Denver. CO — As Congress looks for ways to save the Medicare Trust Fund, starting on July 1, 2013, some Medicare beneficiaries who have only Original Medicare will see changes in how they purchase durable medical equipment. In 2003, Congress passed a law that requires Medicare to replace the current fee schedule payment methodology for selected Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) items with a competitive bid process. This has resulted in a system of national suppliers being responsible for providing medical equipment. The program which is being phased in throughout the country will affect people differently depending on where you live and what medical equipment you use. This program will not affect those individuals who are enrolled in a Medicare Advantage Health Plan.
One of the most important changes is that all diabetic Medicare beneficiaries who use Original Medicare and currently receive test strips and lancets by mail, must now use one of the twenty (20) approved national suppliers. These suppliers accept Medicare assignment meaning they cannot charge more than 20% of the approved charge by Medicare. Individuals who use a retail supplier for test strips and lancets can continue to use a retail supplier, however the retail supplier may or may not accept assignment; thus you as a beneficiary may pay more for your supplies. To find a mail order supplier call 1-800-Medicare or go to www.medicare.gov/supplier.
The next change affects Medicare beneficiaries who have Original Medicare who live in Metropolitan Denver, excluding Boulder, as well as Colorado Springs. Individuals who live in the target areas and who use any of the following items will be affected: oxygen (including equipment and supplies); standard (power and manual) wheelchairs, scooters, and related accessories; enternal nutrients (including equipment and supplies); CPAP and RAD devices (including supplies and accessories), hospital beds and related accessories; walkers and related accessories; negative pressure wound therapy pumps (including related supplies and accessories); and support surfaces (Group 2 mattresses and overlays).
Beneficiaries who live in an area that is included in the competitive bidding program must use a contracted supplier for Medicare to pay for the equipment. A large number of the suppliers in Colorado were not awarded a national bid and therefore are not able to provide medical equipment. Some Colorado based suppliers have sub-contracts with national suppliers and are able to provide services, as well as repairs.
Some Medicare beneficiaries are able to continue with their current supplier through a grandfathering provision; however, individuals should not assume their supplier is being grandfathered. If you supplier is being “grandfathered”, they must give you an Advance Beneficiary Notice or an ABN notifying you that you may be responsible for paying the entire cost of the equipment.
If you are purchasing durable medical equipment and if you are asked to sign an Advance Beneficiary Notice, most likely the item will not be covered by Medicare and you should be prepared to pay the cost for the equipment in full. Rather than sign the Advance Beneficiary Notice, you may want to contact 1-800-Medicare or visit www.medicare.gov/supplier to locate a participating provider.
If a beneficiary lives in a contracted area such as Denver and travel outside of the area, they must use a contracted supplier that serves that area to avoid being charged for the medical equipment. Also if beneficiaries live outside of a contracted area, special rules may apply. This is especially important for individuals who might live on the Western Slope and come to Denver for treatment. Individuals who live on the Western Slope are outside of a contracted area; for them the Denver supplier will be paid differently, than if the beneficiary were purchasing the equipment from a supplier on the Western Slope.
Most individuals who use multiple types of medical equipment will find themselves working with more than one supplier for equipment, as none of the national suppliers provide all types of medical equipment.
A major benefit of this program is that the co-pay will be less since the charges to Medicare are less. For example, beneficiaries who are making a monthly payment either directly or through their Medicare Supplement should see a reduction in the amount of the co-pay starting July 1, 2013.
These new rules represent significant changes for Medicare beneficiaries who are using durable medical equipment. Beneficiaries who have questions should contact 1-800-Medicare or they may call 303-333-3482 for assistance.
Eileen Doherty, MS is the Executive Director of the Colorado Gerontological Society since 1982. She has almost 40 years of experience in education and training, advocacy, clinical practice, and research in the field of gerontology. She is an adjunct instructor at Fort Hays State University teaching non-profit management. She can be reached at 303-333-3482 or at email@example.com.
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