You pay 20% of the Medicare -approved amount, and the Part B deductible applies.
Make sure your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims they submit. It’s also important to ask your suppliers if they participate in Medicare before you get DME. If suppliers are participating suppliers, they must accept assignment (that is, they’re limited to charging you only coinsurance and the Part B deductible on the Medicare -approved amount ). If suppliers are enrolled in Medicare but aren’t “contract suppliers,” they may choose not to accept assignment. If suppliers don’t accept assignment, there’s no limit on the amount they can charge you. To find suppliers who accept assignment, visit Medicare.gov/supplierdirectory or call 1-800-MEDICARE (1- 8 0 0 - 633 - 4 227). TTY users should call 1 -877 -486 -2048. You can also call 1-800-MEDICARE if you’re having problems with your DME supplier, or you need to file a complaint.
For more information, visit Medicare.gov/publications to view the booklet “Medicare Coverage of Durable Medical Equipment and Other Devices.”
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program: If you have Original Medicare and live in a Competitive Bidding Area (CBA) and use equipment or supplies included under the program (or get the items while visiting a CBA), you generally must use Medicare contract suppliers if you want Medicare to help pay for the item.
Visit Medicare.gov/supplierdirectory to see if you live in a CBA and to find Medicare-approved suppliers in your area. If your ZIP code is in a CBA, the items included in the program are marked with an orange star. You can also call 1-800-MEDICARE.
For more information visit Medicare.gov/publications to view the booklet “Your Guide to Medicare’s Durable Medical Equipment Prosthetics, Orthotics, & Supplies (DMEPOS) Competitive Bidding Program.”
Source: Medicare & You 2017