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Medicare


General Information


Types of Medicare Plans

Part A is a traditional Medicare plan that covers hospital care, skilled nursing facility care, nursing home care (non-custodial), hospice and home health services.

Part B is a traditional Medicare plan that covers clinical research, ambulance services, mental health services, limited outpatient prescriptions, physician services, prosthetics/orthotics, durable medical equipment (DME); such as oxygen, beds, wheelchairs, and more.

Durable Medical Equipment and Supply Coverage for Traditional Medicare Part B

  • Must be enrolled in Medicare Part B
  • Medicare covers 80% and the patient has 20% financial responsibility
  • Part B deductibles are applied annually
  • A monthly Part B premium is normally applicable
  • Medicare pays for a wide variety of infusion and respiratory therapies and durable medical equipment under Part B; however, there are very specific medical coverage and documentation guidelines for every item.  Preferred Homecare/LifeCare Solutions will help you and your healthcare providers understand these guidelines.

Part C or Medicare Advantage Plans is a healthcare plan offered by private entities that are approved by Medicare. Medicare Advantage plans are legally required to offer the same coverage benefits as traditional Medicare, and some will include other benefits such as vision, dental, hearing, and even Medicare Part D prescription drug coverage.

Types of Medicare Advantage Plans include:

  1. Health Maintenance Organization (HMO); these plans provide services to beneficiaries through healthcare providers and hospitals on the plan’s list only.
  2. Preferred Provider Organization (PPO); these plans provide services through a network of physicians, clinics, and hospitals.
  3. Private Fee-for-Service (PFFS); these plans set certain amounts for how much a beneficiary will pay for different types of physicians, hospital visits, and other healthcare specialists.
  4. Special Needs Plans (SNPs); are plans designed for people who have specific diseases or ailments, individuals who live in certain institutions, and others who are enrolled in both Medicare and Medicaid. These plans are designed to provide the most comprehensive coverage possible.

Durable Medical Equipment and Supply Coverage for Medicare Advantage Part C Plans

  • Must be enrolled in Medicare Part C
  • May require you to receive services from specific healthcare providers
  • May require your equipment and supplies to be authorized for payment prior to receiving the item
  • Deductibles and co-payments will vary from plan to plan, see your individual Medicare Advantage Plan guidelines for specific coverage and payment information

Part D is a Medicare plan that subsidizes the costs of prescription drugs and prescription drug insurance premiums for Medicare beneficiaries.

Prescription Drug Coverage for Medicare Part D Plans

  • Must be enrolled in Medicare Part D
  • Subject to monthly premiums, annual deductibles and other out-of-pocket costs
  • Each plan has its own formulary or, approved list of covered drugs

Preferred Homecare/LifeCare Solutions assists with:

  • We will work collaboratively with your healthcare providers to obtain all required supporting documentation.
  • We will provide you a detailed explanation if your medical situation does not qualify for Medicare coverage, or if there is not enough supporting documentation to meet Medicare’s requirements.
  • If you do not qualify for Medicare coverage and choose to receive the equipment/supplies, with the understanding of your financial responsibility you will be required to sign an Advanced Beneficiary Notice of Non-Coverage (ABN).

Medicare’s Competitive Bidding Program


The Centers for Medicare and Medicaid Services (CMS) implemented a new program called Competitive Bidding as of January 1, 2011.  This program only applies to certain areas throughout the country for certain Durable Medical Equipment and Supplies for a set three-year period.

Only qualified and accredited suppliers are chosen as Medicare Contract Suppliers.  Patients that reside in a Competitive Bid Area (CBA) and receive a competitive bid item must use a contracted supplier.   

We are pleased to announce that Preferred Homecare and LifeCare Solutions are contracted Medicare Suppliers in most CBAs for:

  • Oxygen
  • Continuous Positive Airway Pressure (CPAP)
  • Respiratory Assist Devices (RADs)
  • Hospital Beds
  • Wheelchairs

We can provide services to patients who may be currently using a non-contracted Medicare supplier.  If you are currently on service with us and are in a CBA you will still continue to receive high-quality care with no interruption in service.

To find out if you live in a CBA go to, www.dmecompetitivebid.com and click on “Find a CBA”

A full list of Contracted Suppliers can be found at http://medicare.gov/supplierdirectory/search.html

You may also wish to visit www.medicare.gov or call 1-800-MEDICARE for more information 


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