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

Reviewed by the How To Help Your Elders editorial team

Medicare covers many medical devices that help older adults stay independent, from wheelchairs and walkers to hospital beds and oxygen equipment. The approval process requires patience and some bureaucratic persistence, but understanding what's covered, how to get approval, and what to do when Medicare says no puts you in the strongest position to get your parent what they need.

Medicare Part B Covers Durable Medical Equipment

According to CMS, Medicare Part B spent over $7.5 billion on durable medical equipment in recent years, covering wheelchairs, walkers, canes, crutches, hospital beds, oxygen equipment, CPAP machines, and many other items. The key requirements are that equipment must be durable (not disposable), medically necessary (not just for comfort), and prescribed by a doctor enrolled in Medicare.

Medicare Part B covers 80 percent of approved equipment costs after the yearly deductible. The remaining 20 percent is your parent's responsibility, though supplemental insurance may cover this portion.

How the Approval Process Works

First, your parent's doctor must prescribe the specific equipment with documentation of why it's medically necessary, the specific type needed, and sometimes quantities. Sometimes you have to ask the doctor specifically to write this prescription.

Next, choose a Medicare-approved supplier. Look for suppliers that display the DMEPOS seal. You can find approved suppliers on the Medicare website. The prescription can be filled at any approved supplier you choose.

Some equipment requires prior authorization before you receive it. The supplier typically handles this paperwork, which can take one to two weeks. The supplier submits the prescription and supporting documentation to Medicare. Once Medicare reviews everything, they send approval or denial. If approved, the supplier proceeds. You may rent or purchase depending on what works best financially. Medicare has specific rules about which option applies to which equipment.

When Medicare Says No

Denials happen more often than anyone would like. The documentation may not be detailed enough, or your parent's condition may not meet Medicare's specific clinical criteria. A denial doesn't mean the equipment is unnecessary. It means it doesn't fit Medicare's current criteria.

You have appeal rights. Request reconsideration within 120 days, providing additional medical evidence. A more detailed letter from the doctor explaining clinical necessity often turns a denial around. There are multiple levels of appeal: first to Medicare directly, then to a hearing officer, with additional appeals beyond that. The process takes time, sometimes months, but persistence pays off.

Alternatives When Medicare Won't Pay

Medicaid may cover equipment Medicare doesn't. Supplemental insurance sometimes covers the 20 percent coinsurance. Some manufacturers offer patient assistance programs. Nonprofits focused on specific conditions sometimes loan or donate equipment. Your parent's doctor may suggest alternative equipment that Medicare would more readily approve.

Rental vs. Purchase

Medicare has specific rules about which equipment they prefer to rent versus purchase. For some items like hospital beds, Medicare may require renting for a certain number of months before transitioning to ownership. For temporary needs, rental makes financial sense. For chronic conditions requiring equipment indefinitely, purchasing eventually costs less.

Making the Process Work

Keep organized records of prescriptions, approval letters, denial letters, and insurance correspondence. Create a timeline of applications and responses. Call Medicare directly at 1-800-MEDICARE when confused about coverage. Ask the supplier exactly what paperwork they're submitting and on what timeline. Get everything in writing. Verbal promises mean nothing when insurance is involved.

Consider working with a patient advocate if the process gets complicated. Some hospital systems have advocates who help with insurance issues. Being respectful and organized yields better results than frustration. When appealing, include context about how your parent's life improves with the equipment. The approval process tests patience, but on the other side is equipment that genuinely helps your parent maintain independence.

Frequently Asked Questions

What does "medically necessary" mean for Medicare purposes? It means a doctor has documented that the equipment is needed to treat a medical condition or improve function, not just for comfort or convenience. The diagnosis and the specific need must be clearly connected in the prescription.

How long does Medicare approval take? Without prior authorization, approval can happen at the point of sale. When prior authorization is required, expect one to three weeks. Appeals of denials can take weeks to months depending on the level of appeal.

Can I use any medical equipment supplier with Medicare? No. Your parent must use a Medicare-approved DMEPOS supplier. Using a non-approved supplier means Medicare won't pay. Search for approved suppliers on Medicare.gov or call 1-800-MEDICARE.

What if my parent needs equipment urgently? For urgent medical needs, the supplier can sometimes expedite the process. In emergencies, equipment may be provided immediately with paperwork filed retroactively. Communicate urgency to both the doctor and supplier.

Does Medicare cover repairs and maintenance? Medicare covers reasonable and necessary repairs and replacement of equipment when medically justified. Contact your supplier about repair coverage. Replacement due to normal wear may require a new prescription.