What counts as durable medical equipment under Medicare?

Equipment must meet five tests: durable (can withstand repeated use), used for a medical reason, not useful to someone without illness or injury, used in the home, and with an expected lifetime of at least three years. Common covered categories include mobility aids (walkers, manual and power wheelchairs, scooters), respiratory equipment (oxygen concentrators, CPAP and BiPAP machines, nebulizers), hospital beds, commodes, patient lifts, blood-glucose monitors and test strips, and certain seat-lift mechanisms. Items that fail the tests (disposables, comfort items, exercise equipment) are not DME.

What does the patient pay for DME in 2026?

Under Original Medicare Part B, the patient pays 20% coinsurance after meeting the Part B deductible ($257 in 2026). On a $1,500 manual wheelchair, the patient's share is about $300; on a $400 walker, about $80. Medigap plans typically pay the 20%, bringing patient cost to zero. Medicare Advantage plans set their own DME copay or coinsurance, often with prior authorization. Medi-Cal members pay nothing. Dual-eligibles have effectively no out-of-pocket cost for covered DME.

Which items need prior authorization in California?

A defined CMS list requires prior authorization before the supplier delivers the item, including certain power wheelchairs (most Group 2 and all Group 3), certain pressure-reducing support surfaces, and specific seat-lift mechanisms. The supplier submits documentation, including the face-to-face encounter and detailed medical-necessity notes, to Noridian (the California DME contractor). Standard hospital beds, manual wheelchairs, walkers, standard CPAP machines, and most oxygen equipment do not require prior authorization, though they still require an order and supporting documentation in the chart.

What is the Competitive Bidding Program?

CMS runs a Competitive Bidding Program in most metropolitan areas, including Los Angeles, San Diego, San Francisco, Sacramento, Riverside, and other California metros, for specified DME categories. Suppliers bid for contracts; only contracted suppliers can furnish those items in those areas and bill Medicare. The program sets payment rates lower than the national fee schedule. Patients have access to any contracted supplier in their area. Outside competitive-bid areas, any Medicare-enrolled DME supplier can serve patients at the national fee schedule.

What does Medicare not cover that families often expect?

Bath benches and shower chairs (deemed not strictly medical under Original Medicare), grab bars, stair lifts and home elevators, raised toilet seats (separate from commodes), most adult diapers and incontinence supplies, and home modifications generally. Medi-Cal covers several of these for adult members. Veterans may have additional VA equipment benefits. For Original-Medicare-only households, these items are out-of-pocket purchases, generally $30 to $300 each depending on the category.

How long does DME coverage last?

Medicare uses a 5-year reasonable useful lifetime rule for most DME. After five years, the patient can qualify for replacement if the equipment is worn out, lost, or no longer meets clinical needs. Repairs to existing equipment are covered when reasonable. For capped-rental items (most wheelchairs, hospital beds, CPAP), Medicare pays a monthly rental for up to 13 months, after which the equipment transfers to the patient as owned. For oxygen, a separate 36-month rental rule applies.

How do we choose a DME supplier?

Use Medicare's supplier directory at medicare.gov to find Medicare-enrolled DME suppliers in your area. The supplier must accept assignment (agree to Medicare's approved amount as full payment) to avoid extra charges. Read reviews, ask about delivery and setup, and ask whether the supplier handles the prior-authorization paperwork. For Medicare Advantage members, the plan's contracted DME network applies. For Medi-Cal members, the managed-care plan or county Fee-for-Service program contracts with specific suppliers.

Durable medical equipment and Medicare: 2026 coverage

What Medicare actually pays for in DME

The durable medical equipment benefit under Medicare Part B covers a wide slice of the equipment a senior needs to recover at home or live with a chronic condition. The headline rule: equipment must be durable, medical, used in the home, ordered by an enrolled provider, and supplied by a Medicare-enrolled supplier. Medicare pays 80% of the approved amount after the annual Part B deductible, and the patient pays the remaining 20%.

For most California households the DME journey starts after a hospital discharge, a new diagnosis, or a fall. The hospital discharge planner, the primary care physician, or a specialist writes the order. The supplier delivers and sets up the equipment, and the patient or family signs an assignment of benefits. Medicare receives the claim. The 20% coinsurance either goes to a Medigap plan, Medi-Cal (for dual-eligibles), or the patient.

The major equipment categories

DME is broad, and the categories matter because the rules differ.

Mobility. Walkers, rollators, manual wheelchairs, lightweight and heavy-duty wheelchairs, power wheelchairs (Groups 1 through 5), and scooters. Power chairs and scooters require detailed mobility evaluations and, for most power chairs, prior authorization.
Respiratory. Stationary and portable oxygen concentrators, oxygen tanks, CPAP and BiPAP machines with supplies, nebulizers and medications, and high-frequency chest-wall oscillation devices for specific conditions.
Beds and transfers. Hospital beds (manual, semi-electric, fully electric in defined cases), trapeze bars, side rails, mattresses including pressure-redistribution surfaces, and patient lifts (Hoyer-style).
Bathroom safety. Bedside commodes are covered. Shower chairs and bath benches are not under Original Medicare, though Medi-Cal covers them in many cases.
Diabetic equipment. Blood-glucose monitors, test strips, lancets, and continuous glucose monitors (CGMs) for insulin-using patients meeting coverage criteria.
Seat lifts. The lift mechanism inside certain recliner-style chairs is covered as DME (the chair itself is not).

