If you have Original Medicare, it is important to use the right supplier. Call 1-800-MEDICARE or visit www.medicare.gov/supplier to find DME suppliers who take assignment Take assignment is a term that means a provider accepts Medicare’s approved amount for a service or item as full payment. See also: Participating Provider and Non-Participating Provider. . Original Medicare normally pays 80% of the Medicare-approved amount after you meet your Part B deductible, and you are responsible for a 20% coinsurance. Your costs will also depend on whether or not you are required to rent or buy the equipment you need.
Be aware that many suppliers are Medicare-approved but do not take assignment. These suppliers may charge you more than Medicare’s approved amount for the cost of services. Medicare will still only pay 80% of its approved amount for services, so you will be responsible for any additional costs.
Note: If you have a Medicare Advantage Plan, your plan will have its own cost and coverage rules for DME. Contact your plan for more information.
Suppliers who have not signed up with Medicare
Avoid suppliers who have not signed up to bill Medicare for DME, also known as opt-out Opt-out providers do not accept Medicare at all and have signed an agreement to be excluded from the Medicare program. They can charge whatever they want for services, and Medicare will not pay for care you receive from an opt-out provider (except in emergencies). The provider must give you a private contract describing their charges and confirming that you understand you are responsible for the full cost of your care and that Medicare will not reimburse you. providers. Medicare will not pay for services you receive from opt-out providers. This means you are responsible for the entire cost.
If you use an opt-out DME supplier, the supplier should ask you to sign a private contract confirming that you understand you are responsible for the full cost of your care. If you do not sign a private contract, you do now owe the supplier for the cost of your DME.