Durable Medical Equipment (DME) and the Nuances of Cost Sharing Transcript

Speaker 1  00:00

No need to lose sleep over planning your Medicare coverage. Lisa Lauro and the team at Secure Money Health want you to get the best, most customized service when planning your Medicare coverage. In fact, Lisa wants to share her new book with you, The Ultimate Medicare Book. It’ll help you choose the right plan, understand your benefits and avoid common pitfalls. Go to mymedicarebook.com. That’s mymedicarebook.com.

 

Speaker 2  00:34

It’s time to secure all your health care needs, and we will really simplify the process. Welcome to Secure Health with Lisa Lauro.

 

Steve Sedahl  00:38

Hey, welcome in to another episode of Secure Money Health Radio, where Medicare matters. Lisa Lauro is here to make sure that we understand the subtleties, the not so subtleties, and the complexities that are Medicare, because there are plenty of them. Hi, Lisa, what’s going on?

 

Lisa Lauro  01:04

Hi, how are ya?

 

Steve Sedahl  00:38

Good, good, good surviving the winter.

 

Lisa Lauro  01:04

Yes, goodness gracious, is it cold!

 

Steve Sedahl  01:07

Oh, man, yeah, it doesn’t seem to be relenting either.

 

Lisa Lauro  01:11

It was 13 degrees this morning and snowing again, so I’m ready. We were just talking this morning about how it’s typically around 41 degrees on average this time of year. So, I’m just ready for spring to kick in.

 

Steve Sedahl  01:29

Oh yeah, me too. I, you know, I got kids and grandkids up in Minnesota. They have been some serious cold.

 

Speaker 1  01:36

Oh, wow, oh goodness.

 

Steve Sedahl  01:39

Oh yeah, 20 below, not even, yeah, that’s why I don’t live there anymore.

 

Lisa Lauro  01:43

I don’t blame you.

 

Steve Sedahl  01:45

All right, let’s jump into this. We’re talking Medicare. We’re talking about this, this episode or this segment. We’re going to talk about Durable medical equipment, DME, and that’s something that I know just from my parents and my grandparents. I’ve heard all about Durable medical equipment, right? So let’s dig into it. How does it apply? What does it mean, and what are we talking about here?

 

Lisa Lauro  02:07

That sounds great, Steve. So Durable medical equipment is used to describe medical tools and devices that help you stay safe and comfortable at home. So, let’s break that down a little bit. These are items like wheelchairs, walkers, hospital beds, oxygen concentrators, nebulizers, you know, and, and, and even more, there’s, you know, the list continues, but those are the basics. Those are the ones, CPAP machines, a lot of folks use those. And those are on there as well.

 

Steve Sedahl  02:40

Okay, so that’s, I mean, that’s all part of it, and it’s all part of Medicare, essentially. Or it can be.

 

Lisa Lauro  02:45

Right, it can be, yeah, so Medicare does cover it. In fact, Medicare Part B helps cover medically necessary Durable medical equipment, if your doctor prescribes it and you get it from a Medicare approved supplier. So that’s the big one. Those two things, your doctor has to prescribe it and you have to get it from a Medicare-approved supplier.

 

Steve Sedahl  03:08

Okay, yes, I understand that. So unless, can I just relate this – CPAP, all right, I’ve got a CPAP and it’s Medicare approved, and it’s through the other and so, but here’s the thing I find annoying, the Medicare approved company keeps pestering me to order more equipment, right, to order more parts, more and stuff, and it’s like, I don’t want anymore, but they just keep, and I think that that, I just think that, you know, be aware if that’s happening to you.

 

Lisa Lauro  03:36

Yeah, that’s interesting. And is it like, what are they trying to offer you? A newer upgraded equipment?

 

Steve Sedahl  03:41

Well, you know, with the CPAP… No, just supplies, so it’s, you know, whether it’s the hose or the mask or the filters or the, you know, and they, the mouthpieces, and they just keep, I keep getting these emails, and I said, I don’t want it. I already got one.

