Medicare Coverage Overview
How Medicare Pays for Home Medical Equipment
Medicare Part B provides coverage for Durable Medical Equipment (DME). DME includes items such as: wheelchairs, walkers, oxygen therapy, prosthetics and orthotics and compression devices. Coverage for these items is strictly limited to those cases that meet the coverage criteria defined in the Local Medical Review Policy (LMRP) for the applicable Durable Medical Equipment Regional Carrier (DMERC).
Medicare pays for Durable Medical Equipment in different ways, depending on the item or service and whether you buy or rent the equipment. Medicare pays the same amount whether the supplier "takes assignment" or not. If the supplier takes assignment and if you have already met your deductible for the year, Medicare pays 80 percent of the Medicare approved charge and you're responsible for the remaining 20 percent. You may pay more if the supplier does not take assignment.
Assignment means that the supplier agrees to accept the Medicare-approved amount as payment in full. If you buy equipment from a supplier who does not take assignment, Medicare will still pay only 80 percent of the Medicare-approved amount. You are responsible for the difference between what Medicare pays and what the supplier charges.
Whether the supplier takes assignment or not, the supplier is still required by law to bill Medicare. To keep your cost to a minimum, ask the supplier if it accepts Medicare assignment.
Medicare Does Not Cover All Medical Products
You Must Pay Medicare Copayments
After you have met your deductible, you're still responsible for paying directly, or through supplemental insurance, at least 20 percent of the Medicare approved amount. This copayment may not be dropped by the supplier except in very special hardship situations and only on a case-by-case basis.
Offers by suppliers to drop copayments or deductibles or to give discounts, coupons, rebates, or other "special offers" -- eliminating the need for copayments on Medicare-approved items -- are illegal. Report such offers to your Medicare carrier.
Special "offers" may seem like a good idea at the time because they appear to be saving you money. But such practices lead to increases in your Medicare Part B premiums and deductibles and unwarranted increased costs to the Medicare program.
Reputable suppliers do not resort to these kinds of incentives. They will provide a reliable product at a reasonable cost to you and the Medicare program.
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