Participating & non-participating suppliers
If you get Medicare covered prescription drugs or supplies, make sure your pharmacy or supplier is enrolled in the Medicare Program. If you go to a pharmacy or supplier that isn't enrolled, Medicare won't pay. You'll be responsible for paying the entire bill for any drugs or supplies.
If they're participating, they must accept assignment. This means they must accept the Medicare-approved amount as payment in full. You should only pay your 20% copayment (and any remaining Medicare Part B deductible) when you get your supplies.
If they aren't participating, they don't have to accept assignment unless they're DMEPOS Competitive Bidding Program contract suppliers. This means that charges may be higher, and you may pay more. You may also have to pay the entire charge at the time of service, and wait for Medicare to send you its share of the charge.
Find Medicare-enrolled suppliers and pharmacies. For Medicare-covered supplies, you should also find out if your pharmacy or supplier is participating with Medicare.
Contract suppliers & exceptions
In most cases, if you have Original Medicare coverage and get program items in program areas, Medicare will only help pay for these items if they're provided by contract suppliers.
However, there are a few exceptions. Your current supplier may choose to be a "grandfathered" supplier. You can also sometimes get a walker from doctors, certain other treating health care practitioners, or hospitals even if they aren't contract suppliers. In these situations, Medicare will still help you pay for these items.
"Grandfathered" suppliers
Suppliers that aren't Medicare contract suppliers can decide to become "grandfathered" suppliers for certain rented items.
If a "grandfathered" supplier rented the equipment to you at the time the program started, the supplier may continue to rent equipment to you. This rule applies only to certain equipment that can be rented, like CPAP devices, oxygen, and oxygen supplies. 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 started in your area, Medicare won't pay for the new equipment.
Supplies from doctors & hospitals
Medicare will help pay for a walker that your doctor or treating health care practitioner (including physician assistants, clinical nurse specialists, and nurse practitioners) gives you, even if he or she isn't a Medicare contract supplier, as long as the walker is supplied in the office during a visit for medical care.
If you're admitted to a hospital and need a walker, Medicare will also help pay for it if the hospital gives it to you while you're admitted or on the day you're discharged from the hospital even if the hospital isn't a contract supplier.
The program doesn't affect which doctors you can use.
Specific brands of supplies
The DME 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 do one or more of these:
- Provide the exact brand or form of item you need.
- Help you find another contract supplier that will provide that brand or form.
- Work with your doctor to find an alternate brand or form that's safe and effective for you.
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