 

Lisa Lauro  03:54

Yeah, you’re just, you’ve just reminded me of a time, I think, where my mom was complaining because some stuff was getting sent to her automatically, and she just had, like, a stockpile of things, and lives in a small, little apartment in Fort Lauderdale, and she was like, I don’t know where to put this stuff. I don’t need it. How do I get it to turn off? Like, I don’t want this on automatic, because I don’t go through it as often as they think I do. So, so I think’s that’s one of those things…does that speak to you, Steve?

 

Steve Sedahl  04:25

That’s exactly right! Yeah, no, that exactly what it is. So, the thing is, is I can reach out to you and you could help me understand, or at least understand why it’s coming or, or how we can maybe slow it down.

 

Lisa Lauro  04:35

Yeah, yeah. I think you know you have to. You definitely need to call and let them know that, you know, can we, I don’t mind getting it on automatic if that’s the case, but can we, can we stretch it out to every six months? You know. So.

 

Steve Sedahl  04:49

Yeah, sure. All right, so with the Durable medical equipment, cost sharing, what do we mean? Does that mean that Medicare will pay a portion and we pay the rest?

 

Lisa Lauro  04:57

Yeah, so Medicare pays, which is, you know, Original Medicare, your A and your B is going to cover, typically, about 80% and then that leaves you with the remaining 20%.

 

Steve Sedahl  05:09

Okay. And so, like with a CPAP, something like that, it all, it all sort of comes out in the end.

 

Lisa Lauro  05:13

Right, right? So the, and it just depends on the plan that you have that you’re supplementing with. So, if you have, you know, the Medigap plans, then usually the, those plans will pick up the 20% but at the Advantage plans, you can pay anywhere from zero to 20% coinsurance based on what you’re, what your needs are. You know, if you’re a diabetic, and they’re sending you – well, I guess that’s diabetic; that would, that would be applicable to diabetic supplies – but certain things will be, you know, maybe not the full 20% maybe it’s, you know, less than that. But they, usually on the Advantage plans, it’s usually zero to 20%.

 

Steve Sedahl  05:51

Okay, zero to 20. Okay, so then do you rent or buy it? And there’s a lot, I mean, you know, I mean a wheelchair, for example, I might not need that forever.

 

Lisa Lauro  06:01

Yeah, right, right. Well, so there’s purchase or rent, right? And it depends on the type of equipment. So, for instance, oxygen concentrators, those are usually rented. They, you go through the approved supplier, they send it out to you, and then you know, when you no longer need it anymore, then you, they, you send it back and that’s it. But I think things like automated wheelchairs and things, you know, scooters, things like that, I think those are ones that you actually purchase, sure, so and walkers would be purchased outright, so you would confer, you can basically talk to the supplier on that and see what’s offered, and then maybe decide whether that’s something you want to purchase or rent.

 

Steve Sedahl  06:47

Okay, all right, but that’s something that you can have a discussion about as well, and whatever, whatever makes most sense for you

 

Lisa Lauro  06:53

Right. Exactly.

 

Steve Sedahl  06:55

And we talk about home use only. What does that what does that get into?

 

Lisa Lauro  06:59

Well, the durable medical equipment is primarily for home use. It should be considered medically necessary for your condition. So again, that’s where the doctor has to put that approval in that it is medically necessary and there’s proper documentation that needs to take place.

 

Steve Sedahl  07:15

All right, folks, if you’ve got questions, if you want to know how this could apply to you, if you’ve got questions about Medicare. Lisa, is your source. 724-293-6653, that’s the number. 724-293-6653, and with durable medical equipment, not everything is covered.

