If you’re living on a fixed income, you shouldn’t have to choose between safety and savings. This hands-on guide shows what Medicare and Medicaid actually pay for—and the smart, legal ways to stretch every dollar.
Quick Snapshot (What’s Covered & What’s Not)
- Medicare (Original Part B) generally covers Durable Medical Equipment (DME) when medically necessary and prescribed for use in the home (you usually pay 20% coinsurance after your Part B deductible). Examples: wheelchairs/scooters, walkers, patient lifts, hospital beds, oxygen, CGMs, braces, prosthetics. Hearing aids and routine eyeglasses are not covered (except a pair of glasses/contacts after cataract surgery). (Medicare)
- Medicaid (Adults) varies by state. Many states cover DME and, via HCBS waivers, assistive tech and sometimes environmental modifications (e.g., ramps, roll-in showers) if they keep you safely at home. (Medicaid)
- Medicaid (Children under 21) must cover what’s medically necessary under EPSDT, including eyeglasses, hearing aids, batteries, cochlear implants—even if adults in that state don’t get the same benefit. (Medicaid)
- Medicare Advantage (MA) plans may include supplemental benefits (vision/hearing) and, for chronically ill members, SSBCI like home & bathroom safety devices/modifications—plan-specific. (Centers for Medicare & Medicaid Services)
- Extra savings: State Assistive Technology (AT) Programs offer free device demos/loans, reuse at deep discounts, and low-interest financing regardless of insurance. (ACL Administration for Community Living)
What Counts as “Assistive Tech” vs. “DME”?
- Assistive Technology (AT): Any tool or device that helps with daily tasks—everything from reachers to speech-generating tablets. State AT Programs let you try before you buy and often reuse devices at low or no cost. (ACL Administration for Community Living)
- DME (Medicare): Equipment that’s durable, primarily medical, and appropriate for home use (e.g., wheelchair, oxygen, patient lift). Medicare pays 80% after the deductible if the supplier is enrolled/accepts assignment. (Medicare)
Medicare Coverage Essentials (Original Medicare)
- Coinsurance: After the Part B deductible, you generally pay 20% of the Medicare-approved amount. Always confirm your supplier accepts assignment to avoid extra charges. (Medicare)
- DME examples: wheelchairs/scooters (face-to-face exam + prescription), hospital beds, oxygen, patient lifts, diabetes supplies (meters, CGMs), braces/orthotics, prosthetic limbs/eyes, therapeutic shoes for diabetes. (Medicare, Centers for Medicare & Medicaid Services)
- SGDs (AAC devices): Medicare covers speech-generating devices as DME when strict criteria are met (SLP evaluation, documentation). (Centers for Medicare & Medicaid Services)
- Not typically covered: hearing aids/fitting exams; most home modifications and bathroom safety gear because they’re not “primarily medical.” Some MA plans may add these as supplemental/SSBCI benefits. (Medicare, Centers for Medicare & Medicaid Services)
- Find enrolled suppliers: Use Medicare’s official DME Supplier tool to compare prices and participation. (Medicare)
Medicaid Coverage Essentials
- State variability: Adult benefits differ by state, but Medicaid must still be adequate in amount, duration, and scope. (Medicaid)
- EPSDT (Under 21): Requires coverage of diagnosis & treatment, including eyeglasses and hearing aids, with reasonable promptness. (Medicaid)
- HCBS waivers (1915(c)/(i)): States can fund assistive technology and environmental modifications (e.g., ramps) to keep people at home. Details vary by waiver and state plan. (Medicaid)
- Transportation: Medicaid must assure non-emergency medical transportation (NEMT) when needed to access covered services. (Medicaid)
At-a-Glance: Coverage by Category (2025)
| Device/Service | Medicare (Original) | Medicaid (Adults) | Medicaid (Under 21) |
| Wheelchairs/Scooters | Part B DME with face-to-face exam & prescription. 20% coinsurance after deductible. (Medicare) | Usually covered as DME (state rules/prior auth vary). | Covered if medically necessary under EPSDT. (Medicaid) |
| Patient Lifts | Covered as DME when medically necessary. LCD defines criteria. (Medicare, Centers for Medicare & Medicaid Services) | Often covered; varies by state policy. | Covered when medically necessary (EPSDT). (Medicaid) |
| CGMs / Diabetes Supplies | CGMs, meters, strips covered under Part B when criteria met. 20% coinsurance. (Medicare) | Generally covered; limits vary by state. | Covered when medically necessary (EPSDT). (Medicaid) |
| Prosthetics & Orthotics | Covered (artificial limbs/eyes; braces). 20% coinsurance. (Medicare) | Typically covered (state variations). | Covered when medically necessary (EPSDT). (Medicaid) |
