Durable Medical Equipment After Hospital Discharge: Medicare Coverage Guide

Your parent is being discharged from the hospital and needs a hospital bed at home, a wheelchair, a walker, or a nebulizer. The discharge planner mentions "DME" and hands you a list of suppliers. But nobody explains how Medicare actually covers this equipment, what your out-of-pocket costs will be, or what happens if you pick the wrong supplier.

Here's how durable medical equipment coverage works after a hospital discharge — and the mistakes that cost families the most money.

What Medicare Covers as DME

Medicare Part B covers durable medical equipment when all four criteria are met:

1. Durability: The item can withstand repeated use (not a single-use supply)
2. Medical purpose: It serves a medical function, not a convenience
3. Home use: It's appropriate for use in the home
4. Physician's order: A doctor prescribes it

Common covered items include hospital beds, wheelchairs, walkers, oxygen equipment, CPAP machines, nebulizers, commodes, and patient lifts. Diabetic supplies, prosthetics, and orthotics are covered under separate Medicare categories.

Not covered: Grab bars, shower chairs, bath lifts, raised toilet seats, stair lifts, and home modifications. These may be covered under MaineCare Section 19 waiver services if your parent qualifies.

How Medicare Pays for DME

Medicare Part B covers 80% of the Medicare-approved amount for DME. Your parent pays the remaining 20% coinsurance after meeting the applicable Part B deductible. If they have a Medigap supplemental plan, it typically covers the 20% coinsurance.

Some equipment is rented rather than purchased:

• Capped rental items (hospital beds, wheelchairs): Medicare rents the equipment for 13 months, then ownership transfers to the patient. During the rental period, the supplier is responsible for maintenance and repairs.
• Oxygen equipment: Rented for 36 months, then the supplier must continue providing equipment and servicing for an additional 24 months at no cost.
• Purchase items (walkers, commodes, nebulizers): Bought outright with the 80/20 split.

The Supplier Trap

The most expensive mistake families make is using a DME supplier that doesn't participate in Medicare's competitive bidding program or isn't enrolled in Medicare at all.

Use only Medicare-enrolled suppliers. If you use a non-enrolled supplier, Medicare pays nothing, and you're responsible for the full cost. Ask the supplier directly: "Are you enrolled in Medicare and do you accept assignment?"

Check Medicare's current supplier requirements. Use Medicare.gov's supplier directory and ask whether any contract-supplier rule applies in your parent's area and for the specific item.

Getting DME Before Discharge

The hospital discharge plan should include DME orders. Before your parent leaves:

1. Confirm the physician has written DME orders. The order must identify the specific item and document the medical necessity and supporting diagnosis required for coverage
2. Ask the discharge planner which supplier is being used. Verify the supplier is Medicare-enrolled
3. Schedule delivery. Ask the hospital and supplier to coordinate delivery before or on the discharge day. If delivery cannot happen in time, ask the discharge team for a safe alternative plan
4. Get trained on the equipment. A hospital bed, oxygen concentrator, or patient lift requires instruction. The supplier or hospital staff should demonstrate proper use before discharge

When Medicare DME Isn't Enough

Medicare DME covers medical equipment but not home modifications. If your parent needs grab bars installed, doorways widened for wheelchair access, or a ramp built, MaineCare Section 19 waiver services cover home modifications for eligible participants. The Section 19 program also covers assistive technology that Medicare may not, subject to program authorization.

The Hospital-to-Home Maine toolkit includes a DME checklist organized by care setting and a worksheet for tracking orders, deliveries, and supplier contact information during the discharge process.

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