By Holly Glen Gearhart
July 1, the government begins its use of the competitive bidding program in order to better control the escalating cost of medical care for Medicare recipients. The first changes involve mail order supplies for diabetics.
If the recipient is already in a mail order program, the same supplier may already be one of the contractors for the program or they could be “grandfathered” so the impact of the change might not inconvenience the patient. You can contact your present supplier to find out if any changes need to be made.
The Medicare Advantage Programs, also known as additional or supplemental insurance to the Medicare program, are not expected to make changes because the competitive bidding program only effects what Medicare contracts to pay, not the additional coverage programs. If you have questions, contact your program to see if any changes will be made.
The Medicare contract program only impacts mail-order supplies and will not limit the supplies you need; Medicare patients still have the choice between getting supplies by mail order or picking them up at a local supplier.
“If you choose to buy your diabetic testing supplies through mail-order, you must use a mail-order Medicare contract supplier in order for Medicare to help pay for the items,” according to the Medicare.gov website.
One caution; local stores do not have to participate as a Medicare contract supplier. If they do not, you may pay more for the same supplies you could receive cheaper somewhere else.
Local stores do have to abide by the Medicare contract amount if they also offer diabetic supplies via mail order. You still have the choice to have your supplies delivered to your home or pick the supplies up at a local store.
“Medicare’s approved payment amount will be the same for mail-order and non-mail-order diabetic testing supplies when the program starts. National mail-order contract suppliers can’t charge you more than any unmet deductible and 20 percent coinsurance. Local stores also can’t charge more than the deductible and 20 percent coinsurance if they accept assignment, which means they accept Medicare’s approved amount as payment in full. Local stores that do not accept Medicare assignment may charge more than 20 percent coinsurance and any unmet deductible,” according to the most recent information available on the Medicare information website.
Therefore, if you choose to purchase your diabetic supplies from a local store, ask before you order supplies or you may find yourself paying a lot more than you need to.
“The expansion of the competitive bidding program means more beneficiaries will benefit from fair pricing on included equipment and supplies,” said Centers for Medicare and Medicaid Services Acting Administrator Marilyn Tavenner. “Each of these contract suppliers has met our stringent standards, so beneficiaries can be assured they will receive their equipment and supplies from accredited, qualified suppliers at significantly lower prices.”
The changes will only effect what Medicare will pay for diabetic supplies; Medicare has new contracts with mail order diabetic suppliers who have agreed to predetermined charges for their supplies. There is no foreseen changes to the quality of supplies for Medicare recipients; if you have additional insurance, Medicare Advantage plans, this change will not affect your diabetic supplies.
You will not have to change doctors, and you will be able to pay the same amount of copay for the same supplies if you are out of town, but there are a few caveats so that you are not overcharged.
For more information, visit http://www.medicare.gov/ or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.