 

Lisa Lauro  07:34

This is true. So things that are not covered would be like luxury upgrades to equipment, you know, because, you know it’s not, it’s probably more of a want versus a need, right? You know. So, so you have to, you know, so grab bars ramps, like they don’t get, they’ll get you to the wheelchair, but they don’t provide you with a ramp. So, you that’s something you would have to do. And so, you know what’s really important here is to make sure you understand what you need, and then you know, and then just find out what’s covered and what isn’t, because you want to definitely stick to what’s medically necessary to ensure your coverage and not go above and beyond. Otherwise, you’re going to find yourself with a bill.

 

Steve Sedahl  08:25

Okay, all right, fair enough. Yeah, 724-293-6653, is the number. Let’s see, not everything covered. So, what about if something breaks or we just have normal maintenance? Is that covered? Or how do we handle that?

 

Lisa Lauro  08:41

So, yeah, Medicare covers repairs or replacements for your durable medical equipment. If it’s damaged or reaches the end of its usable life, is usually the way it works. So, but if it has, like, it depends on the specific item and whether repairs are most cost effective or if it’s just better to replace it at that point?

 

Steve Sedahl  09:02

Sure, yeah, right. Well, I mean, again, if you think about a CPAP, I don’t know that’s got to be good for a few years, isn’t it?

 

Lisa Lauro  09:07

Yeah, yeah. And I’m sure, like, that’s what I think, what they mean by the usable life. So, I think each piece of equipment has, you know, what they think is, you know, sustainable amount of time. And then if it doesn’t meet that requirement, for some reason, you get a lemon of a equipment.

 

Steve Sedahl  09:27

I got a bad CPAP.

 

Lisa Lauro  09:28

I got a bad CPAP, which is not good, but yeah, if that’s the case, then they would then decide whether it would, what’s cost effective to replace it, or to go ahead and fix it.

 

Steve Sedahl  09:44

And there are, there are a number of things that that are included in all of this. And so how do we know what is included and what isn’t? And is that just a discussion that you have to have with a provider?

 

Lisa Lauro  09:55

Yeah, I think you know that’s something that you would have to have with the provider. What’s, what’s medically necessary, and then, if it’s available to you, first and then, and then it comes down to, well, do we want to rent it, or do we want to buy it?

 

Steve Sedahl  10:08

Sure. Well, like a hospital bed. I mean, that that’s a big thing. I had a sister in law where, you know, we had that come in, and when, you know, when she went into a hospice, that, that went out,

 

Lisa Lauro  10:20

Right, right. So obviously, that was rented, right? Yeah, but, but, yeah, hospital beds for home use. That’s, that’s a big one. Blood glucose monitors and test strips for diabetics, infusion pumps for patients requiring a medical like an IV, okay. Commodes, you know, chairs for mobility issues. So, there’s, you know, there’s a whole bunch, but you’ve got, the pro tip here is to always check with Medicare and the supplier before purchasing or renting any equipment to ensure that it is covered. And I think that’s the pro tip with any type of insurance here is that you need to know what’s covered and what isn’t right? Before you go to get your MRI. Is it covered? Is it is it not covered? Is it, you know, how, what is my cost share? I think, I think altogether, that is the underlying bit of information that we really need to address is, you know, know your plan. Know your plan. Know what’s coming.

 

Steve Sedahl  11:30

724-293-6653, Lisa, we’re gonna have to take a quick break here in a second. But I want to remind everyone, the book is available for you right now. It’s The Ultimate Medicare Book. It’s available at medicarebookoffer.com if you want to get a great overview. And again, it’s not, it’s not super deep. I mean, it’s not like 43 pages into for one thing, no, no, no. You give us a great, I guess, common sense version of what we need to know about Medicare.

 

Lisa Lauro  11:53

Well, thanks. That’s the goal I was trying to get. So, I guess I achieved that

 

Steve Sedahl  11:59

Mission accomplished. Folks get, visit the website. It’s medicarebookoffer.com you can also visit securemoneyhealth.com and Lisa’s there, and you will find out not only about Lisa, but you’ll find out a little bit more about what Secure Money Health is, how they operate, and their connection with Secure Money Advisors and a great team over there.

