UNITED STATES—Dear Toni: I am diabetic and I order my diabetic supplies from a mail-order program through my employer benefits. Recently, I have been laid off and had to enroll in Medicare.
How do I receive my diabetic supplies because I received a letter stating my supplier will no longer be covered by Medicare because it is not a “competitive bidding” supplier? Does this mean that if I continue with my current supplier, Medicare will stop paying for my diabetic supplies? Please explain. Silvia, a Memphis, TN.
Hello Silvia: Yes, that is what it means! Medicare will stop paying if you do not use a Medicare “approved” provider.
In 2013, Medicare made new rules regarding diabetic supplies and durable medical equipment, such as diabetic test strips, monitors, lancets etc. Durable medical equipment is medically necessary equipment such as wheelchairs, walkers, oxygen, hospital bed, which have been ordered by a Medicare approved doctor or other health care providers for use at home. And this rule has confused America!!
If Medicare is your primary insurance, you use only “Original” Medicare Parts A and B with a Medicare Supplement (Medicare Advantage Part C plans have different rules) and you order your supplies from a local or mail-order medical supplier, you must use suppliers who have been awarded a contract under the “competitive bidding” rule or you will have to pay 100 percent out of your pocket. This process is for both local or mail order diabetic and medical supplies.
Medicare has a listing of approved local or mail order medical suppliers; the list is available online at www.medicare.gov.
If you are happy with your current diabetic monitor, test strips and lancets, you will want to use a competitive bidding supplier that stocks your testing items. You will need to provide your new supplier with either a new prescription from your doctor or medical provider for your medical or diabetic supplies or have your current prescription transferred to the Medicare “accepted” supplier.
You need a new prescription from your doctor for your lancets and test strips every 12 months. This is important because if you do not receive a new prescription, you will pay 100 percent out of your own pocket. Many on Medicare are concerned about durable medical equipment (DME) that is sent to your house or that you use on a day-by-day basis, such as wheelchairs, walkers, oxygen, CPAC devices, at home wound equipment or any medical device you use at home.
Medicare will only cover a durable medical equipment or at-home supplier in your area that has a competitive bidding status.
You should also make sure that the pharmacy or medical supplier accepts assignment for Medicare-covered supplies. Assignment is an agreement between you (the person with Medicare), Medicare, and doctors, other health care suppliers, or providers. If the pharmacy or supplier accepts assignment, Medicare will pay the pharmacy or supplier directly. You only pay your coinsurance amount when you get your supply from a pharmacy or supplier for assigned claims.
Always ask your local or mail order medical supplier the following:
- Is your company a Medicare “approved” diabetic or DME (durable medical equipment) provider?
- Also ask does their company accept Medicare “assignment?”
“Original Medicare” Part B will provide the medical or diabetic supplies and you must pay the 20 percent co-pay or your Medicare Supplement can pick up the 20 percent if you have one. Talk with your pharmacy or provider if you have questions or call Toni Says® Medicare hotline at 832-519-8664 or email firstname.lastname@example.org with your Medicare questions.
Toni King, author of the Medicare Survival Guide® Advanced edition, is on sale at www.tonisays.com.