Competitive Bid

“What you need to know about Medicare's Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program”

Information about the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.

The DMEPOS competitive bidding 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. This program has already started in nine areas of the country and is scheduled to expand to more areas starting on July 1, 2013.

The competitive bidding program replaces outdated Medicare prices with lower, more accurate prices.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 certain quality medical equipment, supplies, and services from suppliers you can trust
• Helps limit fraud and abuse in the Medicare Program

If you have Original Medicare and you live in (or get the items while visiting) one of the areas where the program has started and use equipment or supplies included in the program, you will almost always have to 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 supplier or a grandfathered supplier, Medicare usually won't pay for the item and you may have to pay full price.

It is important to know if you are affected by this program to make sure you are using a supplier Medicare will pay and to avoid any disruption of service. For more information about Medicare-covered Equipment and Supplies, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

Who will be affected by this program, and in what areas?

You are affected by this program if you live in (or get items while visiting) certain areas of the country and you are receiving certain products. To check if your area and if your item is included in the program, or to find a contract supplier for your area, call 1-800-MEDICARE (1-800-633-4227), or visit www.medicare.gov/supplierdirectory - Opens in a new window. TTY users should call 1-877-486-2048.

Do I have to get new medical equipment and supplies 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 these:

• 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 may also 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. To find a Medicare contract supplier, call 1-800-MEDICARE (1-800-633-4227), or visit www.medicare.gov/supplierdirectory - Opens in a new window. TTY users should call 1-877-486-2048.

When the program starts in my area do I have to change suppliers if I am already renting equipment from a supplier that isn’t a Medicare contract supplier?

If you’re already renting certain medical equipment or receiving oxygen or oxygen equipment that is paid on a monthly basis when the program starts, you may be able to stay with your current supplier. Suppliers that aren’t Medicare contract suppliers can elect to become “grandfathered” suppliers. This means a supplier may continue to rent equipment to you if you were renting the equipment when the program starts. This rule applies only to oxygen, oxygen equipment and certain rented equipment. You may continue using the “grandfathered” supplier until the rental period for your equipment ends. If you start renting additional equipment from a “grandfathered” supplier after the program starts, Medicare won’t pay for the new equipment. If you’re renting equipment that’s eligible for grandfathering, your supplier will let you know in writing 30 business days before the program begins whether it will or won’t become a grandfathered supplier.

What about medical equipment and supplies I get from my doctor or hospital?

Medicare will pay for certain items, like a walker or folding manual wheelchair furnished by your doctor or treating health care provider (including physician assistants, clinical nurse specialists, and nurse practitioners), even if he or she isn’t a Medicare contract supplier, as long as the item is supplied in the office during a visit for medical care and is medically necessary. If you’re hospitalized and need a walker or folding manual wheelchair, Medicare will also pay for these items furnished by the hospital while you’re admitted or on the day you’re discharged from the hospital.

Am I affected if I'm in a Medicare Advantage Plan?

The Competitive Bidding Program applies to Original Medicare only. If you're enrolled in a Medicare Advantage Plan (like an HMO or PPO), your plan will let you know if your supplier is changing. If you're not sure, contact your plan.

Do I have to change doctors?

No. The program doesn't affect which doctors you can use.

What if I need a specific brand of item or supply?

The competitive bidding program has special protections to make sure you get the specific types of medical equipment you need to protect your health. If you need a specific brand of equipment or supplies, or you need an item in a specific form, your doctor must prescribe the specific brand or form in writing. Your doctor must also document in your medical record that you need this specific item or supply for medical reasons. In these situations, a Medicare contract supplier is required to furnish the exact brand or form of item you need, help you find another contract supplier that offers that brand or form, or work with your doctor to find an alternate brand or form that is safe and effective for you.

Do I have to get my diabetic supplies by Mail Order for Medicare to cover them?

Beginning on July 1, 2013, Medicare beneficiaries who have their diabetic testing supplies delivered will have to get their supplies from a contract supplier in order for Medicare to help pay. This applies to beneficiaries living in all parts of the United States, including the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, and American Samoa.

Medicare will help pay for your supplies if you use a mail-order contract supplier or go to your local pharmacy or storefront. Local stores don't have to be Medicare contract suppliers unless they're also offering diabetic supplies through the mail.

IMPORTANT: If you choose to buy your diabetic testing supplies through mail-order, you must use a mail-order Medicare contract supplier in order for Medicare to help pay for the items.

"Mail-order" means items shipped or delivered to the beneficiary’s residence by any method.

What if I travel to one of the areas included in the Competitive Bidding Program and need to get medical equipment or supplies?

If you travel to an area included in the program, you must get any medical equipment or supplies included in the program from a Medicare contract supplier.

	And travel to...	You may go to...
An area participating in the program	A different area participating in the program	A Medicare contract supplier located in the area you traveled to for items included in the Competitive Bidding Program*
An area participating in the program	An area NOT participating in the program	Any Medicare-approved supplier
An area NOT participating in the program	An area participating in the program	A Medicare contract supplier located in the area you traveled to for items included in the Competitive Bidding Program*
An area NOT participating in the program	An area NOT participating in the program	Any Medicare-approved supplier

* If you don’t use a Medicare contract supplier, the supplier may ask you to sign an Advance Beneficiary Notice. This notice says Medicare probably won’t pay for the item or service. The supplier will probably require you to pay for the full cost of the item.

If I travel to one of the areas included in the Competitive Bidding Program, will I pay the same amount I pay at home?

• Your out-of-pocket costs will be the same as when you are at your permanent home. You will still be responsible for paying the 20 percent coinsurance after meeting your annual Part B deductible.
• It's important to know that for any equipment or supplies that are included in the Competitive Bidding Program, the Medicare contract supplier can't charge you more than the 20 percent coinsurance and any unmet annual deductible. If you suspect that you are paying more coinsurance than the Medicare-approved amount, you can call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. You can also call the Fraud Hotline of the HHS Office of Inspector General at 1-800-447-8477. TTY users should call 1-800-377-4950.

How does Medicare pay for equipment or supplies if I have other insurance?

• If your primary insurance policy requires you to use a supplier that doesn't participate in the Competitive Bidding Program, Medicare may make a secondary payment to that supplier. The supplier must meet Medicare enrollment standards and be eligible to get secondary payments. For more information, check with your benefits administrator, insurer, or your plan provider.

Where can I get more information about the DMEPOS Competitive Bidding Program?

• For more information, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

What is the National Mail-Order Program?

Medicare is scheduled to implement a national mail-order program for diabetic testing supplies on July 1, 2013. The national mail-order program will include all parts of the United States, including the 50 States, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam and American Samoa.

This program is designed so you can continue getting quality supplies while saving money. The term mail-order includes all home deliveries. When it starts, you’ll need to use a Medicare national mail-order contract supplier for Medicare to pay for your diabetic testing supplies that are delivered to your home. If you don’t want your diabetic testing supplies delivered to your home, you can go to any local store that is enrolled with Medicare and buy them there.

Medicare’s approved payment amount will be the same for mail-order and non-mail-order diabetic testing supplies when the program starts. National mail-order contract suppliers can’t charge you more than any unmet deductible and 20 percent coinsurance. Local stores also can’t charge more than the deductible and 20 percent coinsurance if they accept assignment, which means they accept Medicare’s approved amount as payment in full. Local stores that do not accept Medicare assignment may charge more than 20 percent coinsurance and any unmet deductible. Therefore, if you get your supplies from a local store, check with the store to find out what your copayment will be.