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Your Health

What You Need to Know about Medicare’s Expanding Medical Equipment Program

If you, a friend or loved one has Original Medicare and needs certain medical equipment and supplies, you should know that Medicare is scheduled to expand its successful competitive bidding program to more areas of the country.

This program will help you save money and ensure that you have access to quality medical equipment and supplies from suppliers you can trust. It will also help limit fraud and abuse in the Medicare program.

Beginning July 1, if you have Original Medicare, live in an affected area (Bakersfield-Delano, Fresno, Los Angeles-Long Beach-Santa Ana, Oxnard-Thousand Oaks-Ventura, Sacramento–Arden-Arcade–Roseville, San Diego-Carlsbad-San Marcos, San Francisco-Oakland-Fremont, San Jose-Sunnyvale-Santa Clara, Stockton or Visalia-Porterville) and need equipment or supplies included in the program, you will most likely need to use Medicare contract suppliers for Medicare to help pay for the item.

The equipment and supplies included in the program are:

» 1. Oxygen, oxygen equipment, and supplies
» 2. Standard (power and manual) wheelchairs, scooters and related accessories
» 3. Enteral nutrients, equipment, and supplies
» 4. Continuous Positive Airway Pressure (CPAP) devices, respiratory assist devices (RADs) and related supplies and accessories
» 5. Hospital beds and related accessories
» 6. Walkers and related accessories
» 7. Negative Pressure Wound Therapy pumps and related supplies and accessories
» 8. Support surfaces (Group 2 mattresses and overlays)

If you’re already renting certain medical equipment or receiving oxygen or oxygen equipment when the program starts, you may be able to stay with your current supplier. Suppliers that aren’t Medicare contract suppliers can choose to become “grandfathered” suppliers and continue to rent your equipment to you.

Here are some simple steps you should take if you use any of the equipment listed above:

» 1. Visit Medicare.gov/supplier to determine if you live in (or will travel to) a ZIP code where the program is expanding or call 800.MEDICARE (800.633.4227). TTY users should call 877.486.2048. If you live in or travel to a competitive bidding area and need equipment or supplies included in the program, you will likely need to use a contract supplier to make sure Medicare will help pay for your item.

» 2. View the list of suppliers to see if your current supplier is a contract supplier. If so, you don’t need to do anything else.

» 3. If you rent certain medical equipment or are receiving oxygen or oxygen equipment when the program starts, check with your supplier to find out if they plan to become a grandfathered supplier. If your supplier chooses to become a grandfathered supplier, they will let you know in writing 30 business days before the program begins. You may choose to keep using them or switch to a contract supplier. If they choose not to become a grandfathered supplier, see to Step 4 below.

» 4. Consult the list of contract suppliers for your area and contact them as soon as possible to ensure continued access to your medical items and Medicare payment for the items.

Also scheduled to begin in July, Medicare will implement a national mail-order program for diabetic testing supplies. When it starts, you’ll need to use a Medicare national mail-order contract supplier for Medicare to pay for your diabetic testing supplies that are delivered to your home.

Make sure to let your friends and loved ones know about these changes as well!

If you have questions or want more information, Medicare has resources to help you understand the new program, including Medicare.gov and 800.MEDICARE (800.633.4227). TTY users should call 877.486.2048. You can also call your local State Health Insurance Assistance Program (SHIP) for free health insurance counseling and personalized help. If you’re in a Medicare Advantage Plan (like an HMO or PPO), your plan will notify you if your supplier is changing. Contact your plan for more information.

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