We’ve received several calls from individuals who have received letters from the Department of Health & Human Services in Baltimore Maryland titled An Important Message for People with Original Medicare. So questions were asked:

Is this letter legitimate?

Yes it is. Individuals with Original Medicare may receive two letters depending on the county where they live in Hawaii. City and County of Honolulu residents could receive two letters; one letter about mail order diabetic supplies and the second letter regarding a change in how you receive your medical equipment and supplies beginning on July 1, 2013.

What is Original Medicare?

Original Medicare is the traditional fee-for-service program offered directly through the federal government. Individuals are not in a Medicare contracted health plan (also known as Part C or Medicare Advantage). Medicare is billed directly and the individual will receive a Medicare Summary Notice.

What is this important change?

On Oahu, Medicare is scheduled to expand the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program beginning July 1, 2013. If you live on Oahu and have Original Medicare (you may still have a retirement plan, but it will not be a Medicare Advantage Plan), and use equipment or supplies under the DMEPOS plan you will generally need to get the equipment or supplies from a Medicare-contract supplier if you want Medicare to pay for them.

Example: On July 2, 2013 John has just returned home from his doctor’s office where he received a prescription for a standard wheelchair because he is unable to walk due to recent health issues. In the prior “plan” year, John’s neighbor Scott needed and received a wheelchair from a medical supply company nearby. John takes his prescription down to the same company, but is informed that they are NOT a Medicare contractor and if he purchases the wheelchair from this company, Medicare may not help pay for it (they should have you sign an “advanced beneficiary notice”).

What should John do? He can go to www.medicare.gov and go to “Find suppliers of medical equipment and supplies”. He can enter his zip code and choose the category “standard wheelchairs.” The website will show the companies contracted with Medicare and then work with one of those companies to get the wheelchair that John needs.

This program may also affect you if you are traveling in another city and need to purchase DMEPOS items.

For the entire nation and US territories, Medicare will also implement a National Mail-Order Program for diabetic testing supplies. If you want Medicare to help pay for these supplies you will have to use the contracted suppliers. This will NOT affect you if you are in a Medicare Advantage Plan or if you buy your supplies at a local pharmacy. This program also begins on July 1, 2013.

Why is Medicare doing this?

It helps you and Medicare save money. It ensures that you have access to quality medical equipment, supplies and services from suppliers you can trust and it helps limit fraud and abuse in the Medicare Program.

Your homework:

  1. Find out if you currently are covered under Original Medicare or a Medicare Advantage Plan. Medicare Advantage Plans have a CMS contract number on them, usually found at the bottom of the card. It will usually look like this CMS H###-###.
  2. If you use certain supplies, find out who the Medicare contractors will be in your area.
  3. If you are not sure or need assistance you can always call the Hawaii SHIP/Sage PLUS Program at 1-888-875-9229 or email us at help@hawaiiship.org You can also find more information about the competitive bidding programs on our website www.hawaiiship.org.

Sage PLUS - Generations Magazine - June-July 2013

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