If you're enrolled in a Medicare Advantage plan — or thinking about switching to one — a behind-the-scenes policy fight is underway that could have a very real impact on whether you can get a wheelchair, an oxygen machine, or a CPAP device without a months-long battle with your insurer. The American Association for Homecare, known as AAHomecare, is throwing its considerable lobbying weight behind a package of Medicare Advantage reforms aimed at making these private insurance plans behave more like traditional Medicare when it comes to covering home medical equipment and home health services.
AAHomecare represents the companies that supply durable medical equipment, or DME, to patients at home — think the local medical supply company that delivers a hospital bed after your hip replacement, or the provider that sets up your oxygen concentrator after a COPD diagnosis. These suppliers have watched with growing frustration as Medicare Advantage plans have increasingly used prior authorization requirements, coverage restrictions, and payment rate squeezes to limit or delay access to equipment that traditional Medicare would cover without the same hurdles. The reforms AAHomecare is backing would, if enacted, force Medicare Advantage plans to align more closely with original Medicare's coverage standards for home medical equipment.
To understand why this matters, you need to understand how Medicare Advantage handles DME differently from original Medicare. Under original Medicare — Parts A and B — durable medical equipment is covered under Part B, and if your doctor prescribes it and the equipment meets Medicare's criteria, you generally get it. There's a defined coverage standard, a fee schedule, and a relatively predictable process. Medicare Advantage plans, by contrast, are run by private insurers like UnitedHealthcare, Humana, Aetna, and Blue Cross Blue Shield affiliates. These plans receive a fixed monthly payment from the federal government to cover your Medicare benefits, and they're allowed to manage how those benefits are delivered — including requiring prior authorization before approving equipment.
Prior authorization sounds reasonable in theory: the insurer reviews whether the equipment is medically necessary before agreeing to pay. In practice, it has become a significant barrier for many beneficiaries. A power wheelchair that a doctor has prescribed after a thorough evaluation can sit in limbo for weeks while an insurer's medical reviewers — who may never have examined the patient — second-guess the clinical decision. Oxygen therapy for a patient with documented low blood oxygen levels can be delayed while paperwork is resubmitted. For older adults managing serious chronic conditions, these delays aren't just inconvenient — they can be medically dangerous.
Data Snapshot: According to CMS.gov data from its Medicare Advantage prior authorization and utilization management transparency reports, Medicare Advantage plans collectively denied approximately 7.4% of prior authorization requests in 2021. That translates to roughly 2 million denied requests out of approximately 35 million submitted. Critically, when beneficiaries appealed those denials, plans overturned their own decisions in favor of the patient about 75% of the time — a striking figure that suggests a substantial portion of initial denials were not clinically justified. CMS.gov also reported that as of 2024, there were 3,959 Medicare Advantage plans available nationwide, with enrollment exceeding 33 million beneficiaries, representing more than half of all Medicare-eligible Americans.
The reforms AAHomecare is supporting fall into several categories. First, they want standardized prior authorization timelines — meaning insurers would be required to respond to DME authorization requests within a defined window, such as 72 hours for urgent requests and seven days for standard requests. Second, they're pushing for continuity of care protections, which would prevent a plan from cutting off coverage for equipment a beneficiary is already using mid-year simply because the plan changes its formulary or coverage policies. Third, they want greater transparency in how plans set their DME payment rates, which have in some cases dropped so low that suppliers are refusing to accept certain Medicare Advantage plans — leaving beneficiaries scrambling to find a provider who will work with their insurance.
For you as a beneficiary, the practical question is: what does your current Medicare Advantage plan actually cover when it comes to home medical equipment, and how does it compare to what original Medicare would provide? This is one of the most overlooked dimensions of Medicare Advantage plan comparison. Most people focus on premiums, drug formularies, and dental or vision add-ons. But if you have heart failure, COPD, diabetes with complications, or mobility limitations — conditions that commonly require home medical equipment — the DME coverage rules in your plan can matter enormously.
