Medical Supplies 101
A weekly letter for the people who carry the most.
Hi friend,
There is a closet in your house that used to hold coats.
Now it holds a box of gloves, two kinds of pads because the first kind did not work, a thickener you bought once and never opened, wipes, a shower chair still in its plastic, and a blood pressure cuff somebody gave you that you are not sure is the right size.
You did not plan that closet. It accumulated. Every item in it arrived on a day when something went wrong, and you solved it in a hurry with whatever was in stock, and then you moved on because there was no time to become an expert in pads.
Here is what I want to say about that closet before we go one sentence further.
It is not clutter, and it is not evidence that you are disorganized. It is a record of every single time something went wrong and you handled it. That closet is a list of problems you already solved.
But it is also expensive, and a surprising amount of what is in there you are paying full price for when you did not have to. Nobody ever sat you down and explained the rules, because there is no meeting for that and no one whose job it is to hold it.
So this week is the meeting. What is covered, what is not, why the two lists are so different from what you would expect, where families quietly overpay, and what to do with the half of that closet you are never going to use.
The two lists
Start here, because almost every frustrating conversation you will have about supplies comes from not knowing this.
There is a list of what your person needs. You know that list by heart. You could recite it in the parking lot at eleven at night. There is a separate list of what Medicare pays for. That list was not built around what a life requires. It was built around a specific and fairly narrow definition, and the definition is the whole reason the two lists do not match.
Medicare’s rule for durable medical equipment is that the item has to be durable, used for a medical reason, typically only useful to someone who is sick or injured, used in your home, and expected to last at least three years.
If it wears out, gets thrown away, or gets used up, it is usually not covered. A wheelchair lasts three years. A walker lasts three years. A box of pads lasts nine days.
The clearest example is incontinence supplies and adult diapers. Medicare says: “Not Covered.” You pay 100 percent. Not a copay. Not a deductible you eventually meet. The entire cost.
For equipment that does qualify, after the Part B deductible, you pay 20 percent of the Medicare-approved amount if your supplier accepts assignment.
The hospital bed is 20 percent and the pads are 100 percent. That is not a judgment about which one matters more to a person’s dignity. It is a definition about how long an object lasts.
You are not missing a benefit you should have found. You are running into a boundary that was drawn a long time ago around durability, and it is worth knowing exactly where that line sits so you can stop searching for a door that is not there and start spending your energy where it actually moves money.
What you pay for incontinence supplies and adult diapers.
What you pay for covered equipment after the Part B deductible, with assignment.
How long an item must be expected to last to qualify as durable equipment.
Sources: Medicare, “Incontinence supplies & adult diapers” and “Durable medical equipment coverage.”
Where families quietly overpay
There are three places it leaks.
The first is the supplier who is not enrolled. If your supplier does not have a supplier number, Medicare will not pay your claim, even if it is a large chain or department store.
A large chain or department store. Which is to say: the place you would naturally go. The big familiar store with the pharmacy counter is not automatically able to bill Medicare for equipment, and if it cannot, the claim does not get paid and the whole amount is yours.
The second is assignment. It means the supplier agrees to accept the Medicare-approved amount as full payment. If they do not accept it, you might have to pay more. Two suppliers, same walker, same Medicare, different bill. The only difference is a question you did not know to ask.
The third is the thing you bought that somebody would have loaned you.
You were not foolish. You were uninformed by a system that had no step where anyone informed you.
What this actually costs
Supply money does not arrive as one bill. It is twelve dollars at the pharmacy, then forty at the medical supply place, then another eleven because you needed the other size after all.
AARP and the National Alliance for Caregiving found that nearly half of caregivers experience at least one negative financial impact from caregiving. This is not the kind of money that takes a house in one afternoon. It erodes.
Nearly half. Not only the families who hired round-the-clock help. Not only the ones facing a nursing home. Nearly half of everybody. Which is why the number worth having is not a national average. It is yours, and you can find it in about four weeks.
Pick one month. Keep every receipt that has a supply on it. Put them in an envelope in that same closet. At the end of the month, add them up once.
That number tells you the biggest line, gives a state program or Medicaid office something concrete to act on, and gives siblings who want to help an easy, specific ask.
“As you can see by the fact that I’m here today, my wheelchair gives me freedom to be out and about in the community.”
The best-kept secret in this letter
Almost every state has a program that will loan you equipment before you buy it, let you try it first, and sell you a refurbished one for a fraction of new. Almost nobody knows they exist.
They are the State Assistive Technology Act Programs, and there is one in every state, plus the District of Columbia, Puerto Rico, and the outlying areas. They are federally funded through the Administration for Community Living.
They let you borrow it first. Device loan activities let people borrow equipment to determine whether it meets their needs before purchasing it.
They let you try it with somebody who knows. Demonstrations compare devices through hands-on exploration guided by a knowledgeable professional.
They resell what other families no longer need. Reutilization programs move equipment to new owners at substantial cost savings.
The shower chair still in its plastic. The walker your father used for six weeks after the hip. The wheelchair in the garage. Somebody in your county is about to spend three hundred dollars on the thing sitting in your garage, and there is a program whose entire job is to move it from you to them.
