Will Insurance pay for my Medical Equipment?

This subject is one of my most asked questions of all time.

Let us see.... 

At the time of purchasing medical equipment—such as Mobility Scooters, Powerchairs, Stair lifts, or hospital beds—cost is often the biggest concern. The good news is that insurance may cover PART, or even all, of your expenses. Understanding how insurance works for durable medical equipment (DME) can help you make smarter decisions and reduce out-of-pocket costs.

What Is Durable Medical Equipment (DME)?

Durable Medical Equipment (DME) refers to medically necessary equipment prescribed by a doctor to help manage a health condition or improve daily living. This includes:

Insurance companies, including Medicare, Medicaid, and private insurers, have specific criteria to determine what qualifies as DME and in most cases they can guide you to find the right provider for the particular equipment you need.

Does Insurance Cover Medical Equipment?

Coverage depends on your policy and the type of equipment. In general:

  • Medicare (Part B): Covers 80% of the approved cost for medically necessary DME if prescribed by a doctor and purchased from a Medicare-approved supplier. The remaining 20% is the patient’s responsibility unless they have supplemental insurance, and here is wher it gets a bit tricky due to the amount of people needing assistance the wait time can be in some instances very long.

  • Medicaid: Coverage varies by state but often provides broader assistance for low-income individuals, if you or a loved one have Medicaid the best approach is to mentally prepare knowing that the process will be slow and there is a slight chance that your claim will be denied. 

  • Private Insurance: Policies differ. Some cover only certain types of DME or require pre-authorization. Others may require you to rent instead of purchase.

Steps to Get Medical Equipment Covered by Insurance

  1. Obtain a Prescription: A doctor must confirm the equipment is medically necessary.

  2. Check Your Insurance Policy: Review what’s covered and the requirements (e.g., documentation, prior authorization).

  3. Work With Approved Suppliers: Most insurers require you to purchase from an in-network or approved supplier.

  4. Submit Claims Properly: Ensure all medical documentation is complete to avoid delays or denials.

  5. Appeal if Denied: If your claim is denied, you have the right to appeal with additional supporting documents from your physician.

What If Insurance Doesn’t Cover It?

If your insurance doesn’t cover the full cost, here are some alternatives:

  • Supplemental Insurance: May cover deductibles or coinsurance.

  • Payment Plans: Many medical equipment providers offer financing options, this last one is the most common to be able to get the quipment faster, after clearing the process which your equipment provider will guide you. 

  • Veterans’ Benefits: Veterans may qualify for assistance through the VA.

  • Nonprofit Organizations & Grants: Some local or national organizations provide financial aid for mobility equipment.

Lastly

Insurance coverage for medical equipment can feel complicated, but with the right steps, you can significantly reduce your costs. Always start with your doctor’s recommendation, confirm coverage with your insurer, and work with a trusted provider who understands the insurance process.

Tip: If you’re unsure where to start, schedule a consultation with a mobility consultant who can guide you through the paperwork and equipment options.

Oliver Millan- Mobility Consultant, Mobility Plus Colorado Springs

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