What are my costs under Medicare?
What are my costs under Medicare?
Under the current Medicare Part B plan, you pay a certain deductible each year. $131 for 2007. A deductible is the amount you must pay each year before Medicare begins paying its portion of your medical bill.
For Durable Medical Equpment, Medicare has certain allowable charges it will pay (that allowable is defined under Medicare rules). Medicare will pay 80% of the allowable charge after your deductible has been met - you are responsible for the other 20%. The 20% balance of the allowable charge is referred to as the co-payment.
You may have a supplemental policy that will pay the Medicare deductible and co-payment.
The co-payment may not be dropped by a supplier except in very special hardship situations and only on a case-by-case basis. A supplier who routinely drops the co-payment may be violating federal law. Note: If your supplier routinely waives Medicare copayments and deductibles, you should report these actions to the appropriate Durable Medical Equipment Regional Carrier (DMERC) or by contacting the Inspector General's Hotline at 1-800-HHS-TIPS.
Medicare reviews two critical elements to decide if they will provide equipment:
- is it medically necessary
- is it the least costly alternative
Medicare, in order to work to manage costs, requires that there be proof that the equipment provided is necessary for you to function within their rules and also that the equipment provided is the least costly option available to meet your need (for example, a standard wheelchair of steel or aluminum rather than one with a carbon fiber frame). Your provider has options within those categories of what brand and style to provide. You also have the option of upgrading through the use of the Advanced Beneficiary Notice, where you agree to pay additional costs for an upgrade out of pocket.