Medicare Durable Medical Equipment: What Part B Covers, What You Pay, and Florida Fraud Warnings

Original Medicare pays 80% of the Medicare-approved amount for durable medical equipment after you meet the Part B deductible, which is $283 in 2026. You pay the other 20%. That's the rule on paper. Whether it's what you actually pay depends on two questions most people never think to ask the supplier: are you enrolled in Medicare, and do you accept assignment?

Get those wrong and you can owe the full bill, or pay a whole rental up front and wait to be reimbursed. Below are the rules, two changes CMS finalized this week, and the Florida angle, which is mostly about fraud and how to spot it on your own claims.

Source: Medicare Coverage of Durable Medical Equipment & Other Devices (CMS Product No. 11045); CMS 2026 Parts A and B fact sheet.

What counts as durable medical equipment

Medicare's definition has four parts, and an item has to meet all of them. Per section 110.1 of the Medicare Benefit Policy Manual, chapter 15, durable medical equipment (DME) is equipment that:

1. can withstand repeated use;
2. is primarily and customarily used to serve a medical purpose;
3. generally isn't useful to someone who isn't sick or injured; and
4. is appropriate for use in the home.

The fourth test is where people get caught. Part B covers DME your doctor or another treating provider (a nurse practitioner, physician assistant or clinical nurse specialist) prescribes for use in your home, according to the CMS booklet. A hospital or nursing home that's giving you Medicare-covered care doesn't count as home. A long-term care facility can. And if you're in a skilled nursing facility on a Part A-covered stay, the facility supplies the equipment you need there, for up to 100 days.

Prosthetics and orthotics follow the same 20% Part B rule: braces, artificial limbs, ostomy and urological supplies, breast prostheses after a mastectomy, diabetic therapeutic shoes, and one pair of standard-frame glasses or contacts after each cataract surgery with an implanted lens (booklet).

Covered and not covered: examples

Source: CMS booklet 11045, pp. 4 and 8; Medicare.gov, Walkers; Medicare Benefit Policy Manual ch. 15, sec. 110.1. Neither list is complete.

The manual's own example is an air conditioner for a heart patient: it may have "some remote medically related use," but its customary use is nonmedical, so Medicare won't pay. In a Florida summer that's a hard rule to hear. The same goes for stair lifts (stairway elevators) and grab bars, often the first things a family wants after a fall.

If you're not sure about an item, ask the supplier before delivery whether Medicare covers it, and get the answer in writing. The booklet also points you to Medicare.gov or 1-800-MEDICARE for item-by-item questions.

What you pay, and when it's more than 20%

The "Medicare-approved amount" is the lower of the supplier's actual charge or the fee Medicare sets for the item (per the booklet). You pay 20% of that after the Part B deductible. The 2026 deductible is $283, up from $257 in 2025 (CMS fact sheet). As of November 6, 2026, CMS hasn't announced the 2027 Part B deductible, so anything you get in January will run against a number we don't have yet.

0$200$400$600

$200

$426.40

$312

Ded. metDed. not metRental

Source: Calculated from the 2026 Part B deductible (CMS) and the 20% coinsurance rule (CMS booklet 11045). Hypothetical amounts, not real Medicare fees.

Show the numbers

	You pay
Ded. met	$200
Ded. not met	$426.40
Rental	$312

Now the part that changes the math. Medicare only pays for DME from a supplier that's enrolled in Medicare and has a Medicare supplier number. If the store doesn't have one, Medicare won't pay your claim, "even if your supplier is a large chain or department store," as the booklet puts it.

Enrollment is step one. Assignment is step two. A participating supplier must accept assignment, meaning it can charge you only the deductible and the 20% coinsurance on the approved amount. A non-participating supplier can decide case by case. If a supplier doesn't participate or won't accept assignment, Medicare.gov says you may be charged more. The limiting charge that caps what non-participating doctors can bill doesn't apply to some supplies and DME, so "more" isn't capped the way you might expect (Medicare.gov).

Rentals have one more trap. Make sure the supplier accepts assignment for every rental month. Otherwise, per Medicare.gov, you'll have to pay the full cost up front and Medicare pays you back later, after the claims are processed.