 

Lisa Lauro  12:19

Right. Yes, a wonderful team. I’m blessed to work with amazing folks.

 

Steve Sedahl  12:25

Well, tell you what we need to take a quick break, please. So let’s come right back and continue our conversation. We’re going to talk about open enrollment period and more when we come back right after this on Secure Money Health Radio.

We are back on Secure Money Health with Lisa Lauro. My name is Steve Sedahl. Lisa has been helping folks for a long time, getting, well, getting ready for retirement. Well, getting ready for Medicare. And I bring up retirement because, well, Secure Money Advisors and Secure Money Health are connected. Lisa and Brian work together. Brian and the whole team at Secure Money Advisors. I use Brian just because I talk with him every week. And again, it’s a great organization, and I have learned over the years just how tight you guys are. I mean, it’s, I’ve talked to a lot of folks that are there, and everybody is just excited. It seems to be a real positive environment across the board. I mean, it’s very, very nice.

 

Lisa Lauro  13:40

It is, you know, we actually do things outside of work together. We really do have a, you know, a great group of people who genuinely care for one another, which is nice, and so we miss each other when we’re, when we’re not, you know, when we don’t have a, we try to get together, like, once a month, which is nice, you know.

 

Steve Sedahl  13:59

I tell you what it’s, it’s, it’s very, I don’t want to say it’s rare, but it’s so pleasant when that work environment is there for you. And you know, yeah, it’s, I feel very fortunate as well. All right. Well, let’s jump into this. We got the Medicare Advantage open enrollment period. Hmm, I thought we just had open enrollment. But we had a different one. Let’s, let’s end the confusion

 

Lisa Lauro  14:25

I know. Yes, that sounds good. So, the enrollment period that happens between October 15 and December 7 is called the annual enrollment period, and then starting January 1 to March 31 is the open enrollment period. And people tend to get these confused, and most folks don’t even know that there is this open enrollment period right now.

 

Steve Sedahl  14:56

Hullo! My hand’s up!

 

Lisa Lauro  14:58

Yeah. So. So, the open enrollment period is where folks that have a Medicare Advantage plan can switch to another Advantage plan. So, it’s Advantage plan to Advantage plan. Okay, and the reason for it is, let’s say during the annual enrollment period sometime, let’s say you’re in November, and you’re, you know, trying to decide between two different plans, and you choose one. And then, you know, couple months go by, and you think, you know, January hits, February hits and you’re like, you know what? This isn’t what I thought it was going to be. Or you find out that your doctor isn’t in the plan, or your medication isn’t covered correctly, whatever the reason may be, this is the opportunity that you have that you can make a change to a different Advantage plan.

 

Steve Sedahl  16:00

Okay. And that’s with or without drug coverage.

 

Lisa Lauro  16:04

And that’s with or without drug coverage, that’s correct, because there are some Advantage plans that are geared for veterans that are called MA-only, they do not have drug plans, but they too, can make a change.

 

Steve Sedahl  16:15

Okay, all right.

 

Lisa Lauro  16:18

Okay? So, so that’s the big one, and then it is important to note, though, that you can only make a change once, so

 

Steve Sedahl  16:32

In a lifetime?

 

Lisa Lauro  16:33

No once a year, once a year, once a year. So, so, whatever plan you decide to change to that needs to be the plan that you’re going to stick out for the remainder of the year.

 

Steve Sedahl  16:44

Okay, all right. Well, I guess that makes sense. I mean, why would, I mean, I can’t see any advantage in plan switching.

 

Lisa Lauro  16:52

Right. I know. I mean, but you never know. People are different. So maybe they…

 

Steve Sedahl  16:56

People are different. Yes indeed.

 

Lisa Lauro  16:57

People are different, you know? And so maybe, so I want to try this one now. I’m going to try this one, or I’m going to try this other one. And now you know what? I want to go back to the original one. Nope, yes. Not happening.

