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What is the DMEPOS Competitive Bidding Program?
In January 2011, Medicare began phasing in the DMEPOS Competitive Bidding Program in some parts of the country. This program was mandated by Congress through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).
The Competitive Bidding Program requires providers and suppliers of certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) to submit bids for their products. Qualified suppliers with winning bids who meet strict quality and financial standards are then chosen as Medicare-approved contract suppliers.
Under this new program, if you have Original Medicare (Part A and Part B) and live in a competitive bid area (CBA), you almost always have to use a Medicare contract supplier if you want Medicare to pay for certain DMEPOS products and services. You must also use a Medicare contract supplier if you get certain DMEPOS items while visiting or traveling in a CBA, even if you do not permanently live in one of these areas.
This program does not affect beneficiaries with Medicare Advantage Plans.
What is the purpose of the Competitive Bidding Program?
The main purpose of the Competitive Bidding Program is to replace the prices Medicare currently pays for DMEPOS items with lower, more accurate and more current market prices. By using prices set through competition and ensuring suppliers are all licensed and accredited, the program will:
- Reduce your out-of-pocket expenses (Medicare beneficiaries are expected to save $17 billion between 2013 and 2022)
- Help Medicare and taxpayers save money (Medicare expects to save almost $26 billion between 2013 and 2022)
- Ensure you have access to quality DMEPOS supplies and services from reliable suppliers
- Help reduce Medicare fraud and abuse
Competitive Bidding Program Timeline
|January 1, 2011||Round 1 of the program went into effect in several metropolitan CBAs in the following states: CA, FL, IN, KS, KY, MO, NC, OH, PA, SC, and TX.|
|July 1, 2013||
Round 2 of the program is scheduled to expand to an additional 91 metropolitan CBAs across the country.
On the same date, a national mail-order program for diabetic supplies will go into effect in all parts of the United States, including the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, and American Samoa.
|January 1, 2014||A second phase of Round 1 (called Round 1 Recompete) will go into effect in the original CBAs listed above. Several additional DMEPOS supplies are included in this phase.|
|2014 through 2016||The program will continue expanding to metropolitan regions in all 50 states.|
What kinds of items are included in the Competitive Bidding Program?
The following categories of DMEPOS items are included in Round 1 of the program, which began January 2011.
- Oxygen, oxygen equipment, and supplies
- Continuous Positive Airway Pressure (CPAP) devices and related supplies
- Respiratory Assist Devices (RADs) and related supplies and accessories
- Standard power wheelchairs, scooters, and related accessories
- Complex rehabilitative power wheelchairs and related accessories (Group 2 only)
- Walkers and related accessories
Note: You do not need to use a Medicare contract supplier if you obtain a walker from a healthcare provider during an office visit for medical care, or while admitted to a hospital.
- Mail-order diabetic supplies
- Hospital beds and related accessories
- Pressure-reducing support surfaces (Group 2 mattresses and overlays in Miami-Fort Lauderdale-Pompano Beach only)
- Enteral nutrients, equipment, and supplies
The following additional DMEPOS items will be included in the program when the Round 1 Recompete phase goes into effect on January 1, 2014:
- Standard nebulizers
- Standard manual wheelchairs and related accessories
- Pressure-reducing support surfaces (Group 1 and 2)
- Transcutaneous electrical nerve stimulation (TENS) devices
- Commode chairs
- Patient lifts and seat lifts
- Negative pressure wound therapy pumps and related supplies and accessories
- External infusion pumps and supplies
Will I pay the same price for items from a Medicare contract supplier?
If you live in a competitive bidding area, or purchase DEMPOS equipment while traveling to one of these areas, you will pay less. That's because under the program, contract suppliers can charge you only the winning bid amount, which is less than what Medicare currently pays.
For example, if your supplier currently charges $100 for a walker, Medicare will pay $80 (80 percent) and you will pay $20 or 20 percent (after you meet your Part B deductible). If the new winning bid for this same item is $70, contract suppliers cannot charge more than this amount. Therefore, when you purchase the walker from a contract supplier, Medicare will pay $56 and you will pay only $14.
What if I need a specific brand?
The Competitive Bidding Program has special protections in place to ensure you get the specific types of medical equipment you need. If you need a certain brand or a specific version of an item, your doctor must prescribe your requirements in writing. Your doctor must also document in your medical record that you need this specific item for medical reasons. Medicare contract providers are required to:
- Provide the exact brand or version you need, or
- Help you find another contract supplier that will furnish this item, or
- Work with your doctor to find an alternative brand that is right for you.
How does the program work if I have other insurance?
If you have other insurance that pays before Medicare, your primary insurance plan may require you to use a supplier that is not a contract supplier. In this case, Medicare may make a secondary payment to that supplier. You should always ask your insurer or plan provider how your coverage will work with Medicare whenever buying or renting DEMPOS items.
Does the program affect me if I'm in a Medicare Advantage Plan?
No, the Competitive Bidding Program applies only to people with Original Medicare (Part A and Part B). If you are enrolled in a Medicare Advantage Plan, your plan will notify you if your suppliers ever change.