The booklet gives you the script. Ask, before anything is delivered:

• Are you a Medicare-enrolled supplier?
• Do you accept assignment?
• If not, will you consider assignment in my case?
• If you won't, what's your non-assignment charge?
• Will you bill Medicare for me?

You can look suppliers up in Medicare's medical equipment supplier directory. A Medigap policy may help cover the 20%; how those policies work in this state is on our Medicare Supplement insurance in Florida page.

Rent or buy: how Medicare pays

You usually don't pick. The item's payment category does, and an enrolled supplier will know which one applies. The booklet says Medicare pays for most DME on a rental basis.

Source: CMS booklet 11045, pp. 11-14; 42 CFR 414.220; 42 CFR 414.229; 42 CFR 414.226.

Capped rental. Under 42 CFR 414.229, Medicare pays monthly rent for no longer than 13 months of continuous use, and the supplier must transfer title to you on the first day after the 13th paid month. While you're renting, repairs and replacement parts are the supplier's problem, and the supplier picks the item up when it needs fixing or when you're done with it.

Inexpensive items. Total rental payments are capped at what Medicare would pay to buy the item. The booklet suggests that if you'll need it for more than a few months, you may decide to buy instead of rent.

Oxygen. This is the one people misread. Rental payments stop after 36 months of continuous use, but the supplier doesn't walk away. It must keep providing the equipment, supplies and maintenance for another 24 months, up to 5 years total, and it can't charge you for the equipment after month 36. If you use tanks, Medicare keeps paying monthly for the oxygen contents. After the 5 years, a new 36-month and 5-year cycle starts, and you may choose any Medicare-enrolled supplier for it (booklet).

If you travel: Medicare won't pay for oxygen related to air travel, and your supplier doesn't have to provide an airline-approved portable concentrator. If you move or spend months away after month 36, getting you oxygen in the new area is the supplier's responsibility.

Repairs, replacement and hurricanes

Once you own an item, Medicare may cover repairs and replacement parts at 80% of the approved amount, up to what it would cost to replace the item. You pay 20%. One catch from the booklet: the supplier that sold it to you isn't required to repair it, so you may have to find another enrolled supplier.

Replacement is possible if the item is lost, stolen, damaged beyond repair, or has been used past its reasonable useful lifetime, which is generally 5 years from the date you start using it. The regulation, 42 CFR 414.210(f), says that lifetime can't be less than 5 years and is counted from delivery to you, not from the item's age.

Orders, face-to-face visits and prior authorization

Every DME item needs a written order from a treating practitioner before Medicare pays. Under 42 CFR 410.38(d), the order has to show your name or Medicare number, a description of the item, the quantity if relevant, the order date, and the practitioner's name or NPI and signature. For power mobility devices and items on CMS's required list, two more conditions apply: the order has to reach the supplier before delivery, and the practitioner must have had a face-to-face visit with you, in person or by telehealth, within the 6 months before the order.

Prior authorization is a separate step. For items on CMS's Required Prior Authorization List, the supplier asks Medicare for a provisional yes before delivering, and a claim without one is denied (42 CFR 414.234). The power wheelchair page on Medicare.gov says the supplier usually submits the request and documents for you, and a request can be denied if Medicare finds you don't medically need the chair or doesn't get enough information. Since January 1, 2025, CMS says standard reviews take no more than 7 calendar days and expedited ones 2 business days (CMS).

Source: CMS, DMEPOS prior authorization program; CMS, probationary prior authorization; CMS, CY 2027 Home Health final rule fact sheet (CMS-1844-F).

Two of those come from the CY 2027 home health final rule CMS released on November 4, 2026 (fact sheet). First, a new face-to-face exam isn't required when the replacement is the same item (same billing code), though the original visit must still be on file if the claim is audited. Second, a 2026 law adds certain external infusion pumps and home infusion drugs to the DME benefit starting April 1, 2027, when a qualified home infusion supplier gives or supervises the drug at home and frequency criteria are met. If you get infusions in a clinic now, ask the prescriber whether that changes anything next spring.

I checked the CY 2027 physician fee schedule final rule, released the same week, and didn't find changes to the beneficiary DME rules described here.

