Starting January 1, 2011 if you live or are visiting certain regions in North Carolina, South Carolina, Ohio, Kentucky, Indiana, Texas, Missouri, Kansas, Florida, Pennsylvania and California you will usually need to get your durable medical equipment (DME) from specific suppliers in order for Original Medicare to cover it. The competitive bidding process does not apply to Medicare Advantage plans.
DME suppliers submitted applications to Medicare and Medicare selected certain suppliers who will receive contracts. You can contact 800-Medicare to find out who the contract suppliers are in your region.
If you live or are visiting in a region where the competitive bidding process is in effect, you need to see a contract supplier if you are getting:
- Oxygen equipment and supplies
- Standard power wheelchairs
- Complex rehabilitative power wheel chairs
- Mail order diabetes supplies
- Enteral nutrients, equipment and supplies
- Continuous Positive Airway Pressure (CPAP) devices
- Respiratory Assist devices (RADs)
- Hospital beds and related accessories
- Support surfaces (only in Miami)
Medicare will cover walkers received from certain non-contract providers (such as hospitals, doctors, podiatrist, nurse practioners, physician assistants and clinical nurse specialists) if you receive it as part of their care for you. If you receive the walker from a non-contract hospital, you should receive it during your stay or before you leave the hospital.
If you buy any of these items from a contract supplier, the supplier must accept assignment. They must bill Medicare and take assignment. Taking assignment means that they accept the Medicare-approved amount as payment in full. You or your supplemental insurance will pay 20 percent of the Medicare approved amount (plus any unmet portion of your Part B deductible).
If you purchased DME from a non-contract supplier before January 1, 2011 you can keep your DME as long as the supplier agrees to be “grandfathered”. If the supplier will not be “grandfathered” than you must switch to a contract supplier. You can continue to receive your DME from “grandfathered” suppliers until your contract with the supplier ends or the DME is no longer medically necessary.
If you go to a non-contract DME supplier you will have to sign an Advance Beneficiary Notice (ABN). This notice states that Medicare will not pay for your DME and you will be responsible for the full cost. If the supplier does not have you sign an ABN you will not be responsible for the full cost.