Why Insurance Coverage Matters

Durable medical equipment (DME) can be a lifesaver—but it doesn’t come cheap. Fortunately, many insurance providers, including Medicare and Medicaid, will help cover the cost if the equipment is deemed medically necessary. This guide walks you through how to get that coverage without the stress.

Step 1: Talk to Your Doctor

Everything starts with a diagnosis. Your healthcare provider must determine that the equipment is medically necessary and write a prescription or a Certificate of Medical Necessity (CMN).

• Be specific with your doctor about your condition and daily challenges.

• Ask if there are particular brands or models that work best for your situation.

Step 2: Understand What Insurance Will Cover

Not all equipment is covered. To qualify, DME must generally:

• Be durable (lasts 3+ years)

• Be used for a medical reason

• Be used at home (not in a hospital)

• Be prescribed by a doctor

Check your plan’s Durable Medical Equipment coverage policy. Medicare Part B, for example, usually covers 80% of the approved cost once your deductible is met.

Step 3: Find a Supplier That Accepts Your Insurance

Make sure the DME supplier is enrolled in and accepts your insurance plan. For Medicare, that means choosing a Medicare-enrolled DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics and Supplies) supplier.

• Ask for itemized pricing

• Confirm they will handle insurance claims directly (many do)

Step 4: Submit All Required Paperwork

Depending on your provider, you may need:

• A prescription

• Medical records

• A prior authorization form

• Proof of medical necessity

Work closely with your doctor and supplier to get everything filed correctly. A small delay in documentation can hold up your equipment delivery.

Step 5: Follow Up on the Claim

Even when the paperwork is perfect, it helps to follow up:

• Ask for a copy of your claim

• Check online member portals for claim status

• If denied, ask for a written explanation and appeal options

Bonus Tip: Renting Can Save You Money

Some insurance plans may prefer you rent expensive equipment like hospital beds or oxygen concentrators. Rentals often reduce out-of-pocket costs and may be a better fit for short-term needs.

Commonly Covered DME Items:

• Walkers and canes

• Manual and power wheelchairs

• Hospital beds

• CPAP machines

• Oxygen supplies

• Nebulizers

Final Thoughts

Getting durable medical equipment covered by insurance doesn’t have to be overwhelming. With the right doctor, the right supplier, and a bit of paperwork know-how, you can access the support you need without draining your savings.

Visit LittleWins to connect with our local community and browse listings that may be eligible for coverage.