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

## **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.*

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

**Quick Answer:** Medicare Part B covers durable medical equipment (DME) — things like wheelchairs, walkers, CPAP machines, oxygen equipment, hospital beds, and blood glucose monitors — when your doctor certifies the equipment is medically necessary and you obtain it from a Medicare-enrolled supplier. In 2026, after meeting the $283 annual Part B deductible, you typically pay 20% of the Medicare-approved amount. Some high-cost items like power wheelchairs require prior authorization before Medicare will pay. This guide explains what's covered, what it costs, and how to navigate the process 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
• **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
• **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

**Diabetes Supplies (2026 Update)**

For beneficiaries with diabetes, Medicare covers:

• Blood glucose monitors and test strips
• Lancets and lancing devices
• Insulin pumps and related supplies (when medically necessary)
• Continuous Glucose Monitors (CGMs) — an important 2026 update: Medicare has expanded CGM coverage, and as of 2023 CMS removed the requirement that a beneficiary be "insulin-treated" to qualify for a CGM. If you have diabetes and your doctor documents medical necessity, CGM coverage is now more accessible than before.

**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 (within 6 months for most equipment)

**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)

**Important:** If you obtain DME from a supplier that is NOT enrolled in Medicare, Medicare will not pay — and you could be responsible for the full cost. Always verify supplier enrollment before obtaining equipment.

**Competitive Bidding Program (2026)**

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

• **Pricing:** Results in lower costs for beneficiaries in covered areas
• **Supplier choice:** You must use contract suppliers in bidding areas
• **Quality standards:** Contract suppliers must meet additional quality requirements

The competitive bidding program currently covers a wide range of common items including CPAP machines and supplies, oxygen equipment, walkers, and diabetes monitoring supplies. You can check whether your area is covered at Medicare.gov.

**Cost Responsibilities for DME (2026)**

**Your Share of Costs**

After meeting your **$283 Part B annual deductible** 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 (capped rental applies to items like power wheelchairs and oxygen equipment)

**A practical example:** If Medicare approves a CPAP machine at $800, and you've already met your deductible, you pay $160 (20%) and Medicare pays $640. If your supplier doesn't accept assignment, they can charge up to 15% more — meaning you could owe up to $184 instead.

**Prior Authorization Requirements (2026)**

**Equipment Requiring Prior Authorization**

Certain high-cost items require prior approval before Medicare will pay, including:

• **Power wheelchairs and scooters:** Complex rehabilitation technology
• **Hospital beds:** In most circumstances
• **Oxygen equipment:** Depending on type and diagnosis
• **Non-invasive ventilators:** For home use

CMS has expanded its Prior Authorization program for DME in recent years to protect against improper payments. The list of items requiring prior authorization continues to grow — always check with your supplier and doctor before assuming coverage.

**Prior Authorization Process**

1. **Supplier submits request** along with supporting documentation from your doctor
2. **Medicare reviews** medical necessity and coverage criteria
3. **Decision notification:** Generally within 10 business days for standard requests; 2 business days for expedited requests when your health would be seriously jeopardized by delay
4. **If approved:** Equipment can be ordered and delivered
5. **If denied:** You have appeal rights and can request reconsideration

**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, roll-in showers)
• Home elevators
• Widening doorways

*Note: Some Medicare Advantage plans may offer limited home modification benefits as supplemental coverage — check your specific plan.*

**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
• Missing prior authorization

**Your Appeal Rights**

You can appeal DME denials through the standard Medicare appeals ladder:

1. **Redetermination** by your MAC (file within 120 days; decision within 60 days)
2. **Reconsideration** by a Qualified Independent Contractor (QIC)
3. **Administrative Law Judge (ALJ) hearing** (minimum $200 in 2026)
4. **Medicare Appeals Council** review
5. **Federal District Court** (minimum $1,960 in 2026)

For more on the appeals process, see our dedicated post on Understanding Medicare Administrative Contractors (MACs).

