You’ve been paying health insurance premiums for years, yet you’re still reaching into your wallet for reading glasses, blood pressure monitors, and other medical supplies. Meanwhile, your insurance company is sitting on a goldmine of covered equipment that most people never think to request.

The truth is, health insurance plans – especially Medicare and Medicare Advantage – cover far more durable medical equipment (DME) than most people realize. From mobility aids to sleep apnea machines, these “hidden freebies” can save you hundreds or thousands of dollars annually if you know what to ask for.

Understanding Durable Medical Equipment Coverage

Durable medical equipment includes reusable medical devices that serve a medical purpose, can withstand repeated use, and are primarily used for medical rather than convenience purposes. Your insurance likely covers 80% of approved DME costs after you meet your deductible, but the key is knowing what qualifies and how to navigate the approval process.

Medicare defines DME as equipment that meets specific criteria: it must be prescribed by a doctor, serve a medical purpose, be reusable, and be appropriate for home use. Private insurance often follows similar guidelines but may have different coverage levels and approval processes.

Mobility and Safety Equipment

Wheelchairs and Scooters

Manual wheelchairs are typically covered when you have a mobility impairment that limits your ability to participate in daily activities. Power wheelchairs and scooters require more extensive documentation but are covered for people who can’t operate a manual wheelchair due to strength, endurance, or coordination issues.

Your doctor needs to document that you have a mobility limitation that significantly impacts your daily activities and that a wheelchair or scooter is medically necessary. The approval process can take several weeks, but the equipment can cost $300-$3,000 that you won’t have to pay out of pocket.

Walkers and Canes

Standard walkers, rolling walkers, and canes are covered when you have balance issues, weakness, or other conditions that affect your ability to walk safely. These items typically cost $50-$200 but are fully covered with proper documentation.

Four-wheel walkers with seats are particularly popular among older adults and are covered when medically necessary. Your doctor simply needs to document that you need assistance with mobility and that the equipment will help prevent falls.

Bathroom Safety Equipment

Many insurance plans cover bathroom safety equipment like raised toilet seats and shower benches when prescribed by a doctor. These items prevent falls and help people with mobility issues maintain independence.

Installation costs aren’t typically covered, but the equipment itself – which can cost $100-$500 – often is. Note that grab bars require permanent installation and usually aren’t covered as DME, but other safety equipment may be.

Respiratory Equipment

Sleep Apnea Machines

CPAP and BiPAP machines are covered when you have a diagnosis of sleep apnea confirmed by a sleep study. These machines typically cost $500-$3,000, but insurance covers the rental or purchase after you meet your deductible.

The catch? You usually need to demonstrate compliance by using the machine regularly. Insurance companies monitor usage through built-in data recording, and you typically need to use the machine at least 4 hours per night for 21 out of 30 consecutive days.

Nebulizers and Oxygen Equipment

Nebulizers for asthma or COPD are covered when prescribed by your doctor. Home oxygen equipment, including concentrators and portable oxygen tanks, is covered for people with qualifying lung conditions and specific blood oxygen levels.

These items can be expensive – oxygen concentrators cost $300-$600 to purchase – but are typically covered as rental equipment. Your doctor needs to document your oxygen levels and medical necessity.

Diabetes Management Equipment

Blood Glucose Monitors

Blood glucose monitors, test strips, and lancets are covered for people with diabetes. While basic monitors might cost $20-$100, continuous glucose monitors (CGMs) can cost $200-$300 monthly and are increasingly covered by insurance.

The key is getting your doctor to prescribe the specific equipment and supplies you need. Many insurance plans have preferred brands, so check your formulary before purchasing equipment independently.

Insulin Pumps

Insulin pumps are covered for people with Type 1 diabetes or Type 2 diabetes who meet specific criteria. These devices cost $4,000-$6,000 but are typically covered when medically necessary.

You’ll need documentation showing that multiple daily injections haven’t adequately controlled your blood sugar and that you’re capable of operating the pump safely.

Cardiac and Monitoring Equipment

Home Blood Pressure Monitors

Automatic blood pressure monitors are covered for people with hypertension who need regular monitoring. These devices typically cost $30-$100 but are fully covered with a prescription.

Your doctor needs to document that home monitoring is medically necessary for managing your condition. This is particularly important for people with hard-to-control blood pressure or white coat syndrome (elevated blood pressure readings in medical settings due to anxiety).