Competitive bidding returns in 2028

Medicare's DME Competitive Bidding Program has been on pause since January 1, 2024, when the last contracts expired (CMS). CMS is restarting it. Under the current Round 2028 timeline, supplier registration opens December 1, 2026, bidding runs January 5 to March 10, 2027, winners are announced in late summer or early fall 2027, and contracts take effect January 1, 2028. CMS calls those target dates.

The round covers seven product categories: Class II continuous glucose monitors and insulin pumps, urological supplies, ostomy supplies, hydrophilic urinary catheters, and off-the-shelf back, knee and upper extremity braces (CMS fact sheet). All of them run as one nationwide remote item delivery program covering every state, so Florida is in it (CMS). Items get shipped to your home, or you can pick them up at a local pharmacy or storefront owned by a contract supplier.

Why it matters: starting in 2028, Medicare will generally pay for those items only from contract suppliers, with a transition period. People who already own a CGM or insulin pump can keep using it until it needs replacing, and contract suppliers must furnish the brand the doctor ordered (CMS fact sheet). If you use a CGM, catheters or ostomy supplies, watch your mail in fall 2027.

If you're in a Medicare Advantage plan

Medicare Advantage plans must cover the same medically necessary categories of DME as Original Medicare. What changes, per the CMS booklet, is which suppliers you can use and what you pay; both depend on the plan. Plans can also require approval before covering services, which in most cases Original Medicare doesn't (Medicare & You 2027). Everything in the cost section above describes Original Medicare.

So before equipment is delivered, ask two questions: is this supplier in the plan's network, and is authorization on file? The plan's Evidence of Coverage lists its cost sharing for equipment. If the plan won't cover an item you believe you need, you can appeal and get an independent review; the levels and deadlines are in the Medicare appeal process. And if you use oxygen or a wheelchair and switch plans during open enrollment, the booklet says to call the new plan as soon as possible to make sure it will keep covering your equipment. People shopping in December tend to check doctors and drugs and forget the equipment. SHINE can go over a change with you; the bigger picture is on our Medicare in Florida page.

Florida: equipment fraud and your claims

Most suppliers bill honestly. But DME keeps showing up in federal fraud cases in Florida, and the schemes look alike: someone gets your Medicare number, a doctor you've never met "orders" braces or other equipment, and Medicare gets billed whether or not anything shows up at your door.

Port St. Lucie man, five DME suppliers (sentenced 2025)$61.5MTamarac / Coral Springs residents, braces (DOJ release, June 2026)$6.9MStuart company, equipment never delivered (sentenced 2022)$2.2M

Source: U.S. Department of Justice: July 1, 2025; Southern District of Florida, updated June 1, 2026; Southern District of Florida, Oct. 12, 2022.

Show the numbers

Case	Billed
Port St. Lucie man, five DME suppliers (sentenced 2025)	$61.5M
Tamarac / Coral Springs residents, braces (DOJ release, June 2026)	$6.9M
Stuart company, equipment never delivered (sentenced 2022)	$2.2M

What the cases describe:

• Port St. Lucie man: a hidden owner of five DME suppliers, nominee owners and kickbacks to patient recruiters. About $61.5 million billed, about $26.7 million paid, a 12-year sentence (DOJ).
• Tamarac and Coral Springs residents: about $6.9 million billed for medically unnecessary orthotic braces, with kickbacks to an offshore marketing company for patient referrals and fraudulent doctors' orders (DOJ).
• Stuart company: about $2.2 million billed over five months in 2022 for equipment beneficiaries never requested or received; Medicare paid more than $1.4 million (DOJ).

Those are the closed cases. In the June 2026 national takedown, which charged 455 defendants over more than $6.5 billion in false claims, one defendant in the Southern District of Florida was charged with an additional $3.7 billion in false claims for urinary catheters and other DME (DOJ). Those are charges, not convictions. Notice the overlap with the Round 2028 bidding list, which includes urological supplies and braces, and with the prior authorization codes that started in Florida before most states.