**Tips for Obtaining DME Coverage**

**Work with Your Doctor**

• **Discuss needs thoroughly:** Ensure proper documentation of medical necessity
• **Ask about the face-to-face requirement:** Make sure your visit is recent enough to qualify
• **Keep records:** Maintain documentation of your medical condition and equipment needs
• **Ask about prior authorization:** Know before your equipment is ordered whether it requires pre-approval

**Choose Suppliers Carefully**

• **Verify Medicare enrollment:** Use Medicare's supplier directory at Medicare.gov
• **Ask about assignment:** Whether the supplier accepts Medicare's approved amount as payment in full
• **Compare costs:** Understand your out-of-pocket expenses before agreeing
• **Check the competitive bidding program:** Whether contract suppliers are required in your area

**Understand Your Coverage**

• **Review your plan:** Medicare Advantage plans may have different coverage rules and supplier networks
• **Know your costs:** Understand deductibles, coinsurance, and rental vs. purchase options
• **Plan for maintenance:** Factor in ongoing costs for supplies and repairs

**Frequently Asked Questions**

**What does Medicare Part B cover for durable medical equipment in 2026?**

Medicare Part B covers DME that is medically necessary, durable, serves a medical purpose, and is appropriate for home use — including wheelchairs, walkers, CPAP machines, oxygen equipment, hospital beds, blood glucose monitors, and more. Your doctor must certify medical necessity and you must obtain equipment from a Medicare-enrolled supplier. After the $283 Part B deductible, you pay 20% coinsurance.

**How much do I pay for DME with Medicare in 2026?**

After meeting the $283 annual Part B deductible, you typically pay 20% of the Medicare-approved amount. If your supplier accepts Medicare assignment, that's the most you'll owe. If they don't accept assignment, they can charge up to 15% above the approved amount. The total 20% coinsurance plus any excess charge is your out-of-pocket responsibility.

**Does Medicare cover power wheelchairs and scooters?**

Yes, when medically necessary and documented by your doctor. Power wheelchairs and scooters require prior authorization before Medicare will pay — your supplier submits the request along with supporting documentation from your doctor. After approval, you pay 20% coinsurance after the Part B deductible.

**Does Medicare cover CPAP machines?**

Yes. CPAP machines for sleep apnea are covered under Part B when your doctor documents the diagnosis and medical necessity. CPAP is typically rented for the first 13 months, after which you own the equipment. You pay 20% coinsurance after the $283 Part B deductible. In competitive bidding areas, you must use a contract supplier.

**Does Medicare cover Continuous Glucose Monitors (CGMs)?**

Yes — and coverage has expanded. As of 2023, CMS removed the requirement that a beneficiary be insulin-treated to qualify for a CGM. If you have diabetes and your doctor documents medical necessity, CGM coverage is now more broadly accessible. The device and supplies are covered under Part B, with the standard 20% coinsurance after the Part B deductible.

**What if my DME claim is denied?**

You have appeal rights. Start with a redetermination request to your MAC (file within 120 days of your MSN; decision within 60 days). If still denied, you can escalate to reconsideration, an ALJ hearing (minimum $200 in 2026), Medicare Appeals Council review, and Federal District Court (minimum $1,960 in 2026). Make sure your doctor provides thorough documentation of medical necessity — that's the most common fix for DME denials.

**The Bottom Line on Medicare DME Coverage**

Medicare Part B provides meaningful coverage for the durable medical equipment that helps beneficiaries manage chronic conditions, maintain mobility, and live safely at home. The key requirements are straightforward: medically necessary, prescribed by an enrolled doctor, obtained from an enrolled supplier. The 20% coinsurance after the $283 Part B deductible is consistent with other Part B services.

The two things most likely to cause problems — and most worth knowing in advance — are the **prior authorization requirement** for high-cost items like power wheelchairs, and the **supplier enrollment requirement**. Get both of these right before equipment is ordered and you'll avoid the most common pitfalls.

**Need Additional Help?**

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

• Visit Medicare.gov to search for suppliers in your area and verify enrollment
• Call 1-800-MEDICARE for coverage questions
• Contact your local State Health Insurance Program (SHIP) for personalized assistance
• Ask your doctor's office to help navigate prior authorization requirements

**Required Compliance Disclaimers:**

*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.*

*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.*