The Equipment Bill Has a Share Line: Find Who Pays Which Part Before You Order

You sign for a walker, a bath commode, or an oxygen order and the invoice shows one number. That number is not the whole story. For Medicare-covered durable medical equipment, the bill splits into the Medicare-approved amount, the part Medicare pays, and the part that falls to you. Each piece moves for reasons you can check before the order goes in. (Medicare.gov)

Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.

Start with the coverage route

Ask whether the item is covered for purchase or as a monthly rental. Medicare pays for many items as a rental. The rental runs for a set number of months, and what happens after that depends on the item and the supplier. Write down which route the order uses and what the supplier expects at the end of the covered period. (Medicare.gov)

Ask whether the item is covered at all. Medicare generally covers equipment that a treating clinician orders for a medical reason and that the home setting supports. It does not cover items it treats as convenience. If a supplier says an item is covered, ask for the coverage rule and the documentation that supports it, in writing.

Check the supplier's billing choice

Ask whether the supplier accepts assignment. A supplier that accepts assignment agrees to bill Medicare the approved amount and takes that amount as full payment for the covered item. A supplier that does not accept assignment may charge above the approved amount, and that gap is yours on top of the normal share. Get the answer on the order form, not just over the phone. (Medicare.gov)

Find the deductible and coinsurance lines

Medicare Part B usually has a yearly deductible before it pays, then a coinsurance percentage on covered equipment. After the first delivery, read the Medicare Summary Notice for that claim and match each line against the supplier's invoice. If the numbers do not match, call the supplier first, then the number printed on the notice. (Medicare.gov)

Check the second policy

A Medigap policy may cover some or all of the coinsurance on Medicare-covered equipment, depending on the plan letter. A Medicare Advantage plan has its own cost-sharing and its own supplier network, and it may require approval before the order. Ask the plan which equipment it covers, at what share, and whether the supplier must be in network. Missouri SHIP counselors can read the plan with you at no charge. (Missouri SHIP)

Bring these to the call

• The item name exactly as it appears on the doctor's order
• The supplier's name and whether it is enrolled with Medicare
• The Medicare card and any second policy card
• The most recent Medicare Summary Notice for equipment

The Local Help With Paying for Care page lists where to call in the St. Louis area.

This page stops at the bill. Whether the item is medically needed is a question for the doctor. If a claim is denied and you want to appeal, the plan's appeal steps and a SHIP counselor are the first stops. Questions about your legal rights belong with a lawyer, found through the Missouri Bar's lawyer referral service.