Medical Equipment & Supplies — Project Kos
Medical Equipment & Supplies

Medical equipment
and what your plan covers.

Coverage depends on your plan, your state, and what was ordered. Select your coverage below to see what applies to you — then explore each category for the full picture.

Personalize your coverage view
Select both to color-code your coverage
Covered
Covered with conditions
Not covered
Equipment & supplies

Select a category to see what's covered and how to get it.

Wheelchairs & mobility aids
Manual wheelchairs, walkers, canes, rollators, scooters
Power wheelchairs
Custom power chairs, complex seating systems
Hospital beds & bedroom equipment
Adjustable beds, patient lifts, commodes, trapeze bars
Breathing equipment
Oxygen systems, CPAP, BiPAP, nebulizers
Diabetes supplies
Blood glucose monitors, CGMs, insulin pumps, test strips
Wound care supplies
Dressings, bandages, wound VAC therapy
Braces & supports
Knee, ankle, back, wrist braces — standard or custom
Artificial limbs
Prosthetic legs and arms, fitted and fabricated
Compression garments
Sleeves and stockings for lymphedema swelling
Daily care supplies
Ostomy bags, catheters, feeding tube supplies, incontinence
Bathroom safety equipment
Grab bars, shower chairs, raised toilet seats, bath benches
Hearing aids
Hearing devices and hearing exams
After the doctor signs the order

Who handles your equipment —
and what to expect from them.

Once a physician writes an order, it moves into a world of suppliers, prior authorization reviewers, and insurance contractors. Understanding who each player is — and what they are actually responsible for — changes how you navigate delays and problems.

Step 1 — Physician
The order is written and sent
The physician writes an order specifying the equipment or supply, the diagnosis, and a statement of medical necessity. Documentation must meet your insurance's coverage criteria — vague orders are the single most common cause of delays regardless of plan type. The order goes to either the supplier you choose or a supplier the doctor's office works with regularly.
Step 2 — DME Supplier
Insurance verification and order processing
The supplier verifies your coverage, confirms the item is covered under your plan, and determines whether prior authorization is required. For standard items this takes 1–2 business days. For complex items requiring prior authorization, the supplier assembles a documentation packet and submits it for review — to the Medicare contractor if you have Medicare, or to your Medicaid managed care plan or state agency if you have Medicaid.
Step 3 — Prior authorization review (if required)
Your insurer reviews the clinical documentation
The reviewer — a Medicare Administrative Contractor (MAC) for Medicare, or your Medicaid managed care plan or state agency for Medicaid — determines whether the documentation meets coverage criteria. They are not approving the item because your doctor ordered it; they are checking that the paperwork meets specific standards. Standard review: 10 business days for Medicare, varies by state for Medicaid. Documentation requests reset the clock. Denials can be appealed under both programs.
Step 4 — Delivery
Equipment arrives and is set up
Standard items are delivered to your home, sometimes with setup. Complex equipment like power wheelchairs requires a home visit from an Assistive Technology Professional for fitting and adjustment. For ongoing supplies, you initiate each monthly resupply — it is not automatic under either Medicare or Medicaid.
Equipment
DME Supplier
A business enrolled with Medicare, Medicaid, or both that provides durable medical equipment for home use. The supplier is responsible for verifying your coverage, submitting prior authorizations, arranging delivery, and providing ongoing service. Suppliers must be enrolled with your specific program — a Medicare-only supplier cannot bill Medicaid, and vice versa.
What to expect from a good supplier
Confirms your specific coverage and any cost-sharing before delivery
Provides a prior authorization reference number and estimated timeline
Delivers and sets up equipment with clear instructions
Responds to service and repair requests promptly
Bills your insurance directly — you pay only your applicable cost-sharing
Your rights with DME suppliers
Choose any supplier enrolled with your plan — you are not required to use one the hospital or doctor suggests
Receive a written estimate of your cost-sharing before accepting equipment
If you have Medicare: refuse to sign an ABN (Advance Beneficiary Notice) if you believe the item should be covered
If you have Medicare: file a complaint with 1-800-MEDICARE (1-800-633-4227) for billing disputes
If you have Medicaid: file a complaint with your state Medicaid program or managed care plan for billing disputes
Under both programs: request a written denial notice — this triggers your formal appeal rights
If something goes wrong
If you have Medicare: Call 1-800-MEDICARE (1-800-633-4227) to file a complaint or dispute a charge. Your state's free SHIP counselor can also help navigate billing disputes and appeals.

If you have Medicaid: Contact your state Medicaid program or your managed care plan's member services line directly. Your state has its own complaint and appeals process — timelines and procedures differ from Medicare.

If you have both (dual eligible): Medicare is billed first for covered items. If Medicare denies or partially pays, Medicaid is billed second. Disputes should go to whichever program's claim was the problem — your SHIP counselor can help sort this out at no cost.

Prior authorization denials under any plan: Ask for the specific reason code. Most denials are documentation gaps, not categorical exclusions. Additional clinical documentation from your physician often reverses a denial at the first appeal level.
Data sources & methodology
Medicare coverage data
CMS Medicare Benefit Policy Manual (IOM Pub 100-02) · 42 CFR §414 · Social Security Act §§1861–1862 · CMS Medicare & You 2025 · CMS Medicare Advantage and Part D Final Rule (42 CFR Parts 417, 422, 423). Coverage determinations reflect Original Medicare policy. Medicare Advantage coverage varies by plan.
State Medicaid benefit data
KFF State Health Facts — Medicaid Benefits indicators (kff.org/state-health-facts) · ADA State Dental Policy Report 2025 · Health Affairs doi:10.1377/hlthaff.2023.00873. Hearing aid coverage by state reflects KFF indicator data. KFF notes this indicator is approximate for some states — verify with your state Medicaid agency for definitive coverage status. Dental coverage tiers reflect ADA 2025 benefit classifications. Data reflects 2025 benefit packages — verify current status with your state Medicaid agency.
Coverage confidence levels
High confidence: Medicare coverage categories (sourced to federal statute). Hearing aid coverage by state for Medicaid (sourced to KFF).

Moderate confidence: Medicaid DME equipment coverage (category-level, varies by state plan and managed care contract).

Verify directly: Medicare Advantage plan-specific coverage, state Medicaid prior authorization requirements, managed care formularies.
This page provides general guidance only and does not constitute a coverage determination. Coverage eligibility depends on individual clinical documentation, plan enrollment, and state Medicaid agency decisions. Last updated April 2026. If you believe information on this page is inaccurate, let us know.