What Medicare and Medicaid Do Not Cover: Understanding Medical Equipment Limitations

When it comes to medical equipment, many patients assume that Medicare or Medicaid will pay for everything they need. Unfortunately, that’s not always the case. Both programs have strict rules about what qualifies as Durable Medical Equipment (DME) and which circumstances justify coverage.

At Outfront Medical, we often speak with healthcare providers, patients, and caregivers who are surprised to learn what isn’t covered — and why refurbished equipment can sometimes be the best alternative.

What Counts as Durable Medical Equipment (DME)?

Medicare and Medicaid only cover equipment that meets these conditions:

• It’s durable (can withstand repeated use).
• It’s medically necessary and prescribed by a physician.
• It’s used in the home rather than in a hospital or nursing facility.
• It serves a medical purpose, not for comfort or convenience.

Examples of covered DME typically include:

• CPAP and BiPAP machines
• Oxygen concentrators
• Wheelchairs and walkers
• Hospital beds and patient lifts
• Nebulizers

However, many other items are excluded or only partially covered — and that’s where confusion often begins.

Common Medical Equipment Not Covered by Medicare or Medicaid

Below are categories of equipment that are often denied or ineligible for coverage, even when medically useful:

? Comfort or Convenience Equipment

• Bedside tables or over-bed trays
• Shower chairs, commodes, and grab bars
• Air purifiers, humidifiers, or dehumidifiers
• Cooling or heating pads used for comfort

Medicare classifies these items as “convenience equipment,” meaning they improve quality of life but aren’t essential to treat a diagnosed medical condition.

? Duplicate or Backup Equipment

Medicare and Medicaid generally cover only one item per type.
If you already have a CPAP machine or wheelchair, a second or backup unit will not be reimbursed — even if it’s medically helpful to have a spare.

? Equipment Not Used in the Home

Items primarily used in hospitals, clinics, or during travel — such as portable ventilators for non-home use — may be excluded from coverage.

? Upgrades or Premium Models

If a standard device meets medical necessity, upgraded versions (like a touchscreen monitor, wireless-enabled CPAP, or luxury hospital bed) are not covered.
Patients who want enhanced features must usually pay the difference out of pocket.

? Refurbished or Used Medical Equipment

This is a big one — and where many people find Outfront Medical helpful.
Medicare and Medicaid only reimburse for new DME purchased from approved suppliers.
That means refurbished or pre-owned medical devices, even if fully tested and certified, are not eligible for reimbursement.

However, refurbished equipment can often be purchased at a fraction of the cost of new units — making it a smart and affordable option for patients, clinics, and long-term care facilities that are paying privately.

Why Refurbished Equipment Can Be the Smart Choice

While insurance may not pay for refurbished medical devices, the cost savings can be significant — often 30–70% less than new models.

At Outfront Medical, every refurbished unit undergoes:
✅ Comprehensive inspection and calibration
✅ Replacement of worn parts to OEM standards
✅ Functional testing and quality certification

This ensures reliability and performance at a much lower price point — making it ideal for facilities and patients outside insurance coverage limits.

Final Thoughts

Medicare and Medicaid provide essential support for patients in need, but their coverage rules for medical equipment are limited and sometimes confusing. Understanding what isn’t covered can help patients plan ahead, avoid surprise costs, and explore affordable alternatives.

If you or your facility needs equipment that isn’t covered — from ventilators and infusion pumps to patient monitors or CPAPs — Outfront Medical can help you find reliable refurbished solutions backed by professional testing and service.

? Visit www.outfrontmedical.com or contact sales@outfrontmedical.net to learn more about our available equipment and refurbishment standards.