Get the Equipment Covered: How to Navigate Medicare and Medicaid DME Rules Without Losing Your Mind

Intro:
If you’ve ever spent half your shift trying to figure out which equipment Medicare will cover—or waited weeks for a supplier to deliver a simple shower chair—you’re not alone. Durable Medical Equipment (DME) is one of the most important and most misunderstood parts of home health care.

Nurses and caregivers often know what their patients need, but not always how to get it approved or covered. That’s where good documentation, timing, and communication come in.

Here are three quick things that can save you headaches when ordering DME for your home health patients.

1. The Doctor’s Order Isn’t Enough
Just because a physician writes “order hospital bed” doesn’t mean Medicare or managed care will cover it. Every DME order must be backed by a face-to-face encounter and documentation showing why the patient needs it.

Example:
Instead of writing “needs hospital bed,” document “requires head elevation greater than 30 degrees for orthopnea related to CHF.” That one line can make the difference between approval and denial.

2. Know the 5-Year Rule
Most DME items have what Medicare calls a “reasonable useful lifetime” of five years. That means no replacements—unless the item is lost, stolen, or broken beyond repair.

If your patient still qualifies and the equipment is worn out after five years, they’re eligible for a replacement. Always include the date of original delivery when requesting new equipment.

3. Medicaid Covers More Than You Think
Medicare and Medicaid don’t follow the same playbook. Medicaid (and state programs like Medi-Cal) often cover additional supplies such as incontinence briefs, underpads, and catheters. They may even approve pediatric or bariatric DME that Medicare won’t.

Knowing these differences helps you educate your patients early, avoid surprises, and prevent delays in care.

Final Thoughts:
Durable Medical Equipment is more than just paperwork—it’s safety, dignity, and independence for your patients. When you understand how coverage works, you can get the right tools in the home faster and with fewer denials.

If you want a full list of what Medicare and Medicaid cover, documentation templates, and real-world examples you can copy and paste into your notes, check out my complete field guide:

DME Made Simple: A Home Health Guide for Nurses, Caregivers, and Patients

It breaks down every major DME category—mobility aids, wound care, respiratory, and more—so you can document confidently and spend less time on the phone with suppliers.

✳️ FREE DOWNLOAD: The DME Coverage Checklist

Make sure your patient’s equipment gets approved the first time.
This simple printable checklist walks you through the exact steps to confirm Medicare or Medicaid coverage beforesending that DME order — so you don’t waste time chasing signatures or fixing denials.

What’s inside:

A one-page “Before You Order” checklist
Medicare & Medicaid Do’s and Don’ts
Sample documentation phrases for your SOC or ROC note
Fill-in contact sheet for DME vendors, MDs, and case managers

👉 Download the DME Coverage Checklist (Free PDF)

(Created by Arielle Tamez, RN BSN – RN on Wheels | rnonwheels.com)

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