Q: I’ve been told that I will need to get my mail order diabetes supplies from a different supplier if I want Medicare to pick up the cost. Why would I have to switch?
A: Medicare will soon be changing the way they pay for your Durable Medical Equipment (DME) and diabetic supplies.
You may begin hearing the acronym DMEPOS, which stands for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies. These are the items that will be affected by this new competitive bidding process.
DME suppliers will soon have to compete to become Medicare contract suppliers. This means they will have to submit bids for pricing of certain items. Medicare will choose which suppliers will be Medicare contracted suppliers.
The competition will result in new, lower payment amounts on these items. Only specific areas are affected by this bidding process. These are called Competitive Bidding Areas (CBA). This new process is already in effect in southeast Indiana.
These changes begin July 1, 2013, for parts of northwest, central, and southern Indiana, so you will need to find out if you live in a Competitive Bidding Area. You can do this at www.dmecompetitivebid.com.
If you live in a competitive bidding area (CBA), Medicare will only pay an agreed upon amount for DME. This means you will have to use Medicare contracted suppliers for Medicare to pick up the cost.
When it comes to your diabetic supplies, to continue having Medicare pay, you will be able to:
pick up diabetic testing supplies in person from retail pharmacy locations or other local supplier, as long as the supplier is a Medicare contracted supplier.
have them delivered to your home, as long as the supplier is a Medicare contracted supplier.
Diabetic supplies that are given to you directly by your health care provider may be exempt from this.
Other categories of items that will be affected by this bidding starting July 1 will be:
Oxygen supplies and equipment
Standard (power and manual) wheelchairs, scooter and related accessories
Enteral nutrients, equipment and supplies
CPAP devices and Respiratory Assist devices (RADs) and related supplies and accessories
Hospital beds and accessories
Support surfaces (mattress overlays
Negative Pressure Wound Therapy (NPWT) pumps and related supplies
Check next month’s Ask SHIP column for continued information on this important DMEPOS topic.
If you have questions about Medicare coverage for DMEPOS, or anything else related to Medicare, contact SHIP for help. Call
1-800-452-4800, or visit www.medicare.in.gov.