Your own claims history is the strongest check you have. The Medicare Summary Notice lists every service billed under your number; it isn't a bill, and it's mailed at least twice a year unless you get it electronically. Claims usually show up in your Medicare.gov account within 24 hours after they're processed (Medicare & You 2027). Look for:

• braces, catheters, monitors or other supplies you didn't order or never received;
• a doctor's name you don't recognize as the one ordering equipment;
• a power wheelchair or scooter offered to you when you didn't need one (the booklet names this scheme);
• anyone who calls, uninvited, offering equipment in exchange for your Medicare number. Medicare will never call you to sell you anything (Medicare.gov).

If something's wrong, call 1-800-MEDICARE or report it online through Medicare.gov, or call the HHS Office of Inspector General at 1-800-HHS-TIPS (1-800-447-8477), the number CMS gives in its home health booklet. If boxes keep arriving, don't keep them quietly; report them.

Where to get help

SHINE. Florida's State Health Insurance Assistance Program, run by the Department of Elder Affairs with local Area Agencies on Aging, gives one-on-one Medicare counseling at no charge: 1-800-96-ELDER (1-800-963-5337), or floridashine.org. SHINE also runs Florida's Senior Medicare Patrol, which helps people spot and report suspected fraud, reachable through the same number (SMP Resource Center). More on how SHINE works in Florida.

1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048) for coverage questions, a supplier that won't repair rented equipment, or an oxygen supplier that tries to stop service before its 5 years are up. The booklet specifically says to call when a supplier isn't following the rules.

Your doctor's office. If a DME claim is denied, ask whether it was a paperwork problem: a missing order element, no qualifying visit on file, or no prior authorization. Those can often be fixed and resubmitted or appealed. If equipment is part of a home health plan of care, how that benefit works is covered in Medicare home health coverage.

Federal Medicare rules and your plan's own documents control what's covered. Confirm your situation with 1-800-MEDICARE, SHINE or a licensed agent, and talk to an attorney for legal questions.

Sources

1. CMS: Medicare Coverage of Durable Medical Equipment & Other Devices (Product No. 11045, Feb. 2025)
2. Medicare.gov: Hospital beds (DME costs and assignment)
3. Medicare.gov: Wheelchairs & scooters
4. Medicare.gov: Walkers
5. Medicare.gov: Medical equipment supplier directory
6. Medicare.gov: Does your provider accept Medicare as full payment?
7. CMS: Medicare Benefit Policy Manual, Chapter 15, sec. 110.1
8. CMS: 2026 Medicare Parts A and B premiums and deductibles fact sheet
9. eCFR: 42 CFR 410.38 (DMEPOS scope, written orders, face-to-face)
10. eCFR: 42 CFR 414.210 (reasonable useful lifetime)
11. eCFR: 42 CFR 414.220 (inexpensive or routinely purchased items)
12. eCFR: 42 CFR 414.226 (oxygen equipment)
13. eCFR: 42 CFR 414.229 (capped rental items)
14. eCFR: 42 CFR 414.234 (prior authorization)
15. CMS: Prior Authorization Process for Certain DMEPOS Items
16. CMS: Probationary Prior Authorization for Newly Enrolled DMEPOS Suppliers
17. CMS: CY 2027 Home Health Prospective Payment System final rule (CMS-1844-F) fact sheet
18. CMS: DMEPOS Competitive Bidding Program updates fact sheet
19. CMS Competitive Bidding Implementation Contractor: Round 2028 timeline
20. CMS Competitive Bidding Implementation Contractor: Round 2028 competitive bidding area
21. CMS Competitive Bidding Implementation Contractor: Temporary gap period
22. CMS: Medicare & You 2027
23. Medicare.gov: Reporting Medicare fraud & abuse
24. U.S. Department of Justice: 2026 National Health Care Fraud Takedown
25. U.S. Department of Justice: DME owner sentenced to 12 years for $61 million Medicare fraud scheme
26. U.S. Attorney's Office, S.D. Fla.: Three sentenced for laundering Medicare fraud proceeds
27. U.S. Attorney's Office, S.D. Fla.: DME company owner sentenced for health care fraud
28. CMS: Medicare & Home Health Care (Product No. 10969)
29. SHINE, Florida Department of Elder Affairs
30. SMP Resource Center: Florida