Wheelchairs, walkers, hospital beds, oxygen equipment, bathroom-safety devices, and other home medical equipment can be expensive. Coverage depends on the item, the medical reason it is needed, insurance rules, and the supplier.
Start with the prescribing healthcare professional and insurer. Then check state assistive-technology programs, equipment reuse programs, local loan closets, and nonprofit organizations.
Do not buy, borrow, or modify equipment that affects breathing, mobility, wound care, or fall safety without appropriate professional guidance.
What Counts as Home Medical Equipment?
Common examples include:
- Manual or power wheelchairs
- Walkers, canes, and crutches
- Hospital beds
- Patient lifts
- Bedside commodes
- Shower chairs and transfer benches
- Oxygen equipment
- Nebulizers
- Continuous positive airway pressure equipment
- Infusion equipment
- Pressure-relief surfaces
- Prosthetic and orthotic devices
Coverage rules differ by item. Some products are treated as durable medical equipment, while others are considered convenience, home-modification, or personal-care items.
Start With a Medical Evaluation
A clinician may need to document:
- The diagnosis or functional limitation
- Why the equipment is medically necessary
- Why a less costly option is not sufficient
- Whether the equipment will be used in the home
- How long it is expected to be needed
- Whether training or fitting is required
Ask for a copy of the prescription or order and any supporting notes.
Medicare Coverage
Medicare Part B may cover certain durable medical equipment when eligibility and medical-necessity requirements are met. The prescribing clinician and supplier generally must participate in Medicare under applicable rules.
Before accepting equipment, ask:
- Is this item covered?
- Must it be rented or purchased?
- Is the supplier enrolled in Medicare?
- Has prior authorization been completed?
- What will Medicare pay?
- What deductible or coinsurance may apply?
- Who handles repairs and replacement?
Medicare Advantage plans may use plan-specific suppliers and authorization rules.
Medicaid Coverage
State Medicaid programs may cover medically necessary equipment, supplies, repairs, or replacements. Coverage and prior-authorization rules vary by state and benefit category.
Contact the state Medicaid agency or managed-care plan and ask for:
- The covered-equipment list
- Participating suppliers
- Prior-authorization requirements
- Repair and replacement rules
- Appeal procedures
- Coverage for children or home- and community-based services
Veterans' Benefits
Eligible veterans may receive certain prosthetic, sensory, mobility, or home medical equipment through the Department of Veterans Affairs.
Contact the VA care team or prosthetics service rather than purchasing first and assuming reimbursement will be available.
State Assistive-Technology Programs
Every state and territory has an Assistive Technology Act program. Services may include:
- Device demonstrations
- Short-term equipment loans
- Reuse or exchange programs
- Financing information
- Help comparing devices
- Referrals to local resources
Programs differ, so check the state program directly.
Equipment Reuse and Loan Closets
Community organizations may lend or provide donated equipment such as walkers, wheelchairs, shower chairs, and commodes.
Possible sources include:
- Centers for independent living
- Area agencies on aging
- Disability organizations
- Faith-based groups
- Local health departments
- Hospitals and rehabilitation centers
- Senior centers
- Medical-equipment reuse programs
Ask whether the equipment has been inspected, cleaned, and adjusted appropriately.
Home Modifications Are Different
Ramps, stair lifts, widened doors, grab bars, and bathroom remodeling may not be treated as durable medical equipment.
Possible funding sources include:
- Medicaid waiver programs
- Veterans' housing grants
- State vocational-rehabilitation programs
- Local aging or disability programs
- Community development programs
- Nonprofit home-modification organizations
Get written approval before beginning work when reimbursement is expected.
Be Careful With Used Equipment
Used equipment can be helpful, but confirm:
- Correct size and weight capacity
- Structural condition
- Battery condition
- Availability of replacement parts
- Recall history
- Cleaning and infection-control procedures
- Whether professional fitting is needed
- Whether accepting used equipment affects insurance coverage
Do not use damaged equipment or equipment that cannot be safely adjusted.
Questions to Ask a Supplier
- Are you enrolled with my insurance?
- Is prior authorization required?
- Is the item rented or purchased?
- What is included in the quoted price?
- Who provides fitting and training?
- Who handles maintenance?
- What happens if the equipment fails?
- What is the return policy?
- Are accessories billed separately?
- Will I receive a written estimate?
Sources
- Medicare: Durable medical equipment coverage
- Medicare: Find medical equipment and suppliers
- Administration for Community Living: State assistive-technology programs
- AT3 Center: Find your state assistive-technology program
- Department of Veterans Affairs: Prosthetic and sensory aids
This article is for general information only and is not medical, insurance, or legal advice. Coverage, suppliers, eligibility, and program availability can change.