Coverage · Equipment & Medications
What your insurance actually gets you.
Every category of equipment, supplies, and medications - what is covered, what you pay, where to get it, and what trips people up. Set your state and coverage below to see what applies to you specifically.
If this is your first time looking at coverage
A few terms you will see everywhere
These four terms appear in every column of the matrix below and in every card. Knowing them makes the rest of the page much easier to read.
Deductible
An amount you pay out of pocket each year before your insurance starts paying. For Original Medicare in 2026, this is $283 per year for Part B (medical/equipment) services. After you have spent $283 in covered services, the deductible is "met" and Medicare starts paying its share.
Coinsurance
A percentage of the cost you pay AFTER the deductible is met. Original Medicare's coinsurance is 20% for most Part B items - meaning you pay 20% and Medicare pays 80%. If a wheelchair costs $5,000, you pay $1,000 and Medicare pays $4,000.
Cost-share
A general term that covers ALL the things YOU pay - deductibles, coinsurance, copayments. When the matrix says "cost-share: $$" it means your total out-of-pocket exposure for that category is moderate. The dollar signs are a quick comparison, not specific numbers.
Prior authorization
Approval from your insurance BEFORE they will pay for an item or service. Your doctor submits documentation explaining why you need it. The insurance reviews and approves or denies. This adds 1-4 weeks to most equipment orders. If denied, you have the right to appeal.
At a glance
Your coverage summary
For someone with Original Medicare, no supplement, in California. Updates as you change selectors above.
Durable Medical Equipment
Hospital beds, walkers, CPAP
●
$$
Medicare Part B
✓
Oxygen & respiratory
Concentrators, CPAP, BiPAP
●
$$
Medicare Part B
✓
Diabetic supplies
Strips, monitors, CGMs, pumps
●
$$
Medicare Part B
✓
Mobility & seating
Wheelchairs, scooters, walkers
●
$$
Medicare Part B
✓
Prosthetics & orthotics
Limbs, braces, eye prosthetics
●
$$
Medicare Part B
✓
Wound care & ostomy
Dressings, pouches, NPWT
●
$$
Medicare Part B
✓
Prescription drugs
Part D + Part B drugs
●
$$
Medicare Part B
✓
OTC & retail items
OTC, dental, vision, hearing
●
$$
Medicare Part B
✓
Covered:
● Full
◐ Partial
○ Not covered
Cost:
$0 None
$ Low
$$ Moderate
$$$ High
Watch-outs:
! Has notable gaps
✓ Clean
Durable Medical Equipment
Hospital beds, walkers, CPAP, lifts, and the rest of the rentable equipment Medicare calls DME.
What's covered
Medicare Part B covers equipment your doctor prescribes for use at home that is expected to last at least three years. Examples: hospital beds, walkers, canes, commodes, nebulizers, CPAP machines, manual wheelchairs, and patient lifts. NOT covered: bathroom safety equipment (grab bars, raised toilet seats, shower chairs), stair lifts, recliners, lift chairs (with rare exceptions for the lifting mechanism only), home modifications, items mainly for comfort or convenience, and anything not on the Medicare-approved list.
What you'll pay
After you pay the first $283 in Part B services for the year (the annual Part B deductible), Medicare pays 80% of what they consider the "approved amount" and you pay 20%. There is NO yearly limit on this 20% under Original Medicare alone. A $5,000 wheelchair means you pay $1,000 out of pocket.
Where to get it
Find a Medicare-approved DME supplier in your area. The supplier must agree to "accept assignment" - which means they accept Medicare's approved amount as full payment, so you only owe the standard 20%. Use Medicare.gov's supplier directory, or call 1-800-MEDICARE.
Common gotchas
Many items need approval from Medicare before the supplier can deliver them ("prior authorization") - this can take 1-4 weeks. If a supplier does not accept assignment, they can charge you more than the Medicare amount and you pay the difference. Ask before ordering whether the supplier accepts assignment.
Oxygen & respiratory
Concentrators, portable tanks, CPAP, BiPAP, nebulizers, and respiratory accessories.
What's covered
Medicare covers oxygen equipment when your doctor documents an oxygen-dependent condition. Coverage includes the concentrator (the machine that makes oxygen from room air), portable units for travel, tubing, masks, and refills. NOT covered: oxygen for general comfort or sleep without a documented oxygen need, and oxygen prescribed by a non-Medicare provider.
What you'll pay
Equipment is rented for 36 months. After your $283 yearly Part B deductible is met, you pay 20% of the monthly rental fee. After 36 months, no rental cost - you only pay 20% for monthly maintenance and replacement supplies (tubing, masks).