What it costs in 2026

Pricing depends on the item and whether you are in a Competitive Bidding area. As a rough guide for Original Medicare Part B in California:

Standard walker: $80 to $130 Medicare-approved; patient pays about $16 to $26 of the 20% share.
Manual wheelchair: $300 to $1,500 depending on category; patient share $60 to $300.
Power wheelchair Group 2: $4,000 to $7,000; patient share $800 to $1,400 spread across capped-rental months.
Hospital bed (semi-electric, capped rental): roughly $150 to $250 per month for 13 months, patient share $30 to $50 per month.
Standard oxygen concentrator: capped rental at roughly $180 to $220 per month for 36 months, patient share $36 to $44.
CPAP machine with humidifier: capped rental for 13 months, patient share roughly $20 to $40 per month plus separate supply costs.

Medigap typically eliminates the 20% share. Medicare Advantage uses its own copay structure with prior authorization. Medi-Cal members pay nothing.

Prior authorization and documentation

Some categories require prior authorization, where the supplier submits clinical documentation to Noridian (the California DME contractor) before delivery. The most common items: most Group 2 and all Group 3 power wheelchairs, certain pressure-reducing support surfaces, and seat-lift mechanisms. Standard items do not require prior authorization, but every DME order needs three pieces of documentation in the medical record:

A face-to-face encounter with an enrolled provider within the required window (often 6 months) that documents the medical condition
A detailed written order from the prescriber specifying the exact item, quantity, and clinical justification
Supporting chart notes describing why the equipment is medically necessary, why simpler alternatives will not work, and the expected functional benefit

Most denials in California trace to missing or weak documentation, not to the equipment itself. A clear face-to-face note from the physician is the single biggest factor.

The Competitive Bidding Program in California

CMS runs the Competitive Bidding Program in most California metropolitan statistical areas, including the Los Angeles, San Diego, San Francisco Bay, Sacramento, Riverside, San Jose, Fresno, and Bakersfield regions. Suppliers bid for contracts to furnish defined product categories at set rates. Only contracted suppliers can bill Medicare for those products in those areas. Patients can choose any contracted supplier.

Product categories under competitive bidding rotate periodically but consistently include standard manual wheelchairs, walkers, hospital beds, oxygen equipment, CPAP, enteral nutrition, and a few others. Outside the program (rural California, items not under bidding), any Medicare-enrolled DME supplier can furnish equipment at the national fee schedule.

The 5-year reasonable useful lifetime rule

Medicare expects DME to last at least five years. After five years, if the equipment is worn out, lost, stolen, or no longer meets clinical needs, Medicare can cover a replacement under the same rules as the original. Repairs to existing equipment are covered when reasonable. The rule does not block earlier replacement when the clinical picture changes (a manual-wheelchair user who progresses to needing a power chair, for example).

For capped-rental items, the rental period varies by category. Most wheelchairs, hospital beds, and CPAP machines convert to patient ownership after 13 months of continuous use. Oxygen has a separate 36-month rental rule. Inexpensive routinely-purchased items (canes, walkers, glucose monitors) are typically purchased outright.

Medi-Cal DME in California

Medi-Cal covers a broader list than Medicare, including several items that Original Medicare excludes:

Adult incontinence supplies (briefs, pads, underpads) with monthly limits and a physician order
Bath benches, shower chairs, and certain bathroom safety items
Enteral nutrition and tube-feeding supplies
Some home modifications for members with qualifying needs
Custom seating and positioning equipment beyond standard categories

For dual-eligible members (Medicare plus Medi-Cal), Medicare pays first on items covered by both. Medi-Cal picks up the 20% coinsurance and covers items Medicare excludes. The combination effectively removes out-of-pocket cost for covered DME.

How to start

Identify the functional need: difficulty walking, need for a hospital bed at home, oxygen requirement on discharge, new wheelchair use.
Have the physician document the need with a face-to-face encounter and write a detailed order.
Choose a Medicare-enrolled DME supplier in your area. For competitive-bid items in California metros, the supplier must hold a contract.
For items requiring prior authorization, allow 7 to 10 business days for Noridian review before delivery.
The supplier delivers, sets up, and trains the patient and caregiver. Sign the assignment-of-benefits form. Keep all documentation for the file.

Common misconceptions to clear up

“Medicare will pay for any equipment my parent needs at home.” Only equipment that meets the DME definition and is on the covered list. Grab bars, stair lifts, bath benches, and most home modifications are not DME under Original Medicare.

“The supplier handles everything; we just sign.” The supplier handles the claim, but the physician must document the medical necessity. Weak chart notes are the most common cause of denial.

“Medi-Cal won’t cover the equipment Medicare denied.” For dual-eligibles, Medi-Cal often covers items Original Medicare excludes, including bath safety equipment and incontinence supplies. Ask the managed-care plan before paying out of pocket.

“We have to wait 5 years to replace anything.” The 5-year rule is the default replacement window, but earlier replacement is allowed when the clinical picture changes or the equipment is no longer functional.

Related services and next steps

This guide explains coverage and eligibility, not medical advice. Talk to a licensed clinician about care decisions. California Care Compass does not place referrals on Services & Treatments pages.

Durable medical equipment and Medicare in California: the 2026 rules.