Patients in Medicare Advantage plans (Part C) who need durable medical equipment must call the plan’s utilization management department to find out if the equipment is covered, and, if it is, the amount of the co-payment for which they are responsible. Physicians or other approved providers must certify durable medical equipment (DME) and devices are medically necessary for patients in Part C plans.
About 25 percent of Medicare beneficiaries are enrolled in Medicare Advantage Plans (Part C) such as health maintenance organizations (HMOs) or preferred provider organizations (PPOs). In these plans, beneficiaries receive care from the plan’s approved list of doctors and hospitals.
Starting in 2011, in certain states Medicare began covering certain durable medical equipment only if purchased from a contract supplier. Contract suppliers are suppliers that have contracts with Medicare to provide certain DME in specific regions within the following states. The states are North Carolina, South Carolina, Ohio, Kentucky, Indiana, Texas, Missouri, Kansas, Florida Pennsylvania and California. More states will be added to this program in 2013.