Starting in July 2013, Medicare is scheduled to expand the competitive bidding program to more areas of the country. This program changes the amount Medicare pays for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), and makes changes to which suppliers Medicare will pay to supply these items to you.
The program replaces the outdated, inflated fee-schedule prices Medicare is currently paying with lower, more accurate prices. Under this program, suppliers submit bids to provide certain medical equipment and supplies at a lower price than what Medicare now pays for these items. Medicare uses these bids to set the amount it will pay for those equipment and supplies under the competitive bidding program. Qualified, accredited suppliers with winning bids are chosen as Medicare contract suppliers.
The program helps you and Medicare save money; ensures that you have access to quality medical equipment, supplies, and services from suppliers you can trust; and helps limit fraud and abuse in the Medicare Program.
If you have Original Medicare, live in one of the competitive bidding areas, and use equipment or supplies included under the program (or get the items while visiting a competitive bidding area), you generally must use Medicare contract suppliers if you want Medicare to help pay for the item. If you live in one of the areas where the program is expanding and you're renting oxygen or certain other durable medical equipment at the time the program starts, you'll be able to continue renting these items from your current supplier if that supplier becomes a contract supplier or decides to participate in the program as a “grandfathered” supplier.
If you live in (or get these items while visiting) these areas and don't use a Medicare contract or a grandfathered supplier, Medicare won't pay for the item, and you may have to pay full price.
It's important to know if you're affected by this program to make sure Medicare will help pay for your item and to avoid any disruption of service.
Round 1 of this program is already in effect; but did not affect central Kansas. Round 2 will affect us!
The items included in the Round 1 and 2 areas are: Oxygen, oxygen equipment, and supplies; standard power wheelchairs, scooters, and related accessories; complex rehabilitative power wheelchairs and related accessories (Group 2 only); enteral nutrients, equipment, and supplies; continuous positive airway pressure (CPAP) devices; respiratory assist devices (RADs), and related supplies and accessories; hospital beds and related accessories; Walkers and related accessories; negative pressure wound therapy pumps and related supplies and accessories (Group 2); and support surfaces.
Round 2 was scheduled to start July 1 and will affect McPherson County and surrounding counties. Medicare has listed the contract suppliers on www.medicare.gov/supplier.
You also may call 1-800-MEDICARE (1-800-633-4227) for help finding a contract supplier. Jana McKinney, SHICK counselor, at the McPherson County Extension Office can help too.
Page 2 of 2 - Do I have to get any new supplies or equipment that I need from a Medicare contract supplier? If the equipment or supplies ordered by your doctor or treating health care provider are included in the competitive bidding program where you live or visit, you generally must get your equipment or supplies from a Medicare contract supplier for Medicare to pay for the item.
However, in certain cases, your doctor or treating health care provider can sometimes supply a walker or folding manual wheelchair to you when you're getting other medical care even if he or she isn't a Medicare contract supplier. If you're hospitalized and need a walker or folding manual wheelchair, the hospital can supply you these items while you're admitted or on the day you're discharged from the hospital.
You also may be able to continue to rent some types of medical equipment from your current supplier, if that supplier chooses to be a "grandfathered" supplier. In these situations, Medicare will still help you pay for these items.
The McPherson County Extension Office has an educational fact sheet available free of charge by stopping by 600 W Woodside, or call 620-241-1523. Or you can find it at www.medicare.gov as well.
Jana McKinney is a McPherson County Extension agent for family and consumer sciences