A Simple Guide to HME Insurance Coverage: What’s Covered and What’s Not

Posted on 19 May, 2025

Dealing with insurance when managing your health conditions can be complex. Understanding coverage details typically requires reading fine print, calling customer service numbers, and—unfortunately for some—learning through trial and error. Having a good understanding of what your insurance covers before submitting claims can save you time and potentially hundreds or even thousands of dollars. To help you mitigate these stresses, we put together this simple guide on what home medical equipment is or is not covered by major insurance. Please keep in mind that each insurance policy is different and many change over time. Talk to your insurance provider to ensure coverage.

What Counts as Home Medical Equipment (HME)?

First, we need to define what HME/DME stands means before we can understand coverage. HME/DME stands for Home Medical Equipment and Durable Medical Equipment. These are items like hospital beds, wheelchairs, walkers, blood testing strips, and other medical equipment. These items help people receive care at home or in private facilities, typically from family members or non-professional caregivers.

What is Typically Covered by Insurance

Medicare and CMS have specific requirements to qualify for coverage. The items must be prescribed by a medical professional and necessary for the patient's condition. They must meet the requirements for DME, and the patients have to cover 20% of the Medicare-approved amount. Most major insurance companies follow these guidelines, though out-of-pocket costs may vary for those not on Medicare. If your situation meets these requirements, insurance will likely cover the following items:

  • Wheelchairs, walkers, and canes

  • Hospital beds and commode chairs

  • CPAP machines and oxygen equipment

  • Diabetic monitors and test strips

  • Infusion pumps and prosthetics

What’s Usually Not Covered

Most of the time, items that are not covered under insurance are deemed non-essential. Medical items that provide comfort rather than treat your condition will typically need to be purchased out-of-pocket. These items can include:

  • Equipment for comfort or convenience (air purifiers, humidifiers)

  • Non-medical or fitness-related items

  • Disposable supplies (unless used with covered equipment)

  • Equipment upgrades and deluxe versions

  • Home modifications (e.g., wheelchair ramps)

What to Know About Insurance Plans and HME

It is essential to note that Medicare and private insurance act quite differently in terms of billing and determining your eligibility for HME/DME supplies. If you’re on Medicare Part B, you will pay 20% out of pocket. If you have a Medicare Advantage plan through Humana, Aetna, Blue Cross Blue Shield, or another privatized company, then your out-of-pocket amounts will change from anywhere between $2,500-$10,000. Medicare supplement plans can cover the entire cost, though they come with higher monthly premiums. Those not yet eligible for Medicare should carefully review their private or employer-sponsored insurance policies to understand their coverage limitations.

Final Tips and Takeaways

Whether insurance will cover an item primarily depends on if a medical professional deems it medically necessary. If you have any items that your doctor prescribes as necessary for your condition, there is a good chance it will be covered. We recommend that you read your policy carefully to understand all limitations or specifications it may have for you to receive that coverage. You can find more information about each company below.

If you need additional help finding your Home Medical Equipment and/or Durable Medical Equipment from a trusted supplier, visit our page to begin your search. For additional information about HME supplies and resources, read our previous blogs linked below!

Winning HME Retail: Capitalizing on Today's Consumer Shopping Trends

The HME Prescription Process: A Step-By-Step Guide

CPAP Masks: Choosing the Right One

 
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