When your older adult needs durable medical equipment like a wheelchair, hospital bed, or oxygen equipment, getting it through Medicare can be a confusing process. To avoid paying extra or running into problems with coverage, Boomer Benefits shares 4 key questions to ask a supplier before making a purchase or rental.
Buying or renting durable medical equipment (DME) when your older adult has Medicare can be a confusing and complex process.
If you don’t ask the right questions when choosing a store that sells the equipment your older adult needs, they might end up spending more or could even be denied coverage for the equipment.
Avoid problems by asking these 4 important questions when choosing a durable medical equipment supplier.
1. Do you accept my Medicare plan?
There are two main types of Medicare coverage: Original Medicare or Medicare Advantage.
If your older adult is enrolled in a Medicare Advantage plan, there may be a network of DME suppliers that must be used to ensure coverage. If the supplier isn’t in network with their plan, your older adult may have to pay 100% of the cost.
Some plans also include out-of-network coverage. That coverage is less comprehensive, but the plan may cover some of the cost if this benefit is included.
However, using an in-network provider will guarantee that the durable medical equipment is priced as low as possible.
2. Are you part of the Competitive Bidding Program?
In 2003, Medicare started the Competitive Bidding Program for durable medical equipment.
If your older adult lives in a competitive bidding area, Medicare will only cover equipment from suppliers who are under contract with their program.
Note: Not all DME is subject to competitive bidding.
This program helps reduce out-of-pocket expenses for DME and also ensures that quality equipment is available in most parts of the country.
If your older adult doesn’t live in a competitive bidding area or the needed DME item isn’t subject to the bidding program, then a Medicare-approved DME supplier that accepts assignment is required.
3. Are you a Medicare participating provider?
This is an important question to ask to avoid paying more for durable medical equipment than necessary.
When a supplier is a participating provider, they accept Medicare assignment rates. That means they agree to charge only the Medicare-approved price for covered equipment.
If the supplier is non-participating and doesn’t agree to accept Medicare’s set price for the equipment, then they are able to charge up to 15% more. Your older adult might also have to first pay the full amount for the equipment and later submit their own claim to Medicare for reimbursement.
However, some people don’t have to worry about paying excess charges, even if their supplier isn’t a participating provider.
Medicare beneficiaries from the states listed here don’t have to pay excess charges because these states don’t allow providers to charge more:
- New York
- Rhode Island
Medicare beneficiaries who are enrolled in certain Medigap plans also don’t have to pay excess charges to a non-participating provider because their plan will cover the charges.
4. Do you have an Assistive Technology Professional?
If your older adult is getting certain wheeled equipment, they’ll want to get an evaluation from the supplier’s Assistive Technology Professional (ATP) – someone who specializes in wheeled mobility equipment and seating products.
An ATP knows the qualifications that must be met in order for Medicare to approve the equipment and can make appropriate recommendations.
If your older adult doesn’t need a wheeled mobility device or seating product, then it’s fine to work with a supplier that doesn’t have an ATP.
Get additional help from their doctor
If you are not sure where to start when finding the right DME supplier, ask your older adult’s doctor.
Since their doctor must prescribe the durable medical equipment in the first place, ask if they have any recommendations for DME suppliers as they’re writing out the prescription.
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Guest contributor: Danielle Roberts is a Medicare insurance expert and co-founder at Boomer Benefits where she and her team help baby boomers with their Medicare insurance decisions.
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