Where to get it
A Medicare-approved oxygen supplier. The supplier delivers, sets up, and maintains the equipment. Medicare requires the supplier to provide all backup equipment, tubing, and masks at no extra charge.
Common gotchas
To qualify, your doctor must document specific blood oxygen test results. Coverage is reviewed at month 3 and again before the 36-month rental ends. Switching suppliers during the rental period generally restarts the 36-month clock.
Diabetic supplies
Test strips, lancets, glucose monitors, CGMs, insulin pumps, and pump supplies.
What's covered
Medicare Part B covers blood sugar test strips, lancets (the small needles for finger sticks), blood sugar monitors, control solution, and continuous glucose monitors (CGMs - sensors worn on the skin that read glucose continuously). Insulin pumps and pump tubing are covered as equipment. Insulin used IN a pump is also Part B (not Part D). NOT covered: insulin syringes for injections (those are Part D), insulin you inject yourself (Part D), needles and pens for injection (Part D), at-home A1C kits.
What you'll pay
After your $283 yearly Part B deductible, you pay 20% of the cost. CGMs and pump supplies stay at 20% coinsurance for as long as you use them. There is no yearly out-of-pocket cap under Original Medicare alone.
Where to get it
A Medicare-approved supplier or a pharmacy enrolled as a Medicare DME supplier (not all pharmacies are). Mail-order is the most common path for ongoing supplies because some retail pharmacies are not enrolled.
Common gotchas
Strict quantity limits per month based on whether you use insulin. CGMs require documentation of insulin use or specific glucose patterns. Suppliers can only ship a 90-day supply at a time.
Mobility & seating
Wheelchairs (manual, power, complex rehab), scooters, walkers, canes, crutches.
What's covered
Medicare Part B covers manual wheelchairs, power wheelchairs, scooters, walkers, canes, and crutches when prescribed for use in your home and your doctor documents you need them to function inside your home. Power mobility devices require a face-to-face physician examination within 6 months before the order. NOT covered: stair lifts, vehicle wheelchair lifts, ramps, home modifications, equipment for outdoor mobility only, or upgrades beyond what is "medically necessary" (luxury features).
What you'll pay
After your $283 yearly Part B deductible, you pay 20%. Power wheelchairs are typically rented for 13 months, after which you own them. Manual wheelchairs are usually purchased outright.
Where to get it
A Medicare-approved supplier accepting assignment. For complex power mobility (custom seating, power positioning), the supplier must be specifically accredited for "complex rehab technology."
Common gotchas
Strict documentation needed: your physician must document specific mobility limitations and that less-expensive alternatives (cane, walker, manual chair) will not meet your needs. Power mobility denials are common; appeals often succeed with proper documentation.
Prosthetics & orthotics
Prosthetic limbs and eyes, leg/arm/back braces, and post-surgical breast prostheses.
What's covered
Medicare Part B covers prosthetic limbs, prosthetic eyes, orthotic devices (braces for legs, arms, neck, back), some breast prostheses after mastectomy, and electrical stimulation devices when prescribed and medically necessary. NOT covered: cosmetic prosthetics, dental prosthetics (dentures), most hearing aids, eyeglasses (except after cataract surgery), most foot orthotics for non-diabetic patients.
What you'll pay
After your $283 yearly Part B deductible, you pay 20%.
Where to get it
A Medicare-approved prosthetist or orthotist. Many require professional certification (ABC or BOC). Use Medicare's supplier directory.
Common gotchas
Prosthetic limbs require detailed documentation including a face-to-face exam. Coverage limits how often you can replace items (typically 5 years for prosthetic limbs unless a medical change is documented). Refurbishment is sometimes covered.
Wound care & ostomy
Surgical dressings, ostomy pouches and barriers, negative pressure therapy, lymphedema garments.
What's covered
Medicare Part B covers ostomy supplies (pouches, skin barriers, accessories) and surgical dressings for wound care prescribed by your doctor for use at home. NOT covered: routine first aid supplies, hydrogen peroxide, gauze for non-prescription use, "comfort" supplies, supplies for cosmetic procedures.
What you'll pay
After your $283 yearly Part B deductible, you pay 20%.
Where to get it
A Medicare-approved supplier specializing in ostomy or wound care. Many work nationally via mail-order.
Common gotchas
Quantity limits apply (so many pouches per month, etc.). Higher-tier products (specific brands or features) may require physician documentation of medical necessity. Negative pressure wound therapy has separate strict requirements.
Prescription drugs
Part D plans, Part B drugs, insulin caps, the $2,100 out-of-pocket cap, and where to get the cheapest fills.