 

Steve Sedahl  17:08

Not happening. Alright, but, but again, if you do want to change, if you do see something that’s different, if you know that your current plan has changed, and you want to, you want to upgrade or change, it’s a great opportunity to do that, and we’ve got it through now, through now, through the end of March.

 

Lisa Lauro  17:22

Right, so this is a great time to be discussing this, Steve, because for folks that maybe have tried out their plan this year and are not, you know, comfortable with it for whatever reason or thought it was going to do something more than it does, then this is the time to get in and come see me. Let me help you. Go over the plans that are available and see if we can’t make a switch so and whatever switch you make, it would be effective for the next, very first, the first of the following month.

 

Steve Sedahl  17:55

And again, in order to do that, folks to sit down with Lisa. She can walk you through the process it’s 724-293-6653, in fact, Lisa, if I just had any kind of question about this open enrollment, I can come in, sit down with you. You’re not going to charge me any money to do this.

 

Lisa Lauro  18:11

No, not, I do not charge for any of my visits. If you come to see me six times, I’m not going to charge you for any of them. So, so that is, you know, it’s take advantage, take advantage. If you’re not happy, come and see me. I’m happy to help.

 

Steve Sedahl  18:25

Well, and again, you’re looking out for us. You want us to be satisfied. You want us to be, you know, as happy as we can be with our plans and again, I’m going to go back to Secure Money Advisors and Brian, where, you know it’s, you’re fiduciaries and you operate in that same capacity. In other words, you are going to look out for me, no matter what.

 

Lisa Lauro  18:46

No matter what. That’s right.

 

Steve Sedahl  18:49

Yeah, that’s important to know. Folks, give us a call. We’d love to hear from you. 724-293-6653, or visit securemoneyhealth.com securemoneyhealth.com. So let’s see, can I switch from Original Medicare to an Advantage plan during this time?

 

Lisa Lauro  19:06

You cannot. So if, no, this is Advantage to Advantage, you cannot switch. If you have currently have a Plan G or Plan N, you’re not able to switch during this time from Original Medicare to an Advantage plan.

 

Steve Sedahl  19:19

And again, that’s, those are big decisions to make, and I think it’s important to sit down with somebody who, again, you’re, you’re not obligated to direct anyone in any direction. You’re going to direct folks to what makes sense for them and give them the choice.

 

Lisa Lauro  19:36

That’s right. And I’m glad you mentioned that we have this amazing software that we use in house here, and a huge, like 65-foot screen to put everything up on. So, I mean, it is, like amazing. And what I do is I take a list of your doctors, and I take a list of your prescriptions, and I take, you know, the dosage amounts. And I enter everything into the software, and it will, literally, with a click of a button, tell me what is going to be the recommended plans for you based on that information. And so, it takes out all the guesswork, you know. So, I have a list of recommended plans, and then we go through which ones are recommended for you, and then we tweak it to, you know, well, you know, do you have a lot of dental work this year? Do you have a surgery coming up? Will you have physical therapy? Then we start our tweak it and fine tune it. But that software is amazing. It is a game changer for me and the staff here at Secure Money Health.

 

Steve Sedahl  20:42

Well, and again, obviously, you’re talking about some kind of AI, you know, in creating that, in that software, it’s amazing. I was unaware that that even existed. I want, I would be curious to just to punch in my stuff and see if I see if I picked the right one.

 

Lisa Lauro  20:56

Oh, yeah, right, right.

 

Steve Sedahl  20:59

So that’s what I mean that’s essentially, if I, if I’m wondering, that is exactly what I could do with you right now, and especially if I’ve got an Advantage plan, obviously, and we’re in this the supplemental enrollment period, perfect!

 

Lisa Lauro  21:12

Right? Yeah.

 

Steve Sedahl  21:13

What a great opportunity.

