Medicare Guide

Everything we do is dedicated to helping you restore your lifestyle. Our Medicare Guide, along with the largest selection of medical equipment and supplies in New York, is here to support your healthcare journey.

01

The Different Benefits of Traditional Medicare

  • Covers hospital stays, home health care, and hospice services.
  • Covers doctor visits, lab tests, ambulance services, and medical equipment (monthly premium required).
  • Private plans offering Part A & B benefits, often with network limits and added perks.
  • Optional coverage for prescription drugs.
  • Learn more at www.medicare.gov or compare plans during open enrollment (Oct 15 – Dec 7).
02

What Can You Expect to Pay for Medicare Part B Services?

  • You pay the annual deductible and 20% coinsurance for covered services.
  • Suppliers must attempt to collect this amount unless another insurance covers it.
  • Supplemental insurance may cover your portion.
  • If a supplier doesn’t accept Medicare assignment, you may pay upfront and get reimbursed by Medicare.
03

Other possible costs:

  • Medicare covers only basic equipment.
  • You may choose upgraded products by paying the price difference.
  • This requires signing an Advance Beneficiary Notice (ABN).
04

Purpose of ABN

  • An ABN informs you when Medicare may not pay for an item or service.
  • It allows you to decide whether to proceed and pay out-of-pocket.
05

Durable Medical Equipment (DME) Defined

Medicare covers equipment that:

  • Is durable and reusable
  • Is medically necessary
  • Has no use without illness or injury
  • Is used in the home
06

Understanding Assignment (a claim-by-claim contract)

  • Suppliers accepting assignment take Medicare’s approved amount as full payment.
  • You pay 20% coinsurance and the annual deductible.
  • Extra costs apply for upgraded items listed on the ABN.
  • Non-assignment suppliers require full payment upfront.
07

Mandatory Submission of Claims

  • Suppliers must submit claims for covered services within one year.
  • Claims are not required for items never covered by Medicare.
08

The role of the physician with respect to home medical equipment:

  • Medicare requires a doctor’s order or medical necessity form.
  • Approved healthcare providers can also sign orders.
  • A recent office visit is required to justify new or replacement equipment.
09

Prescriptions before Delivery:

  • Certain items require documentation before delivery, including:
    • Wheelchairs, hospital beds, oxygen
    • Scooters, power wheelchairs
    • Wound therapy devices and TENS units
  • Items costing over $1000 also require prior approval.
10

How does Medicare pay for and allow you to use the equipment?

Medicare may:

  • Purchase the item
  • Rent it monthly
  • Use a 13-month capped rental

After purchase, repairs and replacements may be partially covered if still medically necessary.

11

What is competitive bidding?

  • Some equipment must be obtained from Medicare-contracted suppliers in certain areas.
  • Availability depends on your zip code.
  • Check eligibility at www.medicare.gov or call 1-800-MEDICARE.