Q: I have diabetes and usually buy my supplies through the mail. I was told that Medicare might not pay for them with the company I’ve been using. Is that true?
A: You can still use mail order for your diabetic supplies, but there’s a chance you may have to switch suppliers for Medicare to pay.
Medicare has begun competitive bidding between suppliers to keep the price of durable medical equipment down. As a result, only certain suppliers will be allowed to be reimbursed by Medicare.
This is all part of the new DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies). Program.
Starting July 1, 2013, you will need to make sure your supplier is a Medicare contract supplier. Medicare contract suppliers must always accept assignment on these items.
Contract suppliers are required to accept the Medicare- approved cost as payment and cannot charge any additional fees. The Medicare-approved cost for diabetic testing supplies will be the same for all suppliers.
If you have Original Medicare, you will have two options for purchasing your diabetic testing supplies:
You can have your diabetic testing supplies delivered to your home by a national mail-order contract supplier, or
You can purchase supplies in person from any Medicare-enrolled supplier
If you buy from a supplier, however, that does not accept assignment, you may pay more than the 20 percent coinsurance and any unmet deductible.
Contract suppliers are required to carry the same range of products to Medicare beneficiaries that are available to non-Medicare beneficiaries.
Your physician may prescribe a specific brand or type of delivery to avoid health issues for you. If your practitioner does, he needs to document in your medical record the reason why this is necessary to avoid an adverse medical outcome.
This documentation should include the following:
The product’s brand name or mode of delivery required;
The features this product or mode of delivery has versus other brand name products or modes of delivery; and
An explanation of how these features are necessary to avoid an adverse medical outcome.
If you have questions about buying your medical supplies while on Medicare, or anything else related to Medicare, contact SHIP for help. Call
1-800-452-4800, or visit www.medicare.in.gov.