Insurance
Durable medical equipment (DME)—hospital beds, wheelchairs, CPAP machines, oxygen concentrators, and similar items—can be expensive out of pocket. Most patients rely on Medicare, Medicaid, or private insurance to help cover costs, but the rules aren't always straightforward.
What Counts as DME?
Insurance plans generally define DME as reusable medical equipment prescribed for home use due to a medical condition. Items must be medically necessary, ordered by a qualified provider, and meet plan-specific criteria for coverage.
Not everything in a medical supply catalog qualifies. Lifestyle items, convenience upgrades, and equipment without documented medical need may not be covered.
The Typical Process
Prescription and Documentation
Your doctor writes a prescription and often must provide supporting documentation—diagnosis, prior treatments tried, face-to-face visit notes, and justification for the specific equipment.
Prior Authorization
Many plans require prior authorization before purchase or rental. This can add days or weeks to the timeline, so start early when you know you'll need equipment after surgery or a new diagnosis.
In-Network Suppliers
Insurance may only cover equipment from approved DME suppliers. One Medical Supplies works with many insurance plans serving South Florida patients—we can help verify coverage before you order.
Rental vs. Purchase
Some items are rented for a period then converted to purchase if still needed. Others are bought outright. Medicare and private plans have different rules by equipment category.
Medicare Basics
Medicare Part B covers many types of DME when medically necessary. You'll typically pay 20% of the Medicare-approved amount after meeting your deductible, unless you have supplemental coverage. Competitive bidding and supplier standards affect which providers can bill Medicare in your area.
Private Insurance Variations
Employer plans, ACA marketplace plans, and Medicaid each have their own formularies, prior auth rules, and copays. Always call your insurer with the specific HCPCS code for the equipment your provider recommends.
Tips for a Smoother Experience
- Get prescriptions and documentation in writing before ordering
- Confirm coverage and estimated out-of-pocket cost upfront
- Keep records of all authorizations and correspondence
- Ask about repair, replacement, and resupply schedules for items like CPAP masks and diabetes strips
- Don't assume online retailers outside your network will be reimbursed
We're Here to Navigate With You
Insurance paperwork shouldn't stand between you and the equipment you need. Our team at One Medical Supplies helps patients in Miami and throughout South Florida understand coverage, gather required documents, and choose qualifying products. Contact us before you buy—we'll help you plan ahead.