Does Medicare cover durable medical equipment (DME)?

CPAP and BiPAP machines are capped-rental items. Medicare pays the supplier monthly for thirteen months, you pay your twenty percent each month, and on the first day after the thirteenth month the supplier transfers ownership to you. The supplies (mask, tubing, filters) are billed separately as routinely-purchased items.

Medicare requires a face-to-face evaluation, a sleep study showing qualifying apnea, and a ninety-day compliance check before continuing rental. If you don't use the machine enough during that ninety-day window, Medicare can stop paying.

Oxygen equipment runs on a thirty-six-month rental clock under 42 CFR 414.226(a)(1). After the thirty-sixth month, you don't own the equipment — the supplier still does — but they're required to keep furnishing it for the remainder of the equipment's reasonable useful lifetime, which is at least five years from when it was first delivered.

During those last twenty-four months, Medicare pays the supplier a maintenance-and-servicing fee twice a year. Oxygen contents (the gas itself) are billed separately and continue throughout your medical need.

Power mobility devices — power wheelchairs and scooters — require Medicare prior authorization before the supplier can deliver. Your doctor must conduct a face-to-face exam documenting why a cane, walker, or manual wheelchair won't meet your needs in the home. The supplier files the prior-auth request; CMS responds within ten business days.

If the request is denied, the supplier should not deliver. If they deliver anyway and the claim is denied, you may be billed for the full amount unless the supplier accepted assignment in writing.

DME denials usually come down to one of four things: the supplier wasn't Medicare-enrolled, the doctor's order was missing or incomplete, the item wasn't on the prior-auth list (or was, and wasn't pre-authorized), or the equipment was used outside the home in a way Medicare considers ineligible.

You have one hundred twenty days from the date of the Medicare Summary Notice to file the first level of appeal (redetermination). Don't miss that window. SHIP at 1-877-839-2675 can help you understand the appeal architecture before you file.

Continuous glucose monitors are covered as DME when your doctor documents that you have diabetes treated with insulin or have a history of problematic hypoglycemia. CMS expanded CGM coverage in recent years, so the criteria are looser than they used to be — but the documentation requirements still matter.

Like most DME, CGMs flow through a Medicare-enrolled DME supplier with a written order. Test strips and sensors are billed as separate supply items.

Grab bars, shower chairs, raised toilet seats, and most bathroom safety equipment are not covered as Medicare DME. Medicare's DME definition requires the item to serve a medical purpose, withstand repeated use, and be unsuitable for someone who isn't sick or injured — grab bars don't meet that last test because anyone can use them.

Some Medicare Advantage plans include supplemental benefits that may cover bathroom safety items; benefits and availability vary by plan and service area. SHIP at 1-877-839-2675 can help you compare options.

If you're sorting out DME for a parent, spouse, or other family member, you'll need to coordinate three people: the prescribing doctor, the supplier, and the beneficiary. The doctor writes the order. The supplier verifies Medicare enrollment, files prior auth if needed, and bills Medicare. The beneficiary signs the supplier's paperwork and pays the twenty-percent share.

If the beneficiary can't manage the paperwork themselves, you'll likely need a power of attorney or representative-payee arrangement on file with Medicare. SHIP at 1-877-839-2675 can walk you through what authorization you need.

If your DME question doesn't fit any of the patterns above, the right next step is talking to a person. Two free options: SHIP at 1-877-839-2675 for unbiased Medicare counseling (every state runs one), or a Chapter licensed advisor who can walk you through how Original Medicare versus a Medicare Advantage plan would handle your specific equipment.

Don't call the DME supplier first. They're salespeople. Get the framing from a neutral source, then approach the supplier knowing what you're looking for.