| SGDs (AAC) | Covered as DME with SLP eval & documentation. (Centers for Medicare & Medicaid Services) | Often covered as DME/assistive tech; state processes vary. | Covered when medically necessary (EPSDT). (Medicaid) |
| Eyeglasses | Not routine; covered after cataract surgery (one pair/contacts). (Medicare) | Adult coverage varies by state. (KFF) | Must cover when needed (EPSDT). (Medicaid) |
| Hearing Aids | Not covered by Original Medicare (MA plans may cover). (Medicare) | Many states cover; varies. (KFF) | Must cover when needed (EPSDT). (Medicaid) |
| Home/Bathroom Mods | Generally not covered by Original Medicare. Some MA plans offer as SSBCI. (Centers for Medicare & Medicaid Services) | Frequently covered through HCBS waivers when necessary for community living. (Medicaid) | |
| Transportation to Care | Limited (ambulance when medically necessary). (Medicare) | NEMT required when needed to access covered care. (Medicaid) | Same as adults. (Medicaid) |
Money-Saving Shortcuts Most People Miss
- Use your State AT Program first (free demos/loans; reuse stores). Try devices before you commit; get steep savings on refurbished equipment. Find your program via AT3 Center. (ACL Administration for Community Living, at3center.net)
- Shop enrolled suppliers & ask if they accept assignment (locks in approved rates; you pay only deductible + 20%). Use Medicare’s supplier tool. (Medicare)
- Leverage MA supplemental benefits if you’re on a Medicare Advantage plan—some plans include hearing aids, vision, or home/bathroom safety under supplemental/SSBCI. Check your plan’s EOC. (Medicare, Centers for Medicare & Medicaid Services)
- Apply for Medicare Savings Programs (QMB/SLMB/QI) to reduce or eliminate Part B coinsurance/deductibles if income-eligible. Many beneficiaries qualify and don’t know it. (Medicare)
- For kids: cite your child’s EPSDT right to medically necessary items (eyeglasses, hearing aids, AAC)—even if adults don’t get them in your state. (Medicaid)
- Document medical necessity (detailed provider notes, SLP evals for SGDs, mobility evaluations for wheelchairs). SGDs have specific Medicare criteria—meet them upfront to avoid denials. (Centers for Medicare & Medicaid Services)
- Disaster replacement: lost/damaged DME in emergencies may be repaired/replaced by Medicare when obtained through enrolled suppliers. (Medicare)
How to Get Specific Devices Approved (Step-by-Step)
A) Wheelchairs/Scooters (Power Mobility)
- Face-to-face exam with your treating provider assessing mobility limits at home.
- Prescription & documentation detailing why lesser devices (cane/walker) won’t meet needs.
- Enrolled supplier submits prior auth if required; you pay 20% after deductible. (Medicare)
B) Patient Lifts
- Covered when transfers are required and you’d otherwise be bed-confined; supplier follows LCD criteria. (Centers for Medicare & Medicaid Services)
C) Speech-Generating Devices (SGDs)
- SLP evaluation of cognitive/communication abilities.
- Documentation that an SGD is medically necessary (and why other means are inadequate).
- Supplier uses correct HCPCS and meets LCD L33739; device qualifies as DME under NCD 50.1. (Centers for Medicare & Medicaid Services)
D) Diabetes Tech (CGMs)
- Medicare covers therapeutic CGMs and supplies when criteria are met. Ask your clinician to document insulin use/hypoglycemia risk and training. (Medicare)
E) Eyeglasses & Hearing
- Medicare: one pair of glasses/contacts after cataract surgery only; hearing aids are not covered (check Medicare Advantage). (Medicare)
- Medicaid/EPSDT: children’s eyeglasses & hearing aids must be covered when needed; adults vary by state. (Medicaid, KFF)
F) Home/ Bathroom Safety & Environmental Mods
- Original Medicare: generally not covered; some MA plans may offer under SSBCI for chronically ill members. (Centers for Medicare & Medicaid Services)
- Medicaid HCBS: many states cover environmental modifications (e.g., ramps, widened doors) when they support community living—ask about your state’s 1915(c)/(i) options. (Medicaid)
Pros & Cons (Medicare vs. Medicaid for Assistive Tech)
Medicare
- Pros: Clear national rules for DME; broad coverage for mobility, oxygen, prosthetics, diabetes tech; national supplier lookup. (Medicare)
- Cons: 20% coinsurance; hearing aids/home mods not covered; strict documentation/LCDs for some items (e.g., SGDs, power mobility). (Medicare)
Medicaid
- Pros: For children, EPSDT is powerful (must cover needed items like eyeglasses/hearing aids); adults may access HCBS for assistive tech and home mods. (Medicaid)
- Cons: Benefits/prior auth vary by state; waitlists for HCBS waivers; adult coverage may be limited depending on state policy. (Medicaid)
Your 7-Step Approval Playbook (Copy/Paste Checklist)
- Get a prescription that uses Medicare/Medicaid language (“medically necessary,” “home use,” why lesser devices fail).
