically don't qualify. Neither do items considered comfort or convenience items, no matter how much we might think our parent needs them.

There's also the requirement that the equipment must be medically necessary. This isn't just about wanting something. There has to be a clinical reason a doctor believes this specific piece of equipment will help treat a medical condition or improve function. A manual wheelchair for someone who can walk fine doesn't meet this standard. Oxygen equipment for someone with adequate blood oxygen levels doesn't qualify either.

Medicare Part B covers 80 percent of approved equipment costs after you've met your yearly deductible. The remaining 20 percent becomes your responsibility, though some supplemental insurance plans may cover this.

The Approval Process Step by Step

Here's how it typically works in practice.

First comes the prescription. Your parent's doctor must prescribe the specific equipment. This is non-negotiable. The prescription needs to include details about why the equipment is medically necessary, the specific type needed, and sometimes even the quantities required. Don't assume the doctor will know to write this prescription. Sometimes I had to specifically ask my mother's physician to write one for her walker.

Next, you need to choose a Medicare-approved supplier. Not all medical equipment suppliers are equal in the eyes of Medicare. Look for suppliers that display the DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) seal. These suppliers have met Medicare's quality and customer service standards. You can find approved suppliers in your area on the Medicare website. The prescription can be filled at any approved supplier you choose. Don't feel locked into the one your doctor mentions first.

Then comes the prior authorization request. Some equipment requires that the supplier get approval from Medicare before you actually receive the item. The supplier typically handles this paperwork, but it can take one to two weeks. Other equipment doesn't require prior authorization at all. It's worth asking the supplier upfront whether prior authorization is needed for your parent's specific situation.

The supplier will submit the prescription and any supporting documentation to Medicare. They'll often need detailed information about your parent's condition, why this specific equipment is necessary, and sometimes even measurements or specifications. This is where things can feel intrusive. But Medicare is essentially asking: is this really necessary, or are we paying for something unnecessary?

Once Medicare reviews everything, they send approval or denial. If approved, the supplier can proceed. You might rent or purchase the equipment depending on what works best financially and practically. Some equipment can be rented through Medicare; others must be purchased. Medicare has specific rules about this.

When Medicare Says No

Denials happen more often than anyone would like. Maybe the medical documentation wasn't detailed enough. Maybe Medicare believes your parent's condition doesn't quite meet their clinical criteria. Maybe the equipment your parent's doctor recommended has been deemed by Medicare as not medically necessary for that particular condition.

When denial arrives, it feels personal. But it's not. It's a system working from standardized criteria. Medicare has specific diagnoses and specific situations where they'll approve certain equipment. If your parent's diagnosis or situation doesn't align, the approval gets denied automatically. That doesn't mean the equipment is actually unnecessary. It means it doesn't fit Medicare's criteria.

You have appeal rights. You can request that Medicare reconsider the decision, and you can provide additional medical evidence. Sometimes a second, more detailed letter from the doctor explaining the clinical necessity can turn a denial into approval. You have 120 days from the denial notice to file an appeal. There are actually multiple levels of appeal available if the first one doesn't work. The first appeal goes to Medicare directly. If that fails, you can request a hearing before a hearing officer. Additional appeals are available beyond that.

The appeals process takes time. Sometimes months. But persistence pays off. I know families who received denial letters, appealed, and eventually got approval. The key is providing detailed medical information that connects your parent's condition to why this equipment is genuinely necessary.

Finding Alternatives When Medicare Won't Pay

Sometimes it's worth fighting the denial. Sometimes it's worth looking elsewhere.

Medicaid might cover equipment Medicare doesn't. Supplemental insurance sometimes covers the 20 percent coinsurance and occasionally covers items Medicare rejects. Some manufacturers offer patient assistance programs for those who qualify financially. Nonprofit organizations focused on specific conditions sometimes loan or donate equipment.

Your parent's doctor might also have suggestions for alternative equipment that Medicare would more readily approve. There's often more than one way to solve a mobility or functional problem.

The financial reality is that good medical equipment costs money. If Medicare won't cover it and your parent needs it, you have to make decisions about what your family can afford. That's a genuine struggle, and I've been there.

Understanding Rental vs. Purchase

One decision that often comes up is whether to rent or purchase equipment. Medicare has specific rules about which equipment they prefer to rent versus own. For some items like hospital beds or wheelchairs, Medicare might require renting for a certain number of months before transitioning to ownership. For other items, purchase is the only option.

Rental can make sense financially if your parent might not need the equipment long-term. After surgery, they might use a walker for three months and then never again. Purchasing a walker for three months of use doesn't make sense. But if your parent has a chronic condition like COPD that requires equipment indefinitely, owning eventually costs less than endless rental payments.

Ask the supplier to explain the Medicare rules for your parent's specific equipment. Some suppliers are better equipped to handle rentals. Others work primarily with sales. You want to work with someone who understands the option that works best for your parent.

What Helps You work through This

Keep organized records. Store copies of prescriptions, approval letters, denial letters, and insurance correspondence in one place. When you need to appeal or apply for something new, this history becomes valuable documentation. Create a simple timeline showing when you applied, when Medicare responded, and what they said. This helps if you need to appeal or if problems arise later.

Don't be shy about asking questions. Call Medicare directly at 1-800-MEDICARE if you're confused about coverage. Ask your parent's doctor to be specific in prescriptions. Ask the supplier exactly what paperwork they're submitting and on what timeline. Request a timeline for the entire process before you start. Knowing you'll wait two weeks for prior authorization is better than wondering why your equipment hasn't arrived.

Get everything in writing. If the supplier tells you Medicare will pay for the equipment, get that in writing. If they tell you there's a cost, get documentation. Verbal promises mean nothing when insurance is involved.

Remember that the people processing these requests aren't trying to deny your parent needed equipment. They're trying to manage a massive system with limited resources. Being respectful and organized in your approach tends to yield better results than frustration. If you need to appeal, include a personal story about why this equipment matters. Dry medical language gets lost in the system. Explaining how your parent's life improves with the equipment sometimes moves the conversation forward.

Consider working with a patient advocate if the process gets complicated. Some hospital systems have advocates who help work through insurance. Some nonprofit organizations focused on specific conditions offer this service. Having someone trained in insurance issues sometimes breaks through barriers you hit on your own.

The approval process for medical equipment feels designed to test your patience. But on the other side of that process is equipment that genuinely helps your parent maintain independence and dignity. That's what makes the paperwork and waiting worthwhile.

Always confirm coverage details directly with Medicare or your parent's insurance provider. Requirements and coverage types change. The information here reflects general processes but may not apply to every situation or plan type. When in doubt, contact your parent's Medicare representative or insurance specialist for specific guidance about their coverage.