Every year, the Centers for Medicare & Medicaid Services (CMS) updates the rules governing durable medical equipment coverage. For 2026, those changes are more significant than usual — touching prior authorization requirements, reimbursement rates, and which devices qualify for coverage. If you rely on Medicare for home medical equipment, here's what changed and how it affects you.
1. Expanded Prior Authorization for High-Utilization Equipment
CMS expanded its prior authorization (PA) mandate to additional equipment categories in 2026. Prior authorization is a requirement that your supplier obtain Medicare's approval before delivering certain equipment — a rule designed to curb billing fraud on high-cost, frequently misused items.
New additions to the PA list include:
- Power wheelchairs (Group 3 and above) — CMS data showed significant over-billing in prior years
- Non-invasive ventilators — including CPAP and BiPAP devices for newly enrolled beneficiaries in select states
- Enteral nutrition equipment — feeding pumps and tubes in high-fraud regions
- Transcutaneous electrical nerve stimulation (TENS) units
If your doctor has ordered any of these items, expect a 2–4 week window for prior auth review before equipment is delivered. Plan ahead — especially before a hospital discharge or post-surgical recovery period when equipment is time-sensitive.
Check whether your specific equipment requires prior authorization in our Coverage Hub →
2. Continuous Glucose Monitor (CGM) Coverage — Now Fully Expanded
One of the most patient-friendly changes for 2026: Medicare has fully expanded coverage for therapeutic CGM devices to all insulin-using patients with diabetes, removing the prior restriction to those on intensive insulin therapy. This affects roughly 3.4 million additional Medicare beneficiaries.
Under the new rules:
- A therapeutic CGM (such as the Dexcom G7 or Abbott FreeStyle Libre 3) is now covered under Part B as DME
- Medicare pays 80% after the Part B deductible; you pay 20%
- Sensors and transmitters are covered as DME supplies on a recurring basis
- The prescribing physician must document insulin use and medical necessity
If you were previously denied coverage for a CGM because you weren't on intensive insulin, it's worth talking to your doctor about reordering under the new guidelines.
3. Competitive Bidding Program — New Contract Period
The Medicare Competitive Bidding Program (CBP) entered a new contract period in January 2026. This program requires suppliers in certain metropolitan areas to win a competitive bid before Medicare pays them for select equipment categories. The program affects oxygen, CPAP, power mobility devices, and several other high-volume items.
Why this matters for patients:
- Your supplier may have changed. If your existing supplier did not win a contract for your area, Medicare will no longer pay them. You may need to switch to a contract supplier.
- Reimbursement rates changed. Rates in competitive bidding areas were adjusted based on the new contract submissions — in most markets, rates dropped 8–12% for CPAP and oxygen equipment.
- Rural areas are exempt. If you live outside a competitive bidding area, the single payment amounts from the previous period continue to apply.
To confirm whether your supplier is contracted for your area, call 1-800-MEDICARE or check Medicare's Supplier Directory. You can also search for accredited Medicare DME suppliers near you →
4. Oxygen Therapy: Clarified Rules for Portable Units
CMS clarified coverage rules for portable oxygen concentrators (POCs) in 2026, a long-contested area. Key update: Medicare now distinguishes more clearly between stationary and portable oxygen systems when determining the monthly payment cap and ownership transfer rules.
Under the clarified rules:
- POCs are covered as DME under the 36-month capped rental model (same as stationary concentrators)
- After 36 months of continuous rental, the patient owns the device
- Oxygen contents (liquid oxygen, gas cylinders) continue to be covered beyond the 36-month rental cap
- Servicing and maintenance remain the supplier's responsibility for the duration of medical need
If you're approaching month 36 of your oxygen rental, confirm with your supplier how ownership transfer and ongoing supply delivery will be handled under the new clarified rules.
5. Part B Deductible and Coinsurance in 2026
The standard Medicare Part B deductible increased to $288 in 2026 (up from $257 in 2025). After meeting the deductible, Medicare pays 80% of the CMS-approved amount for DME, and you pay 20%. If you have a Medicare Supplement (Medigap) plan, Part B coinsurance is typically covered — reducing or eliminating your out-of-pocket share.
If you're on Medicare Advantage (Part C), check your plan's DME cost-sharing rules — they may differ significantly from Original Medicare. Some MA plans have $0 copays for certain equipment; others require prior auth even for items Original Medicare covers without it.
6. What To Do Now
If you or a family member relies on home medical equipment, take these steps to make sure your coverage is intact for 2026:
- Confirm your DME supplier is still Medicare-contracted in your area
- Check whether any of your equipment now requires prior authorization
- Review your Explanation of Benefits (EOB) once a new order is placed
- If you're insulin-using and need a CGM, ask your doctor about the new eligibility rules
- If you're nearing month 36 of an oxygen rental, confirm ownership transfer plans
Changes in Medicare policy happen every year, and staying informed is the best protection against unexpected denials or gaps in care.
Explore our full Coverage Hub for detailed DME coverage rules by equipment type →
Frequently Asked Questions
Does Medicare cover all types of home medical equipment in 2026?
Medicare Part B covers medically necessary durable medical equipment when prescribed by a doctor enrolled in Medicare. Not every device is covered — cosmetic items, items used for comfort only, or items that don't meet Medicare's definition of "durable" typically are not covered. Check the Coverage Hub for specifics by equipment category.
What if my supplier lost their competitive bid contract?
You'll need to switch to a contracted supplier in your area. Your existing supplier should notify you, but if not, call 1-800-MEDICARE to find contract suppliers or use our supplier search tool at dmehelper.com/directory/match.
Can I appeal if Medicare denies my DME claim?
Yes. You have the right to appeal any Medicare coverage decision. The denial notice will include instructions. First-level appeals (redetermination) must be filed within 120 days of the denial date.