START WITH YOUR ORDER — The useful question is whether Medicare will help pay for the specific equipment, supplier and coverage route in front of you. Under Original Medicare, Part B generally covers medically necessary DME ordered by an eligible person's clinician for use in the home. Seeing a product category on Medicare's list does not decide one person's claim. Ask the clinician and supplier about suitability and documentation; only the actual coverage process can determine the individual's result.
IN PLAIN ENGLISH · COVERAGE PATH
The rule is general. The decision is individual.
- Identify the item.Get its exact description and billing code.
- Check your coverage route.Original Medicare and Medicare Advantage use different plan processes.
- Confirm before delivery.Ask the supplier and Medicare or your plan about documentation, assignment or network, and your estimated cost.
This is an editorial diagram, not an eligibility tool or a coverage decision.
General rule: for covered DME, after the Part B deductible, the usual share is 20% of the Medicare-approved amount when the supplier accepts assignment. Verify the exact item and supplier.
WHAT YOU MAY PAY — After the Part B deductible, a person generally pays 20% of the Medicare-approved amount for covered DME when the supplier accepts assignment. Medicare defines the approved amount as the lower of the actual charge or the applicable fee. A posted fee schedule amount alone is not a personal price quote. A supplier that does not accept assignment may charge more, so ask before receiving the item.
RENT OR BUY — Medicare says the route depends on the equipment: some items are rented, some purchased, and some offer a choice. Certain capped rental items transfer ownership after a specified rental period. Ask the supplier which rule applies to the exact billed item and who handles maintenance and repairs during and after rental.
IF YOU HAVE MEDICARE ADVANTAGE — Plans must cover medically necessary services Original Medicare covers, but plan networks, prior authorization and cost sharing may differ. Ask your plan whether the proposed item, supplier and authorization path are covered and request a plan-specific cost estimate. Do not apply Original Medicare's usual 20% figure to a Medicare Advantage claim without checking your plan.
BEFORE DELIVERY — Ask for the exact item and billing code, whether the arrangement is rental or purchase, whether the supplier is enrolled and accepts assignment, the required order and any prior authorization, expected patient cost including accessories, and the repair contact. Keep the written answers. For your own coverage, confirm with Medicare or your plan and the supplier; a fee file or this explainer cannot approve a claim.