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Medicare Part B Medical Equipment: What's Covered in 2026

Medicare Part B Medical Equipment: What's Covered in 2026

When you need medical equipment to manage your health conditions, understanding what Medicare Part B covers can help you avoid unexpected costs and ensure you get the equipment you need. Medicare Part B covers durable medical equipment (DME) that meets specific criteria, but the rules and requirements can be complex.

Navigating Medicare's medical equipment coverage doesn't have to be overwhelming. With the right information, you can understand what's covered, how to obtain equipment through approved suppliers, and what costs you can expect.

What is Durable Medical Equipment (DME)?

Medicare defines durable medical equipment as equipment that:

• Can withstand repeated use

• Is primarily used to serve a medical purpose

• Is not useful to someone who doesn't have an illness or injury

• Is appropriate for use in the home

DME must be prescribed by a doctor enrolled in Medicare and obtained from a Medicare-enrolled supplier.

Categories of Covered Medical Equipment

Mobility Equipment

• Wheelchairs: Manual and power wheelchairs when mobility is significantly impaired

• Scooters: Power-operated vehicles for those who can't use a manual wheelchair

• Walkers: Standard, wheeled, and specialized walkers

• Canes: Single-point and multi-point canes

Respiratory Equipment

• Oxygen equipment: Concentrators, portable units, and related supplies

• CPAP machines: For sleep apnea treatment

• Nebulizers: For medication delivery to the lungs

• Ventilators: For home ventilation therapy

Bathroom Safety Equipment

• Shower chairs: When mobility is significantly impaired

• Toilet seats: Raised toilet seats for those with specific medical needs

• Bath benches: For safe bathing when mobility is limited

**Hospital Beds**

• Adjustable beds: When medical condition requires position changes

• Bed rails: For safety when using a hospital bed

• Mattresses: Therapeutic mattresses for pressure sore prevention

Monitoring Equipment

• Blood glucose monitors: For diabetes management

• Blood pressure monitors: When frequent monitoring is medically necessary

• Peak flow meters: For asthma management

Coverage Criteria for DME

Medical Necessity Requirements

For Medicare to cover DME, it must be:

• Prescribed by a doctor: Your physician must certify that the equipment is medically necessary

• Used in your home: Equipment primarily for institutional use isn't covered

• Durable: Must last at least three years with normal use

Documentation Requirements

Medicare requires:

• Written order: From your doctor specifying the equipment needed

• Medical records: Supporting the medical necessity

• Face-to-face examination: Recent visit with your prescribing physician

Medicare-Enrolled Supplier Requirements

Choosing the Right Supplier

You must obtain DME from suppliers that:

• Are enrolled in Medicare

• Meet Medicare's quality standards

• Are located in your geographic area (for most equipment)

Competitive Bidding Program

In certain areas, Medicare uses competitive bidding to set prices for DME. This affects:

• Pricing: May result in lower costs for beneficiaries

• Supplier choice: You must use contract suppliers in bidding areas

• Quality standard*: Contract suppliers must meet additional quality requirements

Cost Responsibilities for DME

Your Share of Costs

After meeting your Part B deductible ($240 in 2026), you typically pay:

• 20% coinsurance of the Medicare-approved amount

• Any amount above Medicare's approved amount if the supplier doesn't accept assignment

Rental vs. Purchase

Some equipment is:

• Rented monthly: You pay 20% of the monthly rental fee

• Purchased outright: You pay 20% of the purchase price

• Rent-to-own: After 13 months of rental payments, you own the equipment

Prior Authorization Requirements

Equipment Requiring Prior Authorization

Certain high-cost items require prior approval, including:

• Power wheelchairs: Complex rehabilitation technology

• Hospital beds: In most circumstances

• Oxygen equipment: Depending on the type and circumstances

Prior Authorization Process

• Supplier submits request: Along with supporting documentation

• Medicare reviews: Medical necessity and coverage criteria

• Decision notification: Approval or denial within specified timeframes

Common Coverage Exclusions

Equipment Medicare Doesn't Cover

• Comfort or convenience items: Equipment that doesn't serve a medical purpose

• Over-the-counter items: Generally available without a prescription

• Backup equipment: Second units for convenience

• Equipment for sports or exercise: Unless specifically prescribed for medical treatment

Home Modifications

Medicare generally doesn't cover:

• Ramps or stair lifts

• Bathroom modifications

• Grab bars (unless part of DME coverage)

• Home elevators

Repair and Maintenance Coverage

What's Covered

Medicare covers:

• Reasonable repairs: To restore equipment to working condition

• Routine maintenance: Basic upkeep and cleaning supplies

• Replacement parts: When repairs aren't cost-effective

Your Responsibilities

You're responsible for:

• Reasonable care: Using equipment properly

• Normal wear: Expected deterioration from regular use

• Damage from misuse: Repairs needed due to improper use

Appeals Process for DME Denials

When Medicare Denies Coverage

Common reasons for denial include:

• Lack of medical necessity: Insufficient documentation

• Supplier issues: Using non-enrolled suppliers

• Coverage exclusions: Equipment not covered by Medicare

Your Appeal Rights

You can appeal DME denials through:

• Redetermination: First level of appeal

• Reconsideration: Second level review

• Administrative Law Judge hearing: Third level if needed

Special Considerations for 2026

COVID-19 Flexibilities

Some temporary coverage expansions may continue, including:

• Telehealth consultations: For DME evaluations

• Modified documentation: Reduced face-to-face requirements

• Extended coverage: For certain respiratory equipment

Technology Advances

Medicare continues to evaluate coverage for:

• Smart medical devices: Connected health monitoring equipment

• Advanced mobility aids: Innovative wheelchair and mobility technologies

• Home diagnostic equipment: Expanded monitoring capabilities

Tips for Obtaining DME Coverage

Work with Your Doctor

• Discuss needs thoroughly: Ensure proper documentation of medical necessity

• Ask about alternatives: Sometimes different equipment may be better covered

• Keep records: Maintain documentation of your medical condition and equipment needs

Choose Suppliers Carefully

• Verify Medicare enrollment: Use Medicare's supplier directory

• Compare costs: Understand your out-of-pocket expenses

• Ask about assignment: Whether the supplier accepts Medicare's approved amount

Understand Your Coverage

• Review your plan: Medicare Advantage plans may have different coverage rules

• Know your costs: Understand deductibles, coinsurance, and rental vs. purchase options

• Plan for maintenance: Factor in ongoing costs for supplies and repairs

Need Additional Help?

For questions about DME coverage or to find Medicare-enrolled suppliers:

• Visit Medicare.gov to search for suppliers in your area

• Call 1-800-MEDICARE for coverage questions

• Contact your local State Health Insurance Program (SHIP) for personalized assistance

Disclaimer: For agent use only. Not affiliated with the U.S. federal government or federal Medicare program. This information is provided for educational purposes only and does not constitute marketing of any specific Medicare plan. Important Disclaimer:  This information is for educational purposes only and does not constitute marketing of any specific Medicare plan. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. This material is not affiliated with or endorsed by the federal Medicare program. For official Medicare information, please visit Medicare.gov or call 1-800-MEDICARE. You can also contact your local State Health Insurance Program (SHIP) for personalized assistance.*