What Medicare Covers as Durable Medical Equipment in 2026

Short answer

Medicare Part B covers durable medical equipment that meets five criteria: it lasts at least three years, has a medical purpose, is appropriate for home use, is not primarily useful to a healthy person, and is not disposable. Once you meet the 2026 Part B deductible of $283, Medicare pays 80 percent and you pay 20 percent. A doctor’s face-to-face exam and written order are always required.

The 5-part DME test in plain language

Medicare uses a specific definition of durable medical equipment. To be covered, an item must pass all five of these tests:

1. Durable. The item can withstand repeated use, and it is expected to last at least three years. This is why disposable supplies like adhesive bandages do not count as DME on their own.
2. Medical. The item has a clear medical purpose. Comfort items and general-wellness devices do not qualify - even if a doctor recommends them.
3. Home-appropriate. The item is designed to be used in your home. Equipment intended for use only in a clinical setting, like a full hospital-grade infusion pump, is billed differently.
4. Not useful to someone without an illness. The item would not be needed by a healthy person. A shower chair, for example, has a medical purpose because it prevents falls in someone with a mobility limitation.
5. Not primarily for convenience. The item addresses a medical need, not a preference. Air conditioners, for instance, are almost never covered, even if a doctor writes a note.

If your equipment fails any one of these five tests, Medicare will not cover it under the DME benefit - even if a doctor prescribes it in writing.

Comprehensive list of DME Medicare covers

The list below groups covered items by category.

A note on continuous glucose monitors and insulin pumps: as of 2026, CMS pays for these items under a monthly rental model rather than a one-time purchase. This is a change from prior years and affects how you receive replacement equipment.

For a broader guide to what a Baba mobility advocate can coordinate across these categories - supplier vetting, delivery, and follow-up - see our mobility service page.

What Medicare does NOT cover as DME

Some items that people commonly assume are covered are not. Original Medicare will not pay for:

• Home modifications. Grab bars, wheelchair ramps, stair lifts, widened doorways, and roll-in showers are not DME.
• Comfort or general-wellness items. Air conditioners, humidifiers (unless part of respiratory therapy), massage devices, and adjustable-height beds sold as “sleep comfort” products.
• Disposable supplies used alone. Bandages, gauze, and incontinence pads are not DME. Some supplies like CPAP filters and diabetic test strips are covered because they attach to a covered device.
• Personal-use items. Toothbrushes, cosmetic items, and general household equipment.

Some Medicare Advantage plans offer supplemental benefits that include a small allowance for home modifications or non-medical equipment. Check your plan documents to see what applies to you.

How to qualify: the 6-step process

Every piece of durable medical equipment follows the same basic path from prescription to delivery. Knowing the six steps in advance helps you avoid delays.

1. Face-to-face encounter. Your treating provider examines you and documents the medical need. For most DME items, this exam must happen within six months before the written order.
2. Written order. Your provider writes a detailed order describing the equipment and the medical reason for it. For items on the CMS expanded list under Rule CMS-6097-N (in effect since April 13, 2026), the written order must be completed before the supplier delivers the equipment.
3. Prior authorization, if required. Certain items - power wheelchairs coded K0856 and above, and select oxygen equipment - need CMS approval before delivery. The standard decision timeline is seven business days.
4. Choose a Medicare-enrolled supplier who accepts assignment. Suppliers who accept assignment agree to Medicare’s approved payment amount, which caps your out-of-pocket cost at the 20 percent coinsurance. You can find enrolled suppliers at medicare.gov/care-compare.
5. Home assessment. For larger items like hospital beds and power wheelchairs, the supplier confirms your home layout can accommodate the equipment safely.
6. Delivery and rental clock. The supplier delivers the item, and the rental period begins. For most equipment, Medicare pays rental for 13 months, after which you own the item. Oxygen equipment is an exception - see the rental section below.