What's covered
Original Medicare covers most outpatient prescription drugs through a separate Part D plan you choose and pay for. Part B (your medical coverage) covers a smaller set of drugs administered by providers (chemotherapy, dialysis drugs, immunosuppressants for transplant patients, certain inhaled drugs, insulin used in a Part B-covered pump). NOT covered without a Part D plan: most retail prescriptions you fill at a pharmacy. Going without Part D when you do not have other "creditable" drug coverage triggers a permanent late enrollment penalty.
What you'll pay
2026 Part D structure: a yearly deductible up to $615 (some plans waive this), then 25% of the cost of covered drugs until your total out-of-pocket reaches $2,100. After $2,100, $0 for the rest of the year. Insulin is capped at $35 per month per insulin. ACIP-recommended vaccines (shingles, RSV, etc.) are $0.
Where to get it
Any pharmacy in your Part D plan's network. Mail-order pharmacy is often cheapest for ongoing maintenance medications.
Common gotchas
Each Part D plan's "formulary" (covered drug list) is different. The cheapest plan for your specific drugs may be the most expensive for someone else. Use Medicare.gov Plan Finder during Open Enrollment (October 15 to December 7) to compare. Late enrollment penalty is 1% per uncovered month for life.
OTC & retail
What your plan does not cover - hearing aids, glasses, dental supplies, OTC medications, and where to pay cash smartly.
What's covered
Original Medicare covers very little here. Some preventive supplies are covered indirectly through Part B preventive benefits. NOT covered: most over-the-counter (OTC) medications, vitamins, supplements, dental supplies, dentures, hearing aids, eyeglasses (except after cataract surgery), reading glasses, dental cleaning supplies, OTC pain relievers, allergy medications, retail health items in general.
What you'll pay
Full retail price for everything not covered.
Where to get it
Pharmacies, retail stores, online sellers. Anywhere.
Common gotchas
This is the largest gap in Original Medicare. People often expect more coverage here than exists. Plan for these costs separately or consider an MA plan with supplemental allowances.
Category deep-dive
Loading...
Common gaps
What your insurance will not cover
Items routinely missed by primary insurance. Some are partially covered by specific supplemental programs.
Hearing aids
Original Medicare and most commercial plans do not cover hearing aids. Some MA plans offer a $500-3,000 allowance per ear.
Not covered by your selection
Eyeglasses
Original Medicare covers one pair only after cataract surgery. Routine glasses are not covered.
Not covered by your selection
Dentures & dental supplies
Original Medicare excludes most dental care, dentures, and dental supplies.
Not covered by your selection
OTC medications
Insulin syringes, OTC pain relievers, vitamins, allergy medications are typically not covered.
Not covered by your selection
Long-term care
Medicare does not cover long-term custodial care (assisted living, nursing home for more than 100 days).
Not covered by your selection
Cosmetic procedures
Cosmetic surgery, cosmetic dental, elective procedures are excluded from all major coverage.
Not covered by your selection
Reference
Glossary of terms
Tap any term to expand the definition. These are the words used throughout this page and the rest of the Project Kos site.
Deductible
The amount you pay out of pocket each year before insurance starts covering services. After the deductible is "met," your insurance picks up its share. Different deductibles can apply to different parts of your coverage (medical, drug).
Coinsurance
A percentage of the cost you pay after the deductible. Original Medicare Part B coinsurance is 20%. If you have a Medigap plan, the supplement may pay this 20% so you owe less or nothing.
Copay (copayment)
A fixed dollar amount you pay for a service or item, regardless of total cost. For example, a $10 copay for a doctor visit. Used most often in Medicare Advantage and commercial insurance.
Cost-share
Umbrella term for everything you pay out of pocket: deductibles, coinsurance, and copays combined.
Out-of-pocket maximum (OOP cap)
The most you can pay in cost-share in one year. Once you hit the cap, your plan pays 100% for the rest of the year. Original Medicare has NO cap. Medicare Advantage has a cap (in-network: $9,250 in 2026). Medigap effectively caps it through coverage of coinsurance.
Premium
The monthly amount you pay to have coverage at all. Separate from any deductible or copay you pay when using care. Most people on Original Medicare pay $202.90/month for Part B in 2026 (higher for higher incomes via IRMAA).
IRMAA
Income-Related Monthly Adjustment Amount - extra Medicare premium you pay if your income is above certain thresholds ($106,000 single / $212,000 joint in 2026). Applies to both Part B and Part D premiums.