Heart Rate Monitors

Heart rate monitors and pulse oximeters are covered for people with cardiac conditions or respiratory issues. These devices help monitor your condition at home and can alert you to potential problems.

While basic pulse oximeters cost $20-$50, more advanced cardiac monitors can cost $200-$500. Insurance typically covers these when prescribed for specific medical conditions.

Orthopedic and Support Equipment

Braces and Supports

Knee braces, back supports, compression stockings, and other orthopedic devices are covered when prescribed by your doctor. These items can cost $50-$500 but are typically covered after your deductible.

Custom-fitted braces require prior authorization but are covered for specific conditions. Off-the-shelf braces are easier to obtain and often covered with a simple prescription.

Hospital Beds

Hospital beds for home use are covered when you have a medical condition that requires positioning that can’t be achieved with a regular bed. Conditions like severe arthritis, cardiac issues, or respiratory problems may qualify you for a hospital bed.

These beds cost $500-$2,000 to purchase but are typically covered as rental equipment. Your doctor needs to document why a regular bed isn’t sufficient for your medical needs.

Vision and Hearing Equipment

Magnifiers and Reading Aids

Electronic magnifiers and reading aids are covered for people with vision impairments that can’t be corrected with glasses. These devices cost $200-$2,000 but are covered when prescribed by an eye doctor.

The key is having documented vision loss that significantly impacts your daily activities. Your eye doctor needs to show that magnification is medically necessary, not just convenient.

Hearing Aids (Limited Coverage)

While traditional Medicare doesn’t cover hearing aids, many Medicare Advantage plans do. Coverage varies widely, but you might get $500-$3,000 toward hearing aids annually.

Check your specific plan benefits, as hearing aid coverage is becoming more common as plans compete for members.

How to Navigate the System

Start with Your Doctor

Your doctor is the key to accessing covered equipment. They need to document your medical condition, explain why specific equipment is necessary, and submit the proper paperwork.

Be specific about your needs and ask directly about covered options. Many doctors aren’t familiar with all available DME options, so do your research and ask about specific items.

Use Approved Suppliers

Insurance companies typically have networks of approved DME suppliers. Using out-of-network suppliers can result in higher costs or denied claims.

Your insurance company can provide a list of approved suppliers in your area. These suppliers understand the approval process and can help ensure your claims are processed correctly.

Understand Prior Authorization

Many DME items require prior authorization before your insurance will cover them. This process can take days or weeks, so plan ahead when possible.

Your doctor’s office or DME supplier typically handles prior authorization, but follow up to ensure paperwork is submitted correctly and on time.

Keep Detailed Records

Document all communications with your insurance company, doctor, and DME suppliers. Keep copies of prescriptions, approval letters, and receipts.

If claims are denied, you have the right to appeal. Having detailed records makes the appeal process much easier and more likely to succeed.

Maximizing Your Benefits

Review Your Plan Annually

DME benefits can change yearly, especially with Medicare Advantage plans. Review your plan documents during open enrollment to understand what’s covered.

New equipment and expanded coverage options are added regularly, so something that wasn’t covered last year might be covered now.

Ask About Upgrades

If you qualify for basic equipment, ask about upgrades that might be covered. For example, if you need a walker, a rolling walker with a seat might be covered for the same copay.

Sometimes premium features are covered when they serve a medical purpose. Don’t assume the most basic option is your only choice.

Consider Rental vs. Purchase

Many DME items are available as rentals or purchases. Rental might be better for short-term needs, like an injury, while purchase makes sense for long-term use.

Your insurance company can explain the cost difference and help you choose the most cost-effective option.

The Bottom Line

Health insurance covers far more medical equipment than most people realize. From mobility aids to monitoring devices, these benefits can save you significant money while improving your quality of life.

The key is understanding what’s covered, working with your doctor to document medical necessity, and navigating the approval process correctly. Don’t let these valuable benefits go unused – they’re part of what you’re paying for in your monthly premiums.

Take time to review your DME benefits and discuss your needs with your doctor. You might be surprised by what’s available and how much money you can save by taking advantage of these often-overlooked benefits.

Key Takeaways

• Insurance covers 80% of approved durable medical equipment after your deductible

• Mobility aids like wheelchairs, walkers, and canes are covered with proper documentation

• Sleep apnea machines and respiratory equipment require compliance monitoring

• Diabetes management equipment including glucose monitors and insulin pumps are covered

• Prior authorization is required for many items, so plan ahead

• Use approved suppliers to ensure proper coverage and processing

• Review your benefits annually as coverage options change regularly