Understanding Your Medicare Coverage for DME in 2026

Insurance questions are one of the biggest stressors when someone needs equipment quickly. While every plan is different, there are common concepts that can help you understand what information is typically needed for durable medical equipment (DME) coverage.

This article is an educational overview. Coverage rules can change and may vary by plan and circumstance—so the best next step is always verification.

What Is DME (Durable Medical Equipment)?

DME generally refers to medical equipment that is:

• Primarily used to serve a medical purpose
• Appropriate for home use
• Expected to last for a period of time (durable/reusable)
• Ordered or prescribed by a qualified provider

Common Requirements for Coverage

• Provider order: A physician’s order/prescription is often required.
• Medical necessity: Documentation may need to support why the equipment is needed.
• Eligible supplier: Coverage can depend on using an approved supplier.
• Correct documentation: Specific forms, diagnosis codes, and notes may be needed.

Rental vs. Purchase (Why It Matters)

Some equipment is commonly rented first, while other items may be purchased. Rental periods, replacement policies, and maintenance expectations vary. Understanding whether an item is billed as a rental or purchase can help set expectations for billing, service, and timeline.

What Information to Gather Before You Call

• Patient name and date of birth
• Insurance provider + member/policy ID
• Provider name and a prescription/order if available
• Equipment type needed (for example: hospital bed, wheelchair, walker/rollator)
• Preferred timeline (urgent, within a week, planned discharge date, etc.)

Next Steps

If you’re unsure what applies to your situation, we recommend starting with verification. It can save time and prevent surprises later.

• Submit an Insurance Verification Request
• Learn more about Insurance & Billing
• Contact our team with a question