Guide to Medicare Coverage & DME

• Part A covers hospital stays, home health care, and hospice services.
• Part B covers physician visits, lab tests, ambulance services, and home medical equipment. Part A typically has no monthly fee unless you use the services; Part B requires a monthly premium regardless of use — in 2026 the standard premium is $202.90/month (or less, based on income), usually deducted from your Social Security check.
• Part C (Medicare Advantage) is offered by private insurers as an alternative to Part B. Coverage matches Part B, but networks are often more restricted and pre-authorization may be required. Premiums and deductibles vary by plan.
• Part D offers optional prescription drug coverage.

Visit medicare.gov to learn more about your benefits or coverage decisions.

Choosing between Traditional Medicare and Medicare Advantage is an important decision. Traditional Medicare provides wide access to doctors and specialists without network restrictions. Medicare Advantage plans often have network limitations and require prior approvals, which can affect your choice of providers and services. We encourage you to research your options carefully before switching plans.

See our handout on this topic →

• In 2026, beyond your monthly premium, you're responsible for the first $283 of Part B expenses, then 20% of approved charges if your supplier accepts Medicare assignment.
• Fayette Medical Supply cannot waive this 20% coinsurance or your deductible — Medicare requires suppliers to pursue collection unless another insurance plan covers it. Exceptions may apply for documented financial hardship.
• A supplemental insurance policy may cover this portion once your supplemental deductible is met.
• If your supplier doesn't accept assignment, you may pay the full price upfront; they'll still file a claim on your behalf, and Medicare will reimburse you directly for approved charges.

Other possible costs: Medicare only covers items meeting your basic need. If you'd like upgraded features, your supplier can offer an Advance Beneficiary Notice (ABN) so you can pay the difference privately.

The Advance Beneficiary Notice of Non-Coverage (ABN) notifies you in advance that Medicare is likely to deny payment for a particular item or service. It gives you enough detail to understand why, so you can make an informed decision about whether to proceed knowing you may incur out-of-pocket costs.

For Medicare to cover an item, it must pass the test of durability:

• Withstands repeated use (excludes disposable items like underpads)
• Serves a medical purpose (an underlying condition the item should improve)
• Is useless absent disability, illness, or injury (excludes preventive items like bathroom safety products)
• Is used in the home (excludes items needed only outside the home)

• When a supplier accepts assignment, they agree to accept Medicare's approved amount as payment in full.
• You're responsible for 20% coinsurance of the approved amount, plus the annual deductible ($283 for 2026).
• If you've chosen an upgraded product, you're also responsible for any additional amount disclosed on the ABN.
• If a supplier doesn't accept assignment, you pay the full amount upfront; they still file a claim, and any Medicare reimbursement is paid directly to you. Suppliers must still notify you in advance via ABN if they believe Medicare won't pay.

Every supplier must submit a claim for covered services within one year of the date of service. If an item is never covered by Medicare, the supplier isn't obligated to submit a claim.

• Every item billed to Medicare requires a physician's order or a Certificate of Medical Necessity (CMN), sometimes with supporting visit notes or test results.
• Nurse practitioners, physician assistants, interns, residents, and clinical nurse specialists can also order equipment and sign CMNs for some items.
• Providers may refuse to complete documentation for equipment they didn't order — talk to your physician about your need for equipment before requesting an item.
• For every new prescribed item, a recent office visit documenting the need is typically required before a supplier can fill the order.

For some items, Medicare requires completed documentation before delivery — more than just a call-in order or prescription:

• Decubitus care (wheelchair cushions, pressure-relieving surfaces, air-fluidized beds)
• Seat lift mechanisms
• TENS units (pain management)
• Power-operated vehicles / scooters
• Electric or power wheelchairs and related options/accessories
• Negative pressure wound therapy (wound vacs)

The Affordable Care Act expanded this list to cover all items over $1,000, plus commonly prescribed items like oxygen, hospital beds, and wheelchairs — over 150 products in total. Your supplier can tell you if your item is subject to these requirements, and cannot deliver these products without a written order from your doctor.