If a step is skipped or documented incorrectly, the claim may be denied. Most DME denials are for missing paperwork, not for lack of medical need. This is why documentation quality matters so much.

What you pay: the 80/20 rule and Medigap

Once your 2026 Part B deductible of $283 is met, Medicare pays 80 percent of the approved amount for each covered DME item. You are responsible for the remaining 20 percent.

For a power wheelchair with a Medicare-approved amount of $3,000, this means:

• Medicare pays: $2,400 (80 percent)
• You pay: $600 (20 percent), plus any unmet deductible

If you have a Medigap policy (also called Medicare Supplement Insurance), most plans cover part or all of the 20 percent coinsurance. Medigap Plan G, for example, pays the coinsurance after you meet the Part B deductible. If you have Medicaid alongside Medicare, your state Medicaid program may cover the coinsurance.

Medicare Advantage plans set their own cost-sharing. Some charge a flat copay for DME rather than 20 percent, and many require you to use in-network suppliers.

Baba provides care navigation and advocacy for clients working to obtain durable medical equipment. Talk to Baba to learn what support may be available.

Rental rules: the 13-month rule and the oxygen exception

Most durable medical equipment follows a capped-rental schedule. Medicare rents the item from the supplier on your behalf for 13 months. After the 13th month, the equipment is yours. The supplier is still responsible for repairs and servicing for the useful life of the item.

Oxygen equipment is the major exception. Medicare rents oxygen equipment for 36 months. After that, the supplier continues providing the equipment and any related services for another 24 months, but you do not take ownership. This is set by CMS Policy Article A52514.

Certain purchase-eligible items skip the rental model entirely. Some inexpensive items - canes, crutches, walkers under a set price cap - are billed as one-time purchases. Complex rehabilitative wheelchairs and certain custom-fitted equipment may also be purchased outright.

If you move to a new state during the rental period, most equipment transfers with you. The 13-month clock does not reset. You may need to switch to a supplier enrolled in your new area, but ownership rules stay the same.

Prior authorization for select DME

Prior authorization is Medicare’s way of confirming, before delivery, that an item meets coverage rules. Not every DME item requires it - but the list of items that do has grown in 2026.

Under Rule CMS-6097-N (effective April 13, 2026), the following now require prior authorization:

• Power wheelchairs coded K0856 and above
• Certain oxygen-related items on the expanded master list
• Additional items listed in the CMS master list update

Suppliers file the prior authorization request. Standard decisions are returned within seven business days. If the request is denied, you can appeal - see the denial section below.

A separate 2026 change affects DMEPOS suppliers themselves. On February 27, 2026, CMS paused new Medicare enrollments for seven categories of medical supply companies for six months. This does not affect existing suppliers, and it does not affect people already receiving equipment. If you are looking to switch suppliers in an affected category during the pause, you may have fewer choices than usual - but supply of the equipment itself is not restricted.

What if Medicare denies your DME claim?

If your DME claim is denied, you have five levels of appeal. The first level is a redetermination, filed within 120 days of receiving the Medicare Summary Notice showing the denial. A Medicare Administrative Contractor reviews the claim and typically issues a decision within 60 days.

The most common reason for a DME denial is documentation - not lack of medical need. CMS reported that 6.34 percent of Medicare fee-for-service payments were improper in 2025, and among DME denials, most were traced to paperwork gaps like missing face-to-face exam notes, incomplete written orders, or a supplier submitting a claim outside the assigned category.

How Baba helps

A Baba advocate handles the parts of the DME process that trip most people up: coordinating the face-to-face exam paperwork with your provider, confirming the written order meets Medicare’s format requirements, choosing a Medicare-enrolled supplier who accepts assignment, following up on prior authorization requests, and stepping in when a claim is denied.

Baba provides care navigation and advocacy for durable medical equipment needs. For readers managing a respiratory condition alongside a mobility issue, our COPD care service coordinates DME needs across both.

To learn how a Baba advocate works with your care team on any DME need, see what a patient advocate does.