Prior authorization
Approval from your insurance before they will pay for an item or service. Your doctor submits documentation; the insurance approves or denies. Adds 1-4 weeks to most orders. If denied, you have the right to appeal.
Step therapy
A requirement that you try a less-expensive option first before insurance will pay for a more expensive one. Common for expensive drugs and equipment.
Formulary
The list of drugs your plan covers. Each plan has its own formulary divided into tiers (cheaper to more expensive). A drug not on the formulary is generally not covered, though you can request an exception.
Network
The set of doctors, hospitals, pharmacies, and suppliers your plan has contracted with. "In-network" means they have agreed to your plan's prices. "Out-of-network" means they have not, and your plan may not cover them or may cover them at a much lower rate.
Assignment (accept assignment)
When a Medicare provider agrees to accept Medicare's approved amount as full payment. If your supplier accepts assignment, you only owe the standard 20% coinsurance. If they do not, they can charge more and you pay the difference.
Medicare Advantage (Part C)
A private insurance plan that replaces Original Medicare (Parts A and B). Often includes drug coverage (MA-PD), dental, vision, hearing, and OTC benefits. Network restrictions apply.
MA-PD
A Medicare Advantage plan that includes Part D prescription drug coverage built in. Most MA plans are MA-PD.
Part B
Medicare's outpatient/medical benefit. Covers doctor visits, outpatient procedures, equipment (DME), and some preventive services. Has a $283 yearly deductible (2026) and 20% coinsurance.
Part D
Medicare's prescription drug benefit, sold by private insurers. You enroll separately if you have Original Medicare. Required to avoid late enrollment penalty (unless you have other "creditable" drug coverage).
Medigap (Medicare Supplement)
Private insurance you can buy to cover the gaps in Original Medicare - coinsurance, copays, sometimes the deductible. 10 standardized plans (A through N), each covering a defined set of gaps. Only works with Original Medicare, NOT Medicare Advantage.
D-SNP (Dual Special Needs Plan)
A Medicare Advantage plan designed specifically for people who have BOTH Medicare and Medicaid (dual-eligible). Often includes enhanced benefits like dental, vision, hearing, and OTC allowances.
Extra Help (LIS)
Federal program that helps with Part D drug costs for low-income Medicare beneficiaries. Reduces or eliminates premiums, deductibles, and copays. Income limit: $23,475 single / $31,725 couple in 2026. Automatic for dual-eligibles.
NPI (National Provider Identifier)
A 10-digit number that identifies a healthcare provider in federal systems. Required for any provider that bills Medicare or Medicaid.
DME (Durable Medical Equipment)
Medical equipment expected to last at least 3 years, used at home, prescribed by a doctor. Covered under Medicare Part B.
CGM (Continuous Glucose Monitor)
A small sensor worn on the skin that reads your blood sugar continuously, sending data to a phone or reader. Covers most of the day, replacing finger sticks. Covered by Medicare Part B with documentation of insulin use or specific glucose patterns.
FEHB / FEDVIP
Federal Employee Health Benefits is the medical coverage for federal workers and retirees. FEDVIP is the SEPARATE federal dental and vision program (most federal employees do not realize FEHB does not cover dental and vision).
Late enrollment penalty
A permanent extra charge added to your Part D or Part B premium if you delay enrollment without having other creditable coverage. Part D penalty is 1% per uncovered month, applied for life.
Data sources & methodology
Federal coverage rules
Medicare DME coverage (42 CFR 410.38, Local Coverage Determinations by DME MAC jurisdiction). Part B drug coverage (Social Security Act Section 1861(s)). Part D structure and cost-sharing (Inflation Reduction Act provisions effective 2024-2026; CMS Final Call Letter 2026). Medicaid DME and pharmacy coverage (42 CFR 440 Subpart B; state plan amendments). VA prosthetics and medical supplies (38 CFR 17.150-17.154). TRICARE pharmacy and DME (32 CFR 199.4-199.18). FEHB plan brochures (current contract year).
2026 figures verified
Part B deductible $283 · Part D OOP cap $2,100 · Part D max deductible $615 · Insulin cap $35/month per insulin · MA in-network OOP max $9,250 · Medigap Plan K OOP $8,000 · Medigap Plan L OOP $4,000 · HD F/G deductible $2,950. All per CMS releases (Nov 14, 2025) and Inflation Reduction Act schedules.
Verify your specific situation: The information above is general - your specific plan may have stricter rules. Use your plan's Evidence of Coverage document, call your plan, or contact your state SHIP (1-877-839-2675, shiphelp.org) for unbiased counseling. For Medicaid specifics, contact your state Medicaid office. For VA, contact your VA medical center. Also see our data sources reference.