Which means this section is two gifts, not one. It is a way to spend less. It is also a way to empty half that closet without throwing away things that are perfectly good.
Assistive technology is defined around maintaining independence and function. Not durability. Not three years. Independence.
Five questions, before you pay for anything
These are not my questions. They come word for word from Medicare’s own booklet on equipment. They take ninety seconds and can mean the difference between the right price and whatever price you happened to get.
- 1
“Are you a Medicare-enrolled supplier?” If the answer is no, Medicare will not pay the claim, no matter how big or familiar the store is.
- 2
“Do you accept assignment?” This is the twenty percent question. Ask it before anything is ordered.
- 3
“If you don’t accept assignment, will you consider assignment in my case?” Most people never learn they are allowed to ask this. You are allowed to ask this.
- 4
“If you won’t consider assignment, what’s your non-assignment charge?” Get the number before you agree, not on the invoice after.
- 5
“Will you bill Medicare for me?” The alternative is paying everything up front and chasing reimbursement yourself, which is a second job.
Five questions. Ninety seconds. Ask them before the order, not after the bill.
Reproduced from Medicare’s “Medicare Coverage of Durable Medical Equipment & Other Devices,” CMS 11045, revised February 2025.
Wherever you are standing in this
If you carry the daily care, set a standing monthly reminder for the two or three items you always run out of, and order them on the same day every month. Not because you are bad at remembering. Because remembering is a cost.
If you live nearby, take the closet. Photograph what is in it, find out what is still sealed, and call the state assistive technology program to ask what they will take and what they will loan.
If you are the one far away, supplies are unusually good territory for you. Find the state program. Call suppliers. Check whether your person’s state Medicaid plan covers incontinence supplies. Set up the standing monthly order.
And you can be the keeper of the envelope. Somebody has to add up the month, and it does not have to be the person who is exhausted.
Why this matters for the person you love
The things in that closet change how your person sees themselves. The shower chair is not a shower chair. It is the day bathing became a thing that required equipment.
That is why so many of these items sit unopened. It is not stubbornness and it is rarely denial. It is a person declining to file the paperwork on their own decline.
Emily Ladau has used a wheelchair her whole life. Her sentence is the one to have in your head when you set a new item down in front of someone who does not want it. Not “you need this now.” Try “this is so you can keep doing the thing you like.”
The grab bar is so she can keep taking her own shower. The walker is so he can keep going to the mailbox himself. The thickener is so dinner stops being frightening.
Same object. Completely different meaning.
You have become very good at knowing exactly what another person needs, down to the brand and the size. It is worth noticing that nobody has ever run that same inventory on you.
Only 14 percent of family caregivers of adults age 50 or older say a health care provider has asked what they need to care for themselves. Fourteen. If it has never occurred to you that somebody should be asking, that is not a gap in your self-awareness. It is a gap in the system.
Source: National Alliance for Caregiving and AARP, Family Caregivers of Adults Age 50-plus, July 2026
One small step, for you
Find one thing in your house that you bought for yourself and never opened. Open it this week.
The good lotion. The nice tea. The book on the nightstand with the receipt still in it. The candle somebody gave you two Christmases ago that felt too good to use on a regular day. There is no regular day coming. Open it.
This whole letter is about a closet full of supplies for somebody else. This one item is not for them.
If you need somewhere to turn this week
All four are government or federally funded, and none of them sell anything. You do not have to carry this alone.
Where to find the free Medicare booklet containing the five supplier questions and enrollment warning.
Search an item to see whether it is covered and what you pay.
Find device loans, demonstrations, and equipment reuse programs in every state and territory.
Free, objective, one-on-one Medicare counseling from federally funded local programs.
Before you go
I want to leave you with the closet, because I think it has been quietly bothering you for months.
You are allowed to not look at it this week. Nothing in there is on fire.
But when you do, go in with the right idea about what you are looking at. That is not a monument to spending too much or choosing wrong. Half of it is problems you already solved. Some of it is somebody else’s answer sitting in your garage waiting to be handed over. And a little of it is just the honest evidence that you have been trying things, which is the only known method.
You have been doing the buying, the returning, the trying again, the standing in an aisle at nine at night reading the back of a box under bad lighting. Nobody taught you any of it and you learned it anyway.
Covered and needed are two different lists. You have been working off the second one this whole time, which is the right one, and paying for the gap yourself.
This week you get to know where the gap actually is.
With you in it,
P.S. Next week we go bigger and heavier, literally: beds, wheelchairs, lifts, and the question that costs families the most money in this whole season, which is whether to rent it or buy it. I will also answer what happens when the equipment arrives and the room it is supposed to go in is not big enough. If this week was the hall closet, next week is the living room that has to become a bedroom.
You have been solving small problems nobody noticed, for a long time, with no manual and no applause. That is not nothing. That is most of what love actually looks like. You are not walking this alone.
A quiet Sunday letter for caregivers
Free. One letter a week. Unsubscribe anytime.