On January 1, 2019, the durable medical equipment (DME) competitive bidding program temporarily ended.
The competitive bidding program was originally designed to reduce out-of-pocket expenses and help ensure that people with Medicare had access to quality DME, supplies, and services from suppliers they could trust. The program benefited people who had Original Medicare, lived in a competitive bidding area, and needed DME that fell under the competitive bidding program.
Under this program, suppliers submitted bids to Medicare to say how much they would charge for DME, and then Medicare used these bids to set DME prices. Suppliers who agreed to provide DME at the rate that Medicare set were called contract suppliers. If an Original Medicare beneficiary lived in a competitive bidding area and was prescribed DME affected by the program, they had to use a contract supplier—one who would supply the product for the price Medicare had determined through the bidding process and meet other Medicare requirements.
The latest supplier contracts ended on December 31, 2018, and Medicare did not move forward with the process needed to continue the program. This temporary end to the competitive bidding program is expected to last two years, until December 31, 2020. New proposals for the details of the next bidding process are underway. The revised program, with different bidding rules, should begin in 2021. Bids would be taken in 2020, and new contract suppliers would be named in 2021.
During the lapse in the competitive bidding program, there will be no contract suppliers. This means that a beneficiary can get DME from any supplier who is enrolled in Medicare. Most beneficiaries will not need to switch suppliers and can continue to use the same supplier they used in 2018. Instances when a beneficiary may need to switch suppliers include if they permanently move outside of their supplier’s normal service area, or if their current supplier is unwilling to continue providing DME on or after January 1, 2019.
Advice from Medicare Rights
If you have Original Medicare and need new DME, you can use the online Medicare Supplier Directory or call 1-800-MEDICARE to locate a supplier. It is important that you choose a supplier who is enrolled in Medicare and takes assignment. If the supplier does not take assignment, you could be responsible for paying a higher out-of-pocket cost.
Capped rental items and oxygen equipment
If you have a capped rental item (meaning an item that Medicare covers for rental first, rather than purchase, because of its high cost), your provider must continue to provide your item through the rest of your 13-month rental period. After 13 months, you will own the equipment. Examples of capped rental items include wheelchairs and hospital beds.
If you have oxygen equipment, your supplier must continue to provide oxygen and equipment through the rest of your 36-month rental period. After the 36th month in a row, the supplier must continue to provide oxygen and oxygen equipment for the rest of the equipment’s lifetime as long as you still have the medical need. The exception is if you travel or permanently move outside of your supplier’s service area. In that case, the supplier must connect you with a new supplier in your area.
Throughout the temporary gap period, you should be aware of aggressive marketing by suppliers. You should be cautious about anyone trying to persuade you to switch suppliers, and should first speak with your current supplier to determine if you need to make a change.
For more information about durable medical equipment, visit Medicare Interactive.