The single most useful thing to understand about Medicare and equipment is this: Medicare Part B pays for durable medical equipment, and that category is narrower than most people expect. A walker is usually covered. A grab bar usually is not. The difference is not about how helpful the item is, it is about how the rules are written.
What Part B covers: durable medical equipment
To qualify as durable medical equipment (DME), an item generally has to meet all of these: it can withstand repeated use, it serves a medical purpose, it is not useful to someone who is not ill or injured, and it is appropriate for use in the home.
Items that commonly qualify:
- Canes and crutches
- Walkers and rollators
- Manual wheelchairs, power wheelchairs, and scooters, with additional documentation requirements
- Hospital beds and pressure-reducing support surfaces
- Commode chairs, when the person cannot reach the bathroom
- Oxygen equipment and supplies
- Blood sugar monitors and test strips
- Patient lifts
- Nebulizers and CPAP devices
What you pay
After the annual Part B deductible, Medicare generally pays 80% of the approved amount and you pay the remaining 20%, with no annual cap on that coinsurance. A Medigap policy or Medicare Advantage plan changes this picture. Some items are rented rather than purchased, and rental rules differ by item.
Two requirements that trip people up
- A treating clinician has to order it, and the medical record has to support the need. “My mother would feel safer with one” is not a basis for coverage.
- The supplier matters. The supplier must be enrolled in Medicare, and for many items must accept assignment. Buying the same walker from a retailer and submitting the receipt generally does not work.
What Medicare does not cover
These are the items families are most often surprised by:
| Item | Usual status | Why |
|---|---|---|
| Grab bars | Not covered | Treated as a home modification, not medical equipment |
| Shower chairs and bath benches | Generally not covered | Considered convenience or comfort items |
| Stair lifts | Not covered | Classified as a home modification |
| Wheelchair ramps | Not covered | Home modification |
| Hearing aids | Not covered by Original Medicare | Statutory exclusion; some Advantage plans include a benefit |
| Lift chairs | Partially | Medicare may cover the seat-lift mechanism only, not the chair |
| Incontinence supplies | Not covered by Medicare | Some state Medicaid programs do cover them |
The lift chair case is worth remembering, because it is the clearest example of how the rules work: Medicare can pay toward the motorized mechanism that helps a person stand, while the furniture around it remains your expense.
Medicaid and state waivers
Medicaid is run state by state, and it frequently covers what Medicare will not, including incontinence supplies, home modifications such as grab bars and ramps, and personal care hours at home.
The route for most people is a home and community-based services (HCBS) waiver. These fund care at home for people who would otherwise qualify for nursing facility care. Each state runs its own waivers with its own names, budgets, and waiting lists. Your Area Agency on Aging can tell you which exist where you live and screen you for eligibility.
Help with premiums and drug costs
- Medicare Savings Programs: state programs that pay Part B premiums, and in some cases deductibles and coinsurance, for people under certain income and asset limits.
- Extra Help (Low-Income Subsidy): substantially reduces Part D drug costs. Administered by the Social Security Administration.
- Patient assistance programs run by drug manufacturers, for specific medications.
- State Pharmaceutical Assistance Programs, which exist in some states.
SHIP: the State Health Insurance Assistance Program, provides free, unbiased Medicare counseling in every state and will screen you for all of the above. They do not sell insurance. Call the Eldercare Locator at 1-800-677-1116 to reach your local SHIP.
Veterans benefits
Eligible veterans may receive equipment and home modification help through the VA that Medicare would not cover. Aid and Attendance is an increased monthly pension for veterans and surviving spouses who need help with daily activities. Start with the VA directly or a county veterans service officer, their help is free, and they handle the paperwork regularly.
How to appeal a denial
Denials are common and frequently reversed, particularly when the clinical documentation was thin the first time.
- Read the notice. It states the reason for denial and the deadline, and the deadline is the part that matters most.
- For Original Medicare, the first step is a redetermination request to the contractor, generally within 120 days of receiving the notice.
- Ask the ordering clinician for a letter of medical necessity that addresses the specific reason given for the denial. Generic letters rarely change the outcome.
- For Medicare Advantage, follow the plan’s internal appeal process; expedited appeals exist when delay would harm the person.
- Get free help. SHIP counselors handle appeals at no cost, and Older Americans Act legal services take benefits cases.
Before you buy
If an item might be covered, the order matters: get the clinician’s order first, confirm the supplier is enrolled with Medicare, and ask the supplier to verify coverage before delivery. Buying first and seeking reimbursement afterward is the most common way families end up paying in full.
Coverage rules, deductibles, and coinsurance change, and Medicare Advantage plans differ from Original Medicare. Nothing here is a coverage determination. Confirm with 1-800-MEDICARE, your plan, or a SHIP counselor before you buy.