New Rules for Durable Medical Equipment in New Jersey

If you are a beneficiary with Original Medicare (a person who has Parts A and B of Medicare and not a Medicare Advantage plan) who uses  or plans to use certain durable medical equipment and supplies, such as oxygen, walkers, or wheelchairs, you should know about the new rules that started on July 1, 2013 in New Jersey.  The Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program is an attempt to save money for taxpayers and people with Medicare and may change the suppliers people with Medicare will need to use.

Most counties and zip codes in New Jersey will now be a part of this competitive bidding program.  You can check if your zip code is in a competitive bidding are by going to a fact sheet at http://www.cms.gov/Outreach-and Education/Outreach/Partnerships/Downloads/DMEPOSBeneFactSheetMarch2013.pdf. 

As of July 1, people with Original Medicare who live in or travel to one of these areas and need the items listed below will need to get these items from an approved contract supplier if they want Medicare to cover these supplies, unless their current suppliers decide to become grandfathered suppliers (non-contract suppliers that choose to continue to provide certain rented medical equipment or oxygen under the terms of the program). 

Beneficiaries will need to find out which suppliers are Medicare contract suppliers to make sure Medicare will  pay for their medical equipment or supplies. You can find out if a supplier is a contract supplier for the program by visiting http://www.medicare.gov/supplierdirectory/search.html or by calling 1-800-MEDICARE (1-800-633-4227). 

The competitive bidding program will only cover certain categories of products.  The 8 product categories that are included in the program are:

1.         Oxygen, oxygen equipment, and supplies;

2.         Standard (power and manual) wheelchairs, scooters, and related  accessories;

3.         Enteral nutrients, equipment, and supplies;

4.         Continuous Positive Airway Pressure (CPAP) devices, Respiratory Assist Devices (RADs) and related supplies and accessories;

5.         Hospital beds and related accessories;

6.         Walkers and related accessories;

7.         Support surfaces (Group 2 mattresses and overlays); and

8.         Negative Pressure Wound Therapy pumps and related supplies and accessories.

In addition to the categories of items listed, Medicare will be starting a national mail-order program for diabetic testing supplies at the same time.  The national mail-order program will include all parts of the United States, including the 50 States, the District of Columbia, Puerto Rico, the US Virgin Islands, Guam, and American Samoa.  With this national mail-order program, people with Original Medicare will need to use a contract supplier for diabetic testing supplies delivered to their homes.  If these supplies are not delivered to a beneficiary’s  home, a beneficiary can go to any retailer that provides these supplies, but they may pay more. 

To assist beneficiaries, Medicare mailed information to people in the competitive bidding areas who use the items included in the program, in addition to those who use diabetic testing supplies across the country.  Approximately 5.7 million people with Medicare have been sent a letter and information.  You can review the letters, introductory brochure, national mail-order program fact sheet and other program education materials by visiting http://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/DMEPOS_Toolkit.html.

Should you have any questions, please contact the Senior Medicare Patrol of New Jersey at 732-777-1940.  You can also contact the State Health Insurance Assistance Program (SHIP) at 1-800-792-8820.