What Is Durable Medical Equipment
Durable medical equipment (DME) refers to reusable medical devices prescribed by a doctor for use in the home. Common examples include wheelchairs, walkers, oxygen concentrators, CPAP machines, hospital beds, pressure relief mattresses, commodes, and lift assists. Unlike disposable medical supplies, DME is built to withstand repeated use and typically lasts several years with proper maintenance.
Medicare and Medicaid Coverage
Medicare Part B covers DME at 80% of the approved amount after you meet your deductible, provided a doctor prescribes it and it meets specific criteria. The equipment must be medically necessary, prescribed for your condition, and used in your home. Medicaid coverage varies by state but generally covers DME with prior authorization. You'll typically rent or purchase through a Medicare-approved DME supplier, and the supplier handles billing directly to insurance.
Coverage denial is common when documentation doesn't establish medical necessity. Your care team must document why the equipment is needed, how it supports your activities of daily living (ADLs), and why you can't manage without it. Keep all prescription orders and medical records that justify the equipment.
Role in Care Plans and Home Care
DME is a core component of home care plans, especially when home health aides or nurses are involved. A hospital bed with rails supports safe transfers for aides assisting with bathing and dressing. A mechanical lift prevents injury to both caregiver and care recipient. Oxygen equipment enables patients with COPD or heart disease to maintain independence while completing ADLs.
Your care plan should specify which equipment is needed, who will use it, maintenance responsibilities, and how it integrates with aide visits or respite care services. If equipment needs change, the care plan must be updated and the prescription renewed.
Getting DME Set Up
- Ask your doctor for a detailed prescription that includes the specific equipment, medical justification, and expected duration of use.
- Choose a Medicare-approved DME supplier. Your doctor may recommend one, or you can search CMS.gov's DME supplier directory.
- Verify your insurance coverage before ordering. Call your insurer to confirm approval and your out-of-pocket responsibility.
- Arrange delivery and setup. Ask the supplier about training on use and maintenance, especially if a home health aide will be using the equipment.
- Keep receipts, prescriptions, and approval letters for your records in case of coverage disputes.
Common Questions
- Can I use DME my family already owns? Medicare requires equipment to come from an approved supplier. Using personal equipment won't be covered. However, some items like canes or grab bars purchased independently may not require formal DME billing.
- What if I need equipment temporarily during respite care? Respite care providers typically have their own DME on hand. Confirm with the facility ahead of time what equipment is available so you don't need to transport your own items.
- How long can I rent before I should buy? Medicare allows rentals for up to 13 months. After that, ownership transfers to you at no additional cost. For items used short-term, renting makes sense. For long-term needs, buying after the rental period saves money.