Need Medical Equipment? See what Medicare Covers....

*Repost* https://www.medicare.gov/coverage/durable-medical-equipment-coverage.html?linkId=24566463&utm_source=facebook&utm_medium=social&utm_campaign=medicare&utm_content=071717_DME&linkId=39844787

Durable medical equipment (DME) coverage

How often is it covered?

Medicare Part B (Medical Insurance) covers medically necessary durable medical equipment (DME) that your doctor prescribes for use in your home. Only your doctor can prescribe medical equipment for you. DME meets these criteria:

• Durable (can withstand repeated use)
• Used for a medical reason
• Not usually useful to someone who isn't sick or injured
• Used in your home
• Has an expected lifetime of at least 3 years

DME that Medicare covers includes, but isn't limited to:

• Air-fluidized beds and other support surfaces (these supplies are only rented)
• Blood sugar monitors
• Blood sugar (glucose) test strips
• Canes (however, white canes for the blind aren't covered)
• Commode chairs
• Continuous passive motion (CPM) machine
• Crutches
• Hospital beds
• Infusion pumps and supplies (when necessary to administer certain drugs)
• Manual wheelchairs and power mobility devices
• Nebulizers and nebulizer medications
• Oxygen equipment and accessories
• Patient lifts 
• Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
• Suction pumps
• Traction equipment
• Walkers

Who's eligible?

All people with Part B are covered.

Your costs in Original Medicare

If your supplier accepts assignment, you pay 20% of the Medicare-approved amount, and the Part B deductibleapplies. Medicare pays for different kinds of DME in different ways. Depending on the type of equipment:

• You may need to rent the equipment.
• You may need to buy the equipment.
• You may be able to choose whether to rent or buy the equipment.

Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them. 

It’s also important to ask your suppliers if they participate in Medicare before you get DME. If suppliers are participating suppliers, they must accept assignment. If suppliers are enrolled in Medicare but aren’t “participating,” they may choose not to accept assignment. If suppliers don't accept assignment, there’s no limit on the amount they can charge you.

Competitive Bidding Program

If you live in or visit certain areas, you may be affected by Medicare's Competitive Bidding Program. In most cases, Medicare will only help pay for these equipment and supplies if they're provided by contract suppliers when both of these apply:

• You have Original Medicare.
• You get competitively bid equipment and supplies in competitive bidding areas.

Contract suppliers can't charge you more than the 20% coinsurance and any unmet yearly deductible for any equipment or supplies included in the Competitive Bidding Program.

Note

To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like:

• Other insurance you may have
• How much your doctor charges
• Whether your doctor accepts assignment
• The type of facility
• The location where you get your test, item, or service

Note

If you live in an area that's been declared a disaster or emergency, the usual rules for your medical care may change for a short time. Learn more about how to replace lost or damaged equipment in a disaster or emergency.

Related Resources

• Where to get covered DME items  
• More information about DME
• Competitive Bidding Program

Manage your Medical Bills

MANAGING YOUR MEDICAL BILLS

Skip to the navigation

*Repost* Brought to you by Cigna: http://www.cigna.com/healthwellness/hw/medical-topics/managing-your-medical-bills-abo3249

Topic Overview

Medical bills. They can be confusing and stressful. But with some basic know-how and organization, you can manage them—and avoid overpaying for your health care.

After you receive a health care service, you get:

• A medical bill from your provider. If you have no health insurance, this is the amount that you pay. If you're insured, you will likely pay less than the provider has billed you for.
• An Explanation of Benefits (EOB) from your insurer. This insurance statement shows how much of the bill you will need to pay.

This may sound simple. But when you get a bill, then an insurance statement, then a revised bill based on the statement or a payment you've already made, things can get confusing.

Organize

Take these simple steps to keep your medical bills in order. You can organize paper bills and statements, or electronic versions on a computer.

• Keep a calendar of your medical appointments. Jot down each appointment, including the provider and the care you've received. Also record the dates you've paid for prescription medicine.
• Organize your medical bills by date of service. If you have bills for more than one family member, keep a separate file for each.
• Pair medical bills with insurance statements. Sometimes an insurance statement will be about more than one medical bill. Keep those papers together. If you can, make a copy of the statement and match it with each separate bill it mentions. Include any payment receipts and updated statements about those bills.
• Create a list or a spreadsheet—whatever works for you. Across the top, label columns that best fit your health insurance. Include these types of headings:
  • Date, type of service, and provider
  • Billed amount
  • Allowable amount (see your insurance statement)
  • Amount insurance pays (see your insurance statement)
  • Amount I pay (see your insurance statement)
  • My payment/date paid
  • Amount I still owe
  • Amount I've paid toward my deductible (see your insurance statements or website)
  • Notes

Update your list or spreadsheet with each bill and insurance statement you receive and with each payment you make.

Don't be surprised if you get several bills for the same care. For example, for a surgery in a hospital, you might get bills from the surgeon, the anesthesiologist, and the hospital. Or for an X-ray, you'll get bills from the imaging facility and the radiologist who reads the image.

Compare your medical bill and insurance statement

Read carefully through your medical bill and insurance statement. Make sure that:

• The date, provider, and type of medical care are correct on both.
• You understand how much of the bill you need to pay. This is the amount that your insurer says you owe.

If you have questions about any part of a bill, call your provider's billing office. And for questions about what's on your insurance statement, call your insurer.

Fix errors

Billing mistakes can happen. Before you pay anything, be sure to read your billing paperwork carefully. Look at your health insurance policy.

• If you think you have found an error, call your provider's billing office or your insurer. Ask to review the statement on the phone.
• If your insurer won't cover a service that your policy says should be covered, file an appeal. Ask your insurer about the appeal process. For information about health insurance appeals, see the U.S. government website at www.healthcare.gov/using-insurance/managing/appealing-denials/index.html.

If you have payment problems

Not paying a medical bill can ruin your credit rating. Talk to the provider's medical billing office. This is one key to keeping your account from going to a collections agency.

• If you realize you've missed a due date for a bill, call the billing office right away. Pay on the phone if you can.
• If you can't pay a bill in full, ask to arrange a payment plan. Many providers are happy to do this, as long as you stay in touch and agree to make small, regular payments.

Current as of: November 20, 2015

Author: Healthwise Staff

Medical Review: Adam Husney, MD - Family Medicine & Kathleen Romito, MD - Family Medicine

This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use . Learn how we develop our content .

This information is for educational purposes only and is unrelated to health plan benefits or coverage. Services addressed may not be covered under your health plan. If you have questions about your coverage, please refer to your benefit plan document or call the number on the back of your health plan membership ID card.

To learn more about Healthwise, visit Healthwise.org .

© 1995-2016 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.