Medicare will pay 80% of the their Allowed Amount for the cost of covered supplies after American MedCare Supply submits the claim to Medicare on your behalf. If you also have Medicare supplemental coverage, the remaining 20% co-insurance may be paid by the supplemental company. If you don't have supplemental coverage, you are responsible for the remaining 20%. All customers are responsible for any applicable deductibles although some Medicare supplemental plans cover the cost of the annual Medicare deductible.
Quantities Allowed by Medicare
Diabetic Supplies-Medicare Allowances
-100 Glucose Test Strips/Lancets every 3 months for non-insulin dependent diabetics
-300 Glucose Test Strips/Lancets every 3 months for insulin dependent diabetics
-Additional test strips are available to diabetics that meet Medicare requirements
-One (1) glucose monitor every five years
-One (1) vial of control solution every 3 months
-One (1) lancing device every 6 months
Urological and Catheter supplies- Medicare Allowances
-Up to 200 intermittent urinary straight tip catheters per month
-Up to 200 intermittent urinary coude tip catheters per month
(coude tip catheters subject to additional Medicare documentation)
-Up to 200 intermittent urinary catheters kits per month
(catheter kits are subject to additional Medicare documentation)
-Up to 35 External (Condom) catheters per month
-One packet of lubricant per episode of intermittent catheterization
-Two (2) bedside drainage bags per month
-Two (2)vinyl leg or abdomen drainage bags with straps per month
-One (1) latex leg bag per month
-One (1) bedside drainage bottle every 3 months
One heating pad every 5 years
One vacuum erection device every 5 years
One orthotic brace unit for each affected area every 5 years
All Medicare payments for claims are subject to the Physician’s Order provided by the Medicare recepient’s physician. American MedCare Supply will coordinate this paperwork for you and will communicate with your physician in order to obtain all Physician’s Orders, medical records and other documentation required or requested by Medicare.
Medicare has strict guidelines for the ordering and reordering of supplies that they cover. American MedCare Supply has been a Medicare Participating Provider for 17 years and we are very familiar with the rules for Medicare reimbursement so that we can assist our customers in properly obtaining their needed supplies and equipment. Generally, Medicare requires written or verbal authorization from the patient immediately prior to the shipment of supplies. You can be assured that having an experienced, Medicare Accredited provider like American MedCare Supply will be a benefit to you both now and in the future.
Deductibles and Co-Insurance
Every calendar year, Medicare requires that all recipients meet their annual deductible; currently the annual deductible is $140. All Medicare recipients are responsible for this amount every year. If our claim to Medicare for your supplies should be reduced by the deductible, we will notify you in writing as to the exact amount that you may owe us. We will never ask you to pay this amount up front, although many of our customers will give us their credit card information so that meeting their obligation is more convenient. Many of our customers have Medicare supplemental insurance that covers their annual deductible.
The twenty percent (20%) co-insurance not paid by Medicare is the responsibility of all Medicare recipients and is also payable by credit card for those individuals that do not carry Medicare supplemental insurance. Again, we will notify you of any such amounts in writing and as a provider that accepts assignment, we will never ask for these amounts up front. For those that do have supplemental insurance, their supplies will essentially be at no additional cost to them. Ask your American MedCare Supply professional if you have any questions.
Supplemental Insurance to Medicare
There are numerous companies that offer Medicare supplemental insurance. These insurance plans follow Medicare guidelines and only cover those items that are approved by Medicare. Often, by having a Medicare supplemental insurance plan, depending on the option you choose, there may be no cost to you for your Medicare covered items. Plans vary greatly, so please contact a specialist at American Medcare Supply for additional information.
Secondary Insurance to Medicare
This type of insurance policy is normally offered through a retirement group, although you may purchase this on your own. These policies typically do not follow Medicare guidelines – they have guidelines of their own. These policies normally do not pay the annual Medicare deductible and often have a deductible of their own. If this is the type of insurance plan you have, the specialists at American Medcare Supply will verify your insurance coverage and will advise you of the costs associated with obtaining your needed medical supplies.
This type of insurance may also be referred to Commercial or Primary insurance. This typically is insurance that is available to you through an employer. This type of coverage varies, as there are many products available – Major Medical policies, HMOs’, EPO’s, PPO’s and traditional indemnity policies. Most have a plan deductible, which you would be responsible for and then they reimburse for covered items under their policy guidelines based on a percentage. The specialists at American Medcare Supply will verify your insurance coverage and will advise you of the costs associated with obtaining your needed medical supplies.
Medicare Advantage/Fee-For Service Plans
This type of insurance is also referred to as a Medicare replacement policy as they assume your Medicare benefits - this becomes your primary insurance. The available plans vary from insurance company to insurance company and they all follow Medicare guidelines as they are governed by their regulations. In order to determine your deductible and co-insurance, the specialists at American Medcare Supply will verify your specific plan benefits. We are here to help!