Helpful hints on navigating supply needs for those approaching Medicare age
As you navigate your early to mid-60s, it's important to be aware that your health insurance coverage will likely change when you turn 65. Unless you or your partner are still working at a job that provides health insurance, you'll need to enroll in Medicare around your 65th birthday. This change in coverage — from either private health insurance or coverage through the Healthcare Marketplace to Medicare — may affect which doctors you may continue seeing, as well as how you receive your prescription medications and medical supplies.
To ensure that you have a seamless transition and can continue to receive your essential medical supplies without disruptions or delays, it's important to enroll in Medicare as soon as you're eligible.
Which part of Medicare covers supplies?
You'll be eligible to sign up for Medicare during the three months before your 65th birthday, your birthday month, and the three months after the month you turn 65. Most people don't have to pay a premium for Medicare Part A, which covers hospital services.
On the other hand, there is typically a monthly premium for Part B, which covers medically necessary services, including supplies that are used at home. This includes durable medical equipment like continuous glucose monitors and insulin pump supplies, as well as prosthetic devices, including ostomy supplies.
After you hit the annual deductible ($233 in 2022 or $226 in 2023), Medicare should cover 80% of the cost of your medical supplies, leaving you responsible for 20%.
In order to continue receiving your medical supplies without disruption, it's essential to sign up for Part B when you initially enroll in Medicare. If you don't, you may experience enrollment delays. You may also have to pay a monthly penalty fee when you sign up later.
Some people opt for a Medicare Advantage Plan, also known as Part C, which combines Part A, Part B and often Part D (coverage for prescription drugs). Some Part C plans help to pay a portion of your Part B premiums.
People who need prescription medications but don't want to enroll in Part C should enroll in Medicare Part D, which also has a premium and possible penalty for those who don't sign up when they enroll initially.
It's also possible to sign up for a Medigap policy, which fills in the gaps of Medicare policies, and may help to pay for part, or all, of your portion (20%) of the cost of certain medical supplies.
Getting supplies covered by Medicare
In order for Medicare Part B to cover your medical supplies, the doctor who orders the supplies and the supplier who fills the order must participate in Medicare.
When you're approaching your 65th birthday, ask your doctor if they're enrolled in Medicare. If they aren't, you'll need to find a doctor who participates in Medicare, or Medicare will deny coverage for your medical supplies. Doctors can decide to enroll in Medicare's Provider Enrollment, Chain, and Ownership System (PECOS), which enables them to order medical supplies for you.
It's also important to know if your medical equipment supplier "accepts assignment" for the supplies that you use, which means that they agree to accept the Medicare-approved fee for those medical supplies as the full payment, even if they typically charge a higher fee. If a supplier doesn't accept assignment, you may have to pay in full for medical supplies up front, then submit a claim to Medicare for partial reimbursement.
Non-participating suppliers may charge as much as they would like for durable medical equipment, but Medicare will only reimburse you 80% of the Medicare-approved fee. This means you may end up paying considerably more for supplies by using a non-participating supplier.
Before you're enrolled in Medicare, you may want to ask your medical supplier if the supplies that you normally receive are accepted on assignment. You'll also want to confirm that the company will be able to send you the same quantity of product in each shipment.
Edgepark accepts assignment for most medical supplies. This means that you'll only pay 20% of the Medicare-approved fee once you reach the deductible. And if you have Medigap, you may not need to pay for some or all of your 20% obligation.
Find out more about ordering your Medicare-approved medical supplies through Edgepark.
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