Medicare Part B Coverage for Durable Medical Equipment: CPAP, Wheelchairs, and More

Durable medical equipment, or DME, is a category of Medicare Part B coverage that many beneficiaries do not think about until they need it. When your physician orders a wheelchair, a CPAP machine, a hospital bed for home use, or home oxygen equipment, Part B typically covers it, but with specific requirements around supplier enrollment, medical necessity documentation, and a rental-versus-purchase decision that Medicare makes for you on longer-term equipment. Understanding how DME coverage works before you need it prevents both unexpected denials and avoidable out-of-pocket costs.

Bryce's Take

The supplier enrollment issue causes more DME problems than anything else. I have had clients get their CPAP from a supplier who seemed legitimate but was not Medicare-enrolled, and then found out Medicare would pay nothing. Always verify enrollment before signing anything with a DME supplier. Medicare's supplier directory is public and takes two minutes to check.

What qualifies as durable medical equipment

Medicare defines durable medical equipment as equipment that withstands repeated use, has a primary medical purpose, is used in the home, and is appropriate for home use. Covered DME includes manual and power wheelchairs and scooters, hospital beds and mattresses, CPAP, BiPAP, and other respiratory assist devices, home oxygen equipment and supplies, walkers, crutches, and canes, blood glucose monitors and test strips, insulin infusion pumps and supplies, prosthetics and orthotics, and traction equipment. The item must be medically necessary as documented by your physician and prescribed through a written order.

Supplier enrollment requirements

This is where many people run into problems. Your DME must be ordered from a Medicare-enrolled DME supplier. If you obtain equipment from a non-enrolled supplier, Medicare will not pay, and you bear the full cost. Before obtaining any DME, verify that the supplier is enrolled in Medicare and accepts Medicare assignment. Assignment means they accept the Medicare-approved payment as full payment; a non-assignment supplier can bill you above the approved amount. The Medicare DME supplier directory is available at medicare.gov.

The 20% cost-sharing and how Medigap helps

Medicare Part B pays 80% of the approved amount for covered DME after the Part B deductible. You pay 20%. For expensive items like power wheelchairs (which can have Medicare-approved amounts of $1,500 to $2,500 or more) or home oxygen equipment, 20% adds up. Medigap Plan G and Plan N both cover the 20% Part B coinsurance for DME, reducing your out-of-pocket to zero for covered items after the annual Part B deductible.

Rental versus purchase: the 13-month rule

For certain DME categories, Medicare pays for rental rather than purchase for the first 13 months of use. After 13 months of continuous rental payments, you own the equipment and Medicare stops paying rental fees. This applies to oxygen equipment, hospital beds, and some other items. For power wheelchairs and scooters, Medicare pays for outright purchase after a period of capped rental. The important implication: if you only need equipment temporarily, Medicare rental coverage may not last as long as your need if you abandon the rental before month 13.

Have questions about whether a specific piece of equipment is covered under Medicare?

DME coverage rules vary by item, and supplier enrollment issues cause many avoidable denials. I can help you navigate a specific equipment need or evaluate whether your current plan handles DME cost-sharing well.

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CPAP machines: a common example

CPAP and BiPAP machines for sleep apnea are covered under Part B after a covered sleep study confirms obstructive sleep apnea and a physician prescribes the device. Medicare pays for a rental period during which you must demonstrate compliance with CPAP use. After 13 months of rental payments, you own the machine. CPAP supplies, masks, filters, tubing, headgear, are covered on an ongoing replacement schedule. The compliance requirement in the first 90 days is important: Medicare requires showing that you use the device at least four hours per night for 70% of nights in a 30-day period during the first three months.

Prior authorization for power mobility devices

Power wheelchairs and power scooters require prior authorization from Medicare before the claim will be paid. The process requires documentation from your treating physician that you have a mobility limitation that significantly impacts your ability to participate in activities of daily living, and that less expensive alternatives are not sufficient. Prior authorization for power mobility devices has specific documentation requirements. Start this process early and work with both your physician and a Medicare-enrolled supplier who is experienced with the authorization process.

Frequently asked questions

Does Medicare cover over-the-counter items like reading glasses or hearing aids?

No. Over-the-counter items are not considered durable medical equipment under Medicare's definition. Prescription eyeglasses following cataract surgery are an exception and are covered. Hearing aids are not covered by Original Medicare but may be covered by Medicare Advantage plans.

What if the DME supplier does not accept Medicare assignment?

A non-participating supplier can charge up to 15% above the Medicare-approved amount in addition to your standard 20% coinsurance. This can significantly increase your out-of-pocket cost. Always confirm assignment status before obtaining equipment.

Can I choose any home oxygen supplier?

You can choose any Medicare-enrolled home oxygen supplier. After 36 months of continuous oxygen rental, Medicare stops paying the monthly rental fee but continues to pay for equipment maintenance and supplies. Switching suppliers during this period can restart the rental clock, so be cautious about changing suppliers unless there is a service issue.

Does Medicare cover repairs to DME I already own?

Yes. Medicare covers repairs to owned DME if the repairs are necessary and do not cost more than replacing the item. Replacement of equipment is also covered when the item is worn out, damaged beyond repair, or the clinical need changes. Replacement schedules vary by item type.

Bryce Casson

Licensed Independent Medicare Broker

Bryce Casson is an independent Medicare insurance broker who works with every major carrier. He does not represent any single insurer, which means his recommendations are based on what actually fits each client's situation, not on commissions or quotas.