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We know that most adults would choose to stay in their homes for as long as they possibly can. As we age, this often means getting some help with day-to-day activities that have grown more difficult with age. Family members and paid caregivers often can provide all the assistance an individual needs, but caregiving can be made easier with the right equipment, such as home oxygen equipment, hospital beds, walkers and wheelchairs. In the long-term care industry, these items are called durable medical equipment, or DME. This equipment can be expensive and may or may not be covered by private insurance. In nearly all cases, the insurer will require that a physician prescribe any such equipment before they will pay for it.
If you have Part B, Original Medicare covers DME when your doctor prescribes it for use in your home. After you pay the Part B deductible ($135 in 2010), you pay the doctor or supplier 20 percent of the cost and Medicare pays the rest. Your supplier will work with your doctor to see that all required information is submitted to Medicare. Medicare Advantage Plans (such as HMOs and PPOs) must cover the same items and services as Original Medicare. Your costs will depend on which plan you choose, and may be lower than through Original Medicare. Call your plan administrator to find out what equipment is covered and at what cost.
For Medicare to pay, suppliers must be enrolled in the Medicare program. Durable medical equipment suppliers enrolled in the Medicare program have been approved by Medicare and have a Medicare supplier number. To find an approved supplier, visit www.medicare.gov or call 1-800-633-4227. Once you've determined that a supplier is enrolled in Medicare, you'll need to ask if the supplier accepts assignment. Suppliers who accept assignment have agreed to the Medicare-approved amount as full payment, which keeps your out-of-pocket costs as low as possible.
If you live in Cincinnati or Cleveland, or you spend part of the year in another state, you need to be aware that Medicare is phasing in a competitive bidding program in certain parts of the country, starting Jan. 1, 2011. Affected areas include metropolitan Cincinnati and Cleveland, as well as popular snowbird destinations in Florida, North and South Carolina, California and Texas. People with Original Medicare who use DME and live for several weeks in any area covered under this competitive bidding program will need to use suppliers that have agreed to take part in the program. Such suppliers are known as Medicare contract suppliers. Under limited circumstances you may keep the supplier you've been using. If you're already getting certain types of DME when the program starts Jan. 1, you may have the choice to stay with your current supplier until the rental period for the specific equipment ends. However, Medicare will not pay for other, additional equipment you rent from a non-contract supplier after Jan. 1.
If you have questions about DME or its coverage under Medicare, call the Ohio Senior Health Insurance Information Program at 1-800-686-1578.
The staff of Boomerang gratefully acknowledges the Ohio Senior Health Insurance Information Program and the Ohio Department of Insurance for contributing to this article.