Does Medicare Pay For Medical Equipment and Home Health Care?

Will I be able to stay in my home if my health changes?

For many people between the ages of 45 and 75, aging in place is a priority. That often means understanding whether Medicare will help cover the cost of equipment and other services needed to take care of their medical needs in the comfort of home.

What Medical Equipment and In-Home Healthcare Does Medicare Pay For?

When determining what Medicare covers, it depends on the plan and eligibility rules. The common equipment and amenities Medicare coverage questions are:

• Will Medicare pay for a mobility scooter?
• Does Medicare pay for oxygen equipment?
• Can I get a hospital bed with Medicare?
• Does Medicare pay for In-home nursing care?
• Can Medicare pay for durable medical equipment?
• Does Medicare pay for gym memberships?

In this guide, we will cover how Medicare DME coverage works, what qualifies as home health care under Medicare, what costs to expect, and where coverage gaps may exist.

A Quick Overview of Medicare Parts A and B

Before focusing on durable medical equipment and in-home services, it’s important to understand which part of Medicare applies.

Medicare Part A (Hospital Insurance)

Part A generally covers limited home health services after a hospital stay. Part A coverage for home health is usually tied to a qualifying inpatient stay and strict criteria. Click here to learn more about Medicare Part A.

Medicare Part B (Medical Insurance)

Part B covers durable medical equipment (DME) and certain in-home health services. DME is the category that covers hospital equipment, mobility scooters, wheelchairs, walkers, oxygen equipment, etc.  To qualify, the equipment must:

• Be prescribed by a doctor
• Considered medically necessary
• The equipment is primarily used in the home
• Equipment is durable and reusable

Click here to learn more about Medicare Part B

For most Medicare DME coverage and many ongoing home health services, Part B is the primary source of coverage. For a full list of what is covered by your plan, contact your insurance company directly. If you are doing research for Medicare planning, ask the insurance company about this before you sign up.

Does Medicare Pay for a Mobility Scooter?

The key question becomes whether the scooter is medically necessary. Medicare requires documentation showing that the individual cannot perform daily activities inside the home without the equipment.

Does Medicare Pay for Oxygen Equipment?

The answer is typically yes — if blood oxygen levels meet specific medical criteria and a doctor prescribes it.

How Medicare Covers Durable Medical Equipment

Medicare DME coverage follows specific guidelines under Part B.  To qualify for DME coverage, the following criteria must be met:

• A doctor must prescribe the equipment
• The equipment must be medically necessary
• The supplier must be enrolled in Medicare and accept assignment
• The Part B deductible must be met

After the deductible, Medicare typically pays 80% of the approved amount, and the beneficiary is generally responsible for the remaining 20% coinsurance.

Some Important Details About Getting Medical Equipment:

• Certain equipment (such as oxygen equipment) is rented rather than purchased.
• Some items may require prior authorization.
• Competitive bidding programs may affect which suppliers are available in certain regions.
• If a supplier does not accept the assignment, out-of-pocket costs may be significantly higher.

Does Medicare Cover In-Home Health Care?

Yes, Medicare does pay for home health care for medically necessary, skilled services. Medicare in-home health services may include:

• Part-time or intermittent skilled nursing care
• Physical therapy
• Occupational therapy
• Speech-language pathology services
• Medical social services

To qualify for Medicare-covered home health care, several conditions must be met:

• The patient must be under a doctor’s care
• A formal care plan must be established and reviewed regularly
• The patient must be considered homebound
• The services must be medically necessary

What Does “Homebound” Mean?

Medicare defines homebound as a condition in which leaving home requires considerable effort and assistance. It does not mean someone can never leave the home, but routine outings must be limited due to your medical condition.

What Is NOT Covered?

 Medicare does not cover all home health benefits. Some common expenses that are not covered are:

• 24-hour home care
• Long-term custodial care
• Assistance with bathing or dressing if no skilled need exists
• Meal delivery services

Understanding Out-of-Pocket Costs

Even when Medicare approves DME or home health services, you may have out-of-pocket costs.

What Original Medicare Covers:

• After the annual Part B deductible is met, beneficiaries typically pay 20% coinsurance for DME
• There is no annual out-of-pocket maximum, which means there is no cap on annual spending, and multiple pieces of equipment or extended treatment can add up financially.

• For home health services, most skilled services are covered with minimal out-of-pocket costs. However, durable medical equipment provided during home health treatment may still require the standard 20% coinsurance.

What Medicare Does Not Fully Cover

• Routine dental care
• Vision exams for glasses
• Hearing aids
• Long-term custodial care
• Gym memberships

Under Original Medicare, gym memberships are not typically covered. Some Medicare Advantage plans may include fitness benefits as an added feature, but those benefits vary by plan.

How Supplemental Coverage May Help

Because of deductibles and coinsurance under Original Medicare, many beneficiaries explore additional coverage options. These are known as Medicare Supplements. Supplemental coverage does not cover all expenses, but it helps stabilize the costs. The most common Medicare supplements are:

Medigap Plans or Medicare Supplement Plans

Medigap does not add new benefits but may reduce out-of-pocket costs. Medigap plans are designed to help cover:

• Part B coinsurance (including the 20% for DME)
• Certain deductibles
• Other cost-sharing amounts

Click here to learn more about Medigap Plans

Medicare Advantage Plans

Medicare Advantage plans bundle Part A and Part B into one plan. These plans:

• Often have provider networks
• May include additional benefits
• May include fitness benefits or wellness programs
• Have annual out-of-pocket maximums
• Plan rules, coverage limits, and provider access vary significantly.

Click here to learn more about Medicare Advantage Plans

Key Takeaways

• Medicare Part B typically covers durable medical equipment when medically necessary.
• Equipment must be prescribed and obtained through a Medicare-approved supplier.
• Beneficiaries usually pay 20% coinsurance after meeting the Part B deductible.
• Medicare does pay for home health care — but only for skilled, part-time medical services.
• Custodial care and 24-hour in-home care are not covered under Original Medicare.
• Original Medicare does not include an annual out-of-pocket maximum.
• Gym memberships are not covered under Original Medicare, though some Advantage plans may offer fitness benefits.
• Supplemental coverage may help reduce cost-sharing expenses.

Get Help with Medicare Equipment and In-Home Health Services

Medicare can play a significant role in supporting aging at home through durable medical equipment and skilled in-home services. However, coverage depends on medical necessity, approved suppliers, and adherence to Medicare guidelines.

For personalized guidance, fill out the form below to speak with a licensed Medicare professional to help you explore your options and ensure that your Medicare coverage aligns with both medical needs and financial goals.