How the DMEPOS Medicare Competitive Bidding Program could affect you
If you are a Medicare beneficiary and have Original Medicare you may have received a notice from Medicare in May about the Durable Medical Equipment Competitive Bidding Program. This program was put in place to help lower the costs of durable medical equipment and supplies for people with Original Medicare. The program is expected to help Medicare beneficiaries save $17 billion between 2013 and 2022.
In January 2011, Medicare began phasing in the Competitive Bidding Program in some parts of the country. The program requires providers and suppliers of certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) to submit bids for their products. Qualified suppliers with winning bids who meet strict quality and financial standards are then chosen as Medicare-approved contract suppliers.
Under this new program, if you have Original Medicare and live in a competitive bid area, you almost always have to use a Medicare contract supplier if you want Medicare to pay for certain DMEPOS products and services. According to Medicare guidelines, durable medical equipment (DME) is equipment that:
- Serves a medical purpose;
- Can be used in your home;
- Can be used over and over again;
- Is likely to last for 3 years or more; and
- Is prescribed by your doctor or other health care professional.
Some examples of DME include walkers, wheelchairs, power scooters, diabetic testing supplies, and oxygen tanks.
The DME Competitive Bidding Program only affects those with Original Medicare, the traditional Medicare program directly administered by the federal government (Part A and Part B). It does not affect those who have a Medicare Advantage plan, also known as a Medicare private health plan. If you have a Medicare Advantage plan, you should contact your plan to see which suppliers are in the plan’s network of providers and will provide DME to you at the lowest cost.
The main purpose of the Competitive Bidding Program is to replace the prices Medicare currently pays for DMEPOS items with lower, more accurate and more current market prices. By using prices set through competition and ensuring suppliers are all licensed and accredited, the program will:
- Reduce your out-of-pocket expenses
- Help Medicare and taxpayers save money
- Ensure you have access to quality supplies and services from reliable suppliers
- Help reduce Medicare fraud and abuse
Important News about Diabetic Testing Supplies
As of July 1, 2013, the Competitive Bidding Program was expanded to 91 regions of the United States. It was also expanded on a national level for mail-order providers of diabetes testing supplies. If you order your diabetes testing suppliers through the mail, you must now use a Medicare contract supplier if you want Medicare to cover your costs. Medicare will still provide coverage if you get your supplies from a drugstore or other retail facility, but you will pay less by using mail order.
For more information about how this program may affect you, check out the Medicare.com website. This site has a good article about the Medicare Competitive Bid Program as well as an online tool to search for a DMEPOS supplier.
If you use diabetes testing supplies, check out the article Diabetic Supplies and the Competitive Bidding Program or get a list of Competitive Bid Winners. The site also has articles about how the program will affect you if you use other equipment such as a power scooter or oxygen supplies.
To find out whether you are affected by the Competitive Bidding Program, you can also contact 800-MEDICARE or go online and visit http://www.medicare.gov/SupplierDirectory/