Medicare Coverage for Durable Medical Equipment (DME)
- DME is coded under Medicare Part B
- After deductible, Medicare pays, 20%
- Client pays 20%
Key Coverage Rules
- If you qualify for hospice, Medi-Cal often pays your Medicare premiums and cost-sharing, ensuring minimal or no out-of-pocket expense
Medi-Cal
(California Medicaid)
- Medi-Cal covers most medically necessary DME and often offers broader coverage than Medicare, including some equipment for community or home use.
Dual Eligibility
(Medi-Medi)
- If you qualify for both Medicare and Medi-Cal, Medi-Cal often pays your Medicare premiums and cost-sharing, ensuring minimal or no out-of-pocket expense.
Simple & Flexible Payment
- Faster Delivery and Setup
- No Prior Authorization Needed
- Special Discounts for Non-Covered Items
Navigating Your Coverage
Insurance coverage can be complex, especially for medical equipment.
Our dedicated billing specialists are here to handle the details of verifying and authorizing your coverage, ensuring a smooth and straightforward experience.
Coverage for Durable Medical Equipment (DME)
- Medicare Part B generally pays 80% of the cost for medically necessary DME after the deductible.
Key Coverage Rules
- Item must be medically necessary
- Is prescribed by a Medicare-enrolled doctor
- Must be appropriate for use in the home
- Client pays 20% co-insurance
Learn more about coverage rules through the official Medicare durable medical equipment guidelines .
Official Government Resources
Access these resources for more detailed information about Medicare and Medi-Cal coverage for DME.
Official Medicare
DME Guide
- Learn about Medicare coverage for DME
Medi-Cal DME Fact Sheet/Forms
- View Medi-Cal fact sheet and forms related to DME
Contact Our
Billing Team
- DME is coded under Medicare Part B
Vital Medical Solutions
Medicare Coverage for Durable Medical Equipment (DME)
Medicare Part B includes coverage for DME. Medicare pays 80% of the cost after your deductible is met.
Key Coverage Rules
Simple & Flexible
Payment
Speedy & private pay: No prior paperwork is required for processing
No prior authorization required. Potential special pricing or discounts for non-covered items.
Medi-Cal
(California Medicaid)
Medi-Cal/Medicaid coverage of DME items, which may extend beyond Medicare to include items for community use.
