If you have Original Medicare, it is important to use the right supplier. Call 1-800-MEDICARE or visit www.medicare.gov/supplier to find DME suppliers who take assignment. Original Medicare normally pays 80% of the Medicare-approved amount after you meet your Part B deductible, and you are responsible for a 20% coinsurance. Your costs will also depend on whether or not you are required to rent or buy the equipment you need.

Be aware that many suppliers are Medicare-approved but do not take assignment. These suppliers may charge you more than Medicare’s approved amount for the cost of services. Medicare will still only pay 80% of its approved amount for services, so you will be responsible for any additional costs.

Note: If you have a Medicare Advantage Plan, your plan will have its own cost and coverage rules for DME. Contact your plan for more information.

Suppliers who have not signed up with Medicare

Avoid suppliers who have not signed up to bill Medicare for DME, also known as opt-out providers. Medicare will not pay for services you receive from opt-out providers. This means you are responsible for the entire cost.

If you use an opt-out DME supplier, the supplier should ask you to sign a private contract confirming that you understand you are responsible for the full cost of your care. If you do not sign a private contract, you do now owe the supplier for the cost of your DME.

Return to: Medicare In-depth

This content was created and copyrighted by the Medicare Rights Center ©2020. Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities. These materials are presented here with support from YourMedicare.com and may not be distributed, modified or edited without Medicare Rights’ consent.

YourMedicare.com takes pride in providing you as much information as possible concerning your Medicare options, but only a health insurance broker licensed to sell Medicare can help you compare your plan options from various insurance companies. When you’re ready, we recommend you discuss your needs with a YourMedicare.com Licensed Sales Agent.