- Attach evaluations (e.g., SLP for SGDs; mobility evals for wheelchairs). (Centers for Medicare & Medicaid Services)
- Pick an enrolled supplier who accepts assignment (Medicare) or your plan’s in-network DME (Medicaid/MA). (Medicare)
- Pre-submit documentation to check prior authorization needs (power mobility, certain support surfaces, etc.). (Medicare)
- If you have Medicaid, ask about EPSDT (for kids) or HCBS/1915(i) for adults needing assistive tech/home mods. (Medicaid)
- Apply for cost help: QMB/SLMB/QI (can wipe out 20% coinsurance) and Extra Help for drug costs. (Medicare)
- Appeal denials with added medical detail; cite the appropriate NCD/LCD (e.g., NCD 50.1 for SGDs). (Centers for Medicare & Medicaid Services)
Where to Start (Right Now)
- Search enrolled DME suppliers near you (Medicare tool). (Medicare)
- Call your State AT Program to try devices and ask about reuse & low-interest loans. (at3center.net)
- If on Medicare Advantage, call your plan to ask whether you have hearing/vision benefits or SSBCI (home safety devices/mods) in 2025. (Centers for Medicare & Medicaid Services)
- If income-limited, apply for QMB/SLMB/QI and Extra Help. (Medicare, Social Security)
Conclusion: Your Safety Net Is Bigger Than You Think
Between Medicare’s DME benefit, Medicaid’s EPSDT and HCBS options, and free/low-cost State AT Programs, most readers can access essential devices without breaking the bank. Use the 7-step checklist, shop enrolled suppliers, and—if you’re in a Medicare Advantage plan—check for hearing/home-safety benefits under supplemental/SSBCI rules. The help is there; this guide shows you exactly where to find it. (Medicare, Medicaid, ACL Administration for Community Living)
FAQs
1) Are hearing aids covered by Medicare in 2025?
Original Medicare doesn’t cover hearing aids or fitting exams. Many Medicare Advantage plans add hearing benefits—check your plan. (Medicare)
2) Will Medicaid cover eyeglasses and hearing aids for my child?
Yes. Under EPSDT, state Medicaid programs must cover medically necessary eyeglasses, hearing aids, batteries, and related services for children under 21. (Medicaid)
3) Can Medicaid pay for ramps or a roll-in shower?
Often yes through HCBS waivers or 1915(i) state plan HCBS, when modifications are necessary to live safely at home. Availability and caps vary by state. (Medicaid)
4) How much will I pay for a Medicare-covered wheelchair or CGM?
After meeting your Part B deductible, you generally pay 20% coinsurance of the Medicare-approved amount—if your supplier accepts assignment. (Medicare)
5) Does Medicare cover a speech-generating device (AAC)?
Yes—Medicare covers SGDs as DME when strict criteria are met (SLP evaluation, documentation). (Centres for Medicare & Medicaid Services)
6) Where can I try an assistive device before buying?
Your State Assistive Technology Program offers free device demonstrations and short-term loans, plus reuse and financing options. (ACL Administration for Community Living)
7) Can Medicare help with home safety equipment like grab bars?
Original Medicare generally doesn’t cover home mods/bathroom safety. Some Medicare Advantage plans may include them for chronically ill members via SSBCI. (Centers for Medicare & Medicaid Services)
8) How do I find an approved supplier and avoid surprise bills?
Use Medicare’s supplier lookup and confirm the supplier accepts assignment before ordering. (Medicare)