How Do Beneficiaries in Medicare Advantage Plans (Part C) Obtain Durable Medical Equipment or Devices?


Patients in Medicare Advantage plans (Part C) who need durable medical equipment must call the plan’s utilization management department to find out if the equipment is covered, and, if it is, the amount of the co-payment for which they are responsible. Physicians or other approved providers must certify durable medical equipment (DME) and devices are medically necessary for patients in Part C plans. 

About 25 percent of Medicare beneficiaries are enrolled in Medicare Advantage Plans (Part C) such as health maintenance organizations (HMOs) or preferred provider organizations (PPOs). In these plans, beneficiaries receive care from the plan’s approved list of doctors and hospitals. 

Starting in 2011, in certain states Medicare began covering certain durable medical equipment only if purchased from a contract supplier. Contract suppliers are suppliers that have contracts with Medicare to provide certain DME in specific regions within the following states. The states are North Carolina, South Carolina, Ohio, Kentucky, Indiana, Texas, Missouri, Kansas, Florida Pennsylvania and California. More states will be added to this program in 2013.

Posted on: March 8, 2013

Ask Your Own Question

Click the link to ask your own question.

Advertisement image
Close X

Ask a Question

  • Thank you for visiting our website and for submitting a question to our FAQ section. Your question has been submitted to our team and you will receive a response within 48 hours. Meanwhile, be sure to sign up for our newsletter, Medicare Matters, for the most up-to-date news and insight delivered to your inbox every weekday morning.

    Click here to sign up for Medicare Matters.
  • submit