Medicare is changing how it pays for certain types of medical equipment…and it’s good to be aware of the changes, so you can make sure that what you buy will be covered by insurance.
The changes affect “durable” medical equipment, which means items you can use repeatedly as opposed to items meant for one-time use. Examples include wheelchairs, walkers, scooters, oxygen equipment, hospital beds, support mattresses, prostheses, orthotics, enteral nutrition devices, etc.
In the past, Medicare simply came up with a fixed amount that it would pay for each piece of equipment of this type. If a supplier accepted Medicare, it would have to charge no more than that amount, and typically Medicare would cover 80% of the cost.
Under the new plan, suppliers of these goods will be asked to submit competitive bids. Medicare will then announce “winners” and “losers.” Winners will be able to sell the equipment at the bid price and have it covered by Medicare. Losers won’t be able to participate.
You can buy equipment from a “loser” supplier if you want, but you won’t be reimbursed by Medicare. The supplier is required to tell you that it isn’t covered by Medicare, and you’ll have to sign a waiver form before you buy.
Initially, the new plan is being rolled out in nine areas: Cincinnati, Cleveland, Dallas, Kansas City, Miami, and Pittsburgh, plus Charlotte, N.C., Orlando, Fla., and San Bernardino, Calif.
Even people who don’t live in these areas are affected, though, because if you happen to travel to one of those areas and you need to buy equipment there, you’ll have to buy from a “winner” supplier or you won’t be reimbursed by Medicare.
Soon, the program will be rolled out to 91 additional metropolitan areas around the country, and it will also apply to mail-order purchases. By 2016, almost the entire country will be covered by the program.
There are some advantages to the change. It may lower the cost of equipment, and it will be harder for seniors to accidentally buy expensive items that aren’t covered by insurance, because they’ll have to sign a waiver if they do so.
On the other hand, if you want your equipment covered by Medicare, the result could be that you’ll have to go to a supplier that’s miles away instead of one down the street, if the one down the street doesn’t win the bidding. Also, if you need more than one piece of equipment, you might have to go to one supplier to get one and another supplier to get another, depending on who won the bidding for which item.
If you rent equipment, there are other rules. For instance, once bidding starts in your area, if the company you’re renting from doesn’t win the bidding, then you might have to switch suppliers midstream.
If your supplier is a “loser,” it can still choose to become a “grandfathered” supplier, which means you can stay with that supplier until the end of your rental period, after which you have to switch. If your supplier doesn’t become a grandfathered supplier, then you’ll have to switch right away, except you can’t be required to return your old equipment until after your new equipment arrives.
These changes apply to Original Medicare. If you’re in a Medicare Advantage plan, your plan will let you know about any changes in suppliers.