Is your senior loved one in need of durable medical equipment (DME) such as a hospital bed, oxygen equipment, electric wheelchair or other home medical equipment? The truth is, buying or renting them when your senior loved one has Medicare can be a complicated and confusing, if not downright daunting process. That’s why we have put together the following 4 crucial questions you need to ask the supplier before making a rental or purchase. Make sure you get thorough answers to avoid getting into trouble with coverage or shelling more money than you should.
Question #1. Are You Under Contract With Competitive Bidding Program?
Medicare kick-started the Competitive Bidding Program back in 2003 to help those in need of durable medical equipment on two fronts:
- Make sure that high-quality DMEs are available throughout the country, and
- Minimize out-of-pocket costs for durable medical equipment especially for older adults
Against this knowledge, it’s worth noting that not all durable medical equipment is eligible under the program. In fact, not all DMEs are subject to competitive bidding. More crucially, you should be aware that Medicare only covers DMEs from suppliers who are part of the Competitive Bidding Program if your senior adult resides in a competitive bidding area.
So, what happens if your senior lives in a non-competitive bidding area? What if the required durable medical equipment isn’t subject to competitive bidding? In either case, a supplier that’s not only Medicare-approved but also willing to take up the assignment will come in handy.
Question #2. Is it Covered by My Medicare Plan?
If your senior is covered under a Medicare Advantage Plan, renting or buying from an on-network supplier will ensure utmost coverage. Getting it from an out-of-network supplier means that your older adult might have to foot the entire bill. While some Medicare Advantage plans include out-of-network coverage, it’s best to use on-network supplier to pay the lowest price possible.
Question #3. Do you an ATP?
An ATP, or Assistive Technology Professional, is an expert who specializes in seating products and wheeled mobility equipment (WME). This is a professional who’ll assess if your older adult meets the requirements needed for Medicare to approve a DME. More importantly, an ATP can offer insights and recommend the best durable medical equipment for your older loved one.
Of course, if your senior loved one does not require wheeled mobile equipment (eg, wheelchair), then you might proceed to a supplier that doesn’t have an Assistive Technology Professional.
Question #4. Are you a Medical Participating Supplier?
Asking this question is a no-brainer if you want to avoid paying extra. Let’s get one thing straight: if your older adult lives in Massachusetts, Ohio, Minnesota, Connecticut, Vermont, Pennsylvania, New York or Rhode Island, you have nothing to worry about because these states don’t permit suppliers to charge more than Medicare set prices for DMEs. However, if your senior doesn’t live in these states and the supplier isn’t a Medicare participating provider, you might be charged up to 15% more to rent or buy DMEs.