There are four typical ways Medicare pays for a covered item:

• Purchase it outright — the equipment belongs to you.
• Rent it continuously until no longer needed.
• "Capped" rental — Medicare rents the item for 13 months, after which it's considered purchased. Outright purchase isn't allowed for these items; this spreads out your coinsurance and protects Medicare if your needs change early.
• Oxygen therapy — Medicare rents for 36 months, covering service and accessories. After that (for two more years), Medicare pays only a small monthly fee for gas/liquid contents and a limited service fee every six months.

Once an item is purchased for you, contact your supplier any time it needs service or repair — Medicare will pay a portion of repairs, labor, replacement parts, and loaner equipment, provided you still need and qualify for the item.

In many parts of the country, Competitive Bidding requires you to obtain certain equipment from specific Medicare-contracted suppliers for Medicare to pay, including:

• Oxygen, oxygen equipment, and supplies
• Standard power wheelchairs, scooters, and related accessories
• Enteral nutrition, equipment, and supplies
• CPAP devices and Respiratory Assist Devices (RADs), plus supplies/accessories
• Hospital beds and related accessories
• Walkers and related accessories
• Support surfaces (Group 1 and 2 mattresses/overlays)
• Manual wheelchairs and accessories
• Mail-order and direct delivery of diabetic supplies
• Nebulizers
• Home infusion therapy including insulin pumps and supplies
• TENS units and supplies
• Patient lifts / Commodes / Seat lifts
• Negative pressure wound therapy devices and supplies

Bidding areas are based on the zip code on file with Social Security. Call 1-800-MEDICARE (1-800-633-4227) or visit Medicare.gov to check your area. Fayette Medical Supply can help answer your questions about competitive bidding and whether we're contracted for services you need.

Below is an abbreviated summary of the standards every home medical equipment supplier must meet to obtain and retain billing privileges (full text at 42 CFR 424.57(c)). Fayette Medical Supply meets or exceeds all of these standards.

• Comply with all applicable federal and state licensure and regulatory requirements.
• Provide complete, accurate information on the DMEPOS supplier application; report changes within 30 days.
• An authorized individual must sign the enrollment application for billing privileges.
• Fill orders from own inventory or contract with companies not excluded from Medicare or other government programs.
• Advise beneficiaries of rental/purchase options for routinely purchased equipment and capped rental items.
• Notify beneficiaries of warranty coverage and honor all warranties, repairing or replacing covered items under warranty free of charge.
• Maintain a physical facility with posted hours, accessible to the public, at least 200 sq. ft. with record storage.
• Permit CMS or its agents to conduct on-site inspections.
• Maintain a business phone listed in a local directory or toll-free directory assistance — no exclusive use of a beeper, answering machine/service, or cell phone during business hours.
• Maintain comprehensive liability insurance of at least $300,000 covering the business, customers, and employees.
• Prohibited from direct solicitation to Medicare beneficiaries.
• Responsible for delivery, instructing beneficiaries on use, and maintaining proof of delivery.
• Answer questions and respond to complaints, maintaining documentation of contacts.
• Maintain, replace, or repair Medicare-covered rented items at no charge.
• Accept returns of substandard or unsuitable items from beneficiaries.
• Disclose these standards to each beneficiary supplied a Medicare-covered item.
• Disclose any person with ownership, financial, or control interest in the supplier.
• May not convey, sell, or reassign a Medicare supplier number.
• Maintain a complaint resolution protocol with records kept at the physical facility, including beneficiary name, address, phone, health insurance claim number, complaint summary, and resolution.
• Furnish CMS any information required by Medicare statute and implementing regulations.
• Be accredited by a CMS-approved accreditation organization, specific to the products/services provided, and notify the accreditor of any new location.
• Disclose all products/services (including new lines) upon enrollment for accreditation.
• Meet surety bond requirements specified in 42 C.F.R. 424.57(c).
• Obtain oxygen from a state-licensed oxygen provider.
• Maintain ordering and referring documentation consistent with 42 C.F.R. 424.516(f).
• May not share a practice location with other Medicare providers/suppliers.
• Remain open to the public a minimum of 30 hours/week (with limited exceptions).