If you use any type of durable medical equipment (DME) in your home, like a wheelchair or oxygen tank, you might need to know about the recent changes Medicare has made to how they cover this type of equipment. Instead of allowing you to go to the nearest Medicare-approved supplier, you now have to find a supplier that participates in the Durable Medical Equipment Competitive Bidding Program. This change is in effect in many parts of the United States, and has been made to cut costs to the Medicare program. In theory, this will also cut costs to you, as well.
The DME Competitive Bidding Program requires durable medical suppliers to submit a bid in order to become a contracted supplier with Medicare. The companies with the lowest bids are awarded a contract, and consumers will then be required to receive their supplies from one of these contracted suppliers.
What Supplies Are Affected?
Durable medical equipment is defined as a medical object than can be used repeatedly, has a specific medical purpose, and serves no purpose if you are not medically required to use it. In layman’s terms, this means that unless you are using the equipment for a valid medical reason, it is not considered Durable Medical Equipment. For example, an oxygen tank is considered durable because it can be refilled, is prescribed by a doctor, and is not useful to anyone who doesn’t need supplemental oxygen to treat an illness.
Other examples of durable medical equipment are wheelchairs and walkers, crutches and oxygen tanks, and hospital beds. These types of supplies require a doctor’s prescription and they have to be medically necessary. Often items such as shower chairs or commodes are considered durable medical supplies, as they allow you to continue to live in your own home and keep your independence.
What Locations are Affected?
As a general rule, the regions affected by the DME Competitive Bidding Program are metropolitan areas or, in states where there are fewer people, the largest cities in the state. For example, Idaho has a very small population, so only the Boise-Nampa area is affected. In states such as California and New York, however, there are many more regional areas that are bound by the DME program requirements.
If you don’t live in an area with an approved DME contractor, you can use any Medicare-approved pharmacy or supplier to receive your equipment. Also, if you currently use a non-Medicare-approved supplier, they may request to be grandfathered and continue to provide your equipment until the rental period has ended.
For more information about locations where you are required to participate in a DME Competitive Bidding Program, please visit the Medicare website. You can enter your zip code and find out immediately what suppliers, if any, are in your area.
What about My Diabetic Testing Supplies?
Although diabetic testing supplies like lancets and syringes are considered durable medical equipment, they fall under their own category. Medicare has created a National Mail-Order Program specifically for diabetic supplies. This allows you to order your syringes via telephone, internet, or email. However, these supplies can also be purchased at any local pharmacy that is approved by Medicare.
If this is the case, this is another gray area where it does not seem like funding and implementing an entirely new program is going to save anyone money. If you are like many senior citizens in the nation, you are comfortable using your local pharmacy and see no reason to change. Unless Medicare begins to make the National Mail-Order Program a requirement, a large number of people will likely not make the change.
What if I Have a Medicare Advantage plan?
If you have a Medicare Advantage Plan, this new DME program will not result in changes for you. Any changes in suppliers will be made by your specific Medicare Advantage Plan and you will be notified of the change. If you do not know what the coverage for durable medical equipment is, your policy administrator should be able to help you.
The main point of these recent changes to Medicare and how they cover your DME is supposedly to save both the federal government and the consumer money. The question is how much these programs cost the government to start and maintain. Then, you have to wonder how they are going to pass the savings on to you, the health consumer. Since at this point you can still use any Medicare-approved supplier or pharmacy if you do not live in a DME region, it is unclear how successful this change is going to be in the long run.
Wiley Long is founder and president of Medigap Advisors, and is passionate about helping people navigate the confusing waters of Medicare. He is the author of The Medicare Playbook: Designing Your Successful Health Coverage Strategy, a clear and simple explanation so you can make the most of your Medicare coverage. For more information visit www.MediGapAdvisors.com.