 

Lisa Lauro  21:14

It’s a great opportunity. Come on in, guys, and let us, let us guide you through this whole process.

 

Steve Sedahl  21:22

Sure, 8, er, 724-293-6653, that’s the number. And again, it’s securemoneyhealth.com you can also, of course, get Lisa’s book at medicarebookoffer.com it’s called The Ultimate Medicare Book. It’s a pretty little book. It’s very small, but compact, but also jam packed with stuff of I mean, again, answering a lot of questions if you don’t have them. And in fact, I think it’s, going forward, Lisa, let’s, let’s do an episode, or, yeah, let’s do an episode in the next few weeks about just getting listener questions?

 

Lisa Lauro  21:55

Oh, that would be wonderful. Yeah,

 

Steve Sedahl  21:57

I’ll scan them and I’ll get the questions. We’ll put you to the test next time. How’s that?

 

Lisa Lauro  22:02

All right, that sounds wonderful.

 

Steve Sedahl  22:04

All right. So, let’s just remind everyone, once again, we’re talking about the, this, an open enrollment period for the Medicare Advantage open enrollment period now through the end of March. If you’ve got an Advantage plan and you’re wondering if it’s the best one for you, or if you need to change it, or you want to tweak it. This is a great opportunity for you.

 

Lisa Lauro  22:24

That’s right, perfect way to wrap up.

 

Steve Sedahl  22:28

And again, so if, folks, if you’re interested, just give us a call at 724-293-6653. 724-293-6653, Lisa, it’s always a pleasure. Boy, the show goes by so quickly. Have a great information, and as a guy on Medicare, you have helped me a lot.

 

Lisa Lauro  22:43

Well, good. That’s what I like to hear. So great being with you today, Steve, take care. Have a wonderful week, and we’ll see you next time.

 

Speaker 2  24:12

Investment advisory services are offered through Foundation’s Investment Advisors LLC, an SEC-registered investment advisor. The content provided is intended for informational and educational purposes only. The views, statements and opinions expressed herein are those of the individual speakers and are not necessarily those of Foundations and its affiliates. The information contained herein does not constitute an offer to sell any securities or represent an expressed or implied opinion or endorsement of any specific investment opportunity offering or issuer. Any discussion of performance or returns is not indicative of future results. Any discussions of specific strategies are for informational purposes only, and have been provided to help determine whether they may be appropriate for your specific situation. If applicable, the primary goal in converting retirement assets into a Roth IRA is to reduce the future tax liability on the distributions you take in retirement or on the distributions of your beneficiaries. Each individual investor situation is different, and any ideas provided may not be appropriate for your particular circumstances. Comments regarding a particular client’s experience may or may not be the same as another client’s experience, and is not an indication that any client or prospective client will experience the same or a higher level of future success or performance. Foundations only transacts business in states where it is properly registered or is excluded or exempted from registration requirements. Registration as an investment advisor is not an endorsement of the firm by securities regulators, and does not mean the advisor has achieved a specific level of skill or ability. Nothing herein constitutes a recommendation that any security portfolio of securities or investment strategy is suitable for any specific person. No legal or tax advice is provided. Please review your retirement tax and legacy planning strategies with a legal or tax professional before transacting or implementing any strategy discussed herein. Any comments regarding safe and secure investments and guaranteed income streams refer only to fixed insurance products. They do not refer in any way to investment advisory products. Rates and guarantees provided by insurance products and annuities are subject to the financial strength of the issuing company, not guaranteed by any bank or the FDIC. This is not endorsed or affiliated with the Social Security Administration, any federal Medicare program, nor any US government agency, if applicable, we do not offer every plan in your area, and contacting us at the phone numbers provided herein will direct you to a licensed insurance agent. Any information we provide is limited to those plans we do offer in your area. Please contact medicare.gov, or 1-800-Medicare to get information on all of your options. All rights reserved.

 

Outro  26:10

Coach P Radio.