What Medical Supplies Does Medicare Cover?
This article was updated on: 10/21/2018
If you live at home and need medical equipment and supplies, Original Medicare (Part A and Part B) may cover some of your costs. Under Medicare, some home-care items fall under the category of Durable Medical Equipment, or DME. To qualify for coverage, your equipment must be prescribed by a Medicare-approved physician and supplied by a participating supplier. Please note that the term “medical supplies” in this article usually refers to DME and not to prescription drugs.
Medicare requires that durable medical equipment (DME) be:
- Durable (expected to last three years or more)
- Medical in nature (used for a medical reason)
- For use in your home
- Generally, not useful to someone who isn’t injured or ill
Under these guidelines, a cane or walker would usually be covered, but a room humidifier, for example, would not be, since it’s not exclusive to medical use.
What types of medical supplies may qualify for Medicare coverage?
Only equipment or medical supplies prescribed by your health care provider may qualify for coverage under your Original Medicare Part B benefits, subject to certain restrictions and conditions (please note the qualifications for durable medical equipment, or DME, listed above). In general, the following types of medical supplies or DME would be eligible for Medicare coverage:
- Hospital beds, lifts, and commode chairs
- Infusion pumps and supplies
- Blood glucose monitors and test strips
- Canes, crutches, walkers, and certain types of wheelchairs
- Oxygen, nebulizers, and nebulizer supplies and medications
- Continuous positive airway pressure (CPAP) machines and supplies
This list is not comprehensive and your health-care provider and equipment supplier can help you with Medicare coverage of specific items not on this list.
What are the restrictions of Medicare coverage for medical supplies?
Medicare coverage for durable medical equipment (DME) is part of your Part B benefits, provided that it is medically necessary and prescribed by your doctor for use at home. In order to qualify, your equipment or medical supplies must be prescribed by and purchased from providers who participate in the Medicare program and accept assignment (you can search the directory for a supplier on Medicare.gov). In most cases, you pay 20 percent of the amount allowed under Medicare after you’ve met any applicable Part B deductible amounts.
If you live in certain parts of the country, however, your equipment or medical supplies may be subject to the Competitive Bidding Program, a new cost-saving initiative that is helping Medicare bring health-care costs into alignment with actual prices for qualifying items. If the Competitive Bidding Program applies to your Medicare coverage, you must use a supplier contracted with the Medicare program in order to receive your benefits.
Are prescription drugs considered medical supplies under Medicare?
Prescription drugs you take at home generally do not qualify for coverage under Original Medicare, Part A and Part B, except under very limited circumstances, such as certain medications used in a nebulizer device. If you need prescription drug coverage, you may want to consider a Medicare plan that includes prescription drug coverage. Please note that a Medicare plan that includes prescription drug coverage will have a formulary, or a list of covered prescription drugs, and the formulary may change at any time (though you will receive a notice when necessary).
If you have health-care expenses for prescription drugs and are covered by Original Medicare, you may want to consider a stand-alone Medicare Part D Prescription Drug Plan to help lower your prescription drug costs now and in the future. There is a second way to receive Medicare prescription drug coverage, and that is through a Medicare Advantage Prescription Drug plan (discussed below).
You may want to consider receiving your Original Medicare (Part A and Part B) coverage through an alternative method called a Medicare Advantage plan. A Medicare Advantage plan covers the same medical supplies and other health care services as Original Medicare (except for hospice care, which Part A still provides). Most Medicare Advantage plans include coverage for prescription drugs (Medicare Advantage Prescription Drug plans), and may include additional benefits such as routine dental and vision that aren’t covered under Original Medicare.
Medicare Advantage Prescription Drug plans have a lot of variations and you may want to check a plan’s details before you enroll. Please note that you’ll need to continue to pay your Part B premium, in addition to any premium charged by the Medicare Advantage plan, along with any deductibles, coinsurance, and copayments.
If you’d like more information about Medicare plan options that may cover your medical supplies and equipment, I am happy to answer your questions and walk you through some options. You can request a phone call or personalized email by clicking one of the links below. A list of plan options you may be eligible for can be found by clicking the Compare Plans button. Learn more about me by clicking the “View profile” link below.
For more information about medical supplies and durable medical equipment, please see:
“Medicare Coverage of Durable Medical Equipment and Other Devices,” Centers for Medicare & Medicaid Services (CMS), last modified September 2015, https://www.medicare.gov/Publications/Search/results.asp?PubID=11045&PubLanguage=1&Type=PubID
“Durable Medical Equipment (DME) Coverage,” Medicare.gov, accessed August 4, 2016, https://www.medicare.gov/coverage/durable-medical-equipment-coverage.html