When comparing Medicare Advantage plans during the Annual Enrollment Period, which runs October 15 through December 7 each year, you can look up each plan's Evidence of Coverage document on Medicare.gov. This document, often 100 pages or more, contains the specific prior authorization requirements for DME categories. It's dense reading, but the section on durable medical equipment will tell you which items require prior authorization, what documentation your doctor needs to provide, and whether the plan uses a separate DME benefit manager — a third-party company the insurer contracts with to handle equipment approvals, which adds another layer of complexity to the process.
If you're already enrolled in a Medicare Advantage plan and you've been denied coverage for home medical equipment, you have appeal rights that are worth exercising. The denial notice you receive must explain the reason for the denial and outline your appeal options. The first level of appeal is a redetermination request, which you submit to the plan itself — you typically have 60 days from the denial notice to file. If the plan upholds the denial, you can escalate to an independent review organization, then to an administrative law judge, and ultimately to federal court. Given that plans overturn their own denials about 75% of the time on appeal, filing that first-level appeal is almost always worth doing.
The broader policy context here is important. Congress and CMS have both been paying closer attention to Medicare Advantage practices in recent years. The Improving Seniors' Timely Access to Care Act, which passed the House with overwhelming bipartisan support and was signed into law in 2022, required CMS to establish new standards for prior authorization in Medicare Advantage, including real-time decisions for routinely approved items and electronic prior authorization systems. CMS has been implementing these rules in phases, with requirements taking effect for plan years 2024 and 2026. AAHomecare's current lobbying push is aimed at strengthening and expanding these protections specifically for the DME category, which advocates say has not been adequately addressed by the existing rules.
One specific area of concern that AAHomecare has highlighted is what happens when a Medicare Advantage plan exits a market or when a beneficiary moves to a new service area. Under current rules, if your plan leaves your county or you relocate, you may qualify for a Special Enrollment Period to switch plans. But your access to ongoing DME — say, a rental oxygen concentrator you've been using for two years — can be disrupted during the transition. The reforms being advocated would require receiving plans to honor existing DME arrangements for a defined transition period, giving beneficiaries time to establish care with new suppliers without a gap in equipment access.
For beneficiaries who are weighing whether to stay in Medicare Advantage or return to original Medicare, the DME issue is one factor in a larger calculation. Original Medicare with a Medigap supplement plan (also called Medicare Supplement Insurance) generally provides more predictable DME coverage because it follows Medicare's standard coverage rules without prior authorization for most equipment. Medigap plans, which are standardized by letter (Plan G and Plan N are the most popular among new enrollees in 2025 and 2026), cover the 20% coinsurance that original Medicare leaves you responsible for on DME and most other Part B services. The trade-off is that Medigap premiums are paid in addition to your Part B premium — the standard Part B premium in 2025 is $185.00 per month — and Medigap plans don't include drug coverage, so you'd need a separate Part D plan.
If you're in a state with a birthday rule — California, Idaho, Illinois, Kentucky, Louisiana, Maine, Maryland, Missouri, Nevada, New Jersey, New York, Oklahoma, or Oregon — you have an annual window around your birthday to switch Medigap plans without medical underwriting, which means you can't be denied or charged more based on your health history. This is a meaningful protection for older beneficiaries who want to move to a more comprehensive Medigap plan but worry about being rejected due to pre-existing conditions.
The bottom line is that the push for Medicare Advantage reforms around home medical equipment is not just an industry lobbying story — it's a patient access story. Hundreds of thousands of Medicare beneficiaries each year experience delays or denials for equipment their doctors have prescribed and that original Medicare would cover. Whether the reforms AAHomecare is backing ultimately become law or regulation depends on the political and regulatory environment, but the direction of travel — toward greater accountability for Medicare Advantage plans on prior authorization — has been consistent across both Republican and Democratic administrations in recent years. Staying informed about these changes, and knowing your appeal rights in the meantime, is the most practical thing you can do right now.