What’s the National Mail-Order Program?
Medicare’s National Mail-Order Program for diabetes testing supplies helps
you get quality supplies and save money. If you want diabetes testing supplies delivered to your home, you’ll need to use a national mail-order supplier that has a contract with Medicare. If you don’t want diabetes testing supplies delivered to your home, you can get them from any local store (local pharmacies or storefront suppliers) that’s enrolled with Medicare.
The National Mail-Order Program includes all parts of the U. S., including the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, and American Samoa.
Will my coinsurance be different if I buy my supplies at a store instead of having them delivered?
No, unless your store doesn’t accept “assignment.” Local stores can’t charge more than any unmet deductible and 20% coinsurance if they accept assignment, which means they accept the Medicare-approved amount as payment in full. Local stores that don’t accept Medicare assignment may charge you more than 20% coinsurance and any unmet deductible. If you get your supplies from a local store, check with the store to find out what your payment will be and if the store accepts assignment. National mail-order suppliers that contract with Medicare are required to accept assignment and can’t charge you more than any unmet deductible and 20% coinsurance.
How can I find out which suppliers to use?
Follow these 3 steps to find a list of national mail-order contract suppliers:
- Visit Medicare.gov/supplier/.
- Enter your ZIP code, and click “Go".
- Select “Mail-Order Diabetic Supplies” in the Competitive Bid Categories section, and click the green “Search” button at the bottom of the page.
How can I find out which suppliers to use? (continued)
You can narrow your results by using the “Modify Your Results” section on the right side of the screen. For example, if you want to search for a contract supplier that offers a certain brand of test strip for your monitor, enter the brand in the “Search for model (brand)” field. Then click the “Update Results” button.
You can also call 1-800-MEDICARE (1-800-633-4227) for help finding a contract supplier. TTY users should call 1-877-486-2048.
Am I affected if I’m in a Medicare Advantage Plan?
No. The National Mail-Order Program applies to Original Medicare only. If you have a Medicare Advantage Plan (like an HMO or PPO), your plan will let you know if your supplier is changing. If you’re not sure, contact your plan.
What if I need a specific item or supply?
If you need a specific item or brand of supply, or a specific form, your doctor must prescribe the specific brand or form in writing. Your doctor must also document in your medical record that you need this specific supply for medical reasons. In these situations, a Medicare contract supplier is required to:
• Give you the exact brand or form of item you need
• Help you find another contract supplier that offers that brand or form
• Consult with your doctor to find an alternative brand or form, and get a revised written prescription from your doctor
My doctor hasn’t prescribed a specific brand of glucose monitor or testing supply, but I like the one I’m using. Can my contract supplier switch me to a different brand?
No. Contract suppliers can’t make you switch to another glucose monitor and testing supplies brand. Contract suppliers must provide the brand of testing supplies that works with your monitor. If the contract supplier doesn’t carry your brand of testing supplies, you can ask the contract supplier to help you find a contract supplier that offers your brand, or ask about other brands they offer. However, the supplier can’t give you this information about alternative brands unless you ask.
How does Medicare pay for supplies if I have other insurance?
If your primary insurance policy requires you to use a supplier that doesn’t participate in the National Mail-Order Program, Medicare may make a secondary payment to that supplier. The supplier must meet Medicare enrollment standards and be eligible to get secondary payments. For more information, check with your insurer, plan provider, or benefits administrator.
I’ve been getting phone calls from suppliers I’ve never used asking me to switch suppliers. Is this allowed?
Medicare has rules to protect you from unsolicited phone calls from suppliers.
If you’re getting phone calls from suppliers you have never used, call the following numbers to let them know:
- Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
- Call the Fraud Hotline of the HHS Office of Inspector General at 1-800-HHS-TIPS (1-800-447-8477). TTY users should call 1-800-377-4950.What should I do if I get phone calls offering me free diabetic supplies or if I get items in the mail that I didn’t order?
If either of these things happen, you should:
- Protect your Medicare number and other personal information. Medicare will never contact you for your Medicare number or other personal information. Don’t give your Medicare number or other personal information to anyone who calls you.
- Don’t accept items that you didn’t order. You should refuse the delivery and/or return it to the sender. Keep a record of the sender’s name and the date you returned the items.
- Call the Fraud Hotline of the HHS Office of Inspector General at 1-800-HHS-TIPS.
How can I help Medicare fight fraud?
When you get health care items or services, save your receipts and statements to check for mistakes. Compare this information with your claims to make sure you or Medicare weren’t billed for items or services you didn’t get. The sooner you see and report errors, the sooner we can stop fraud.
Medicare has several easy ways for you to review your claims:
- Check your “Medicare Summary Notice” (MSN) or any statements you get from your Medicare plan.
- Visit MyMedicare.gov.
- Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
If you suspect fraud, call 1-800-MEDICARE. You can also visit oig.hhs.gov, or call the fraud hotline of the Department of Health and Human Services Office of Inspector General at 1-800-HHS-TIPS (1-800-447-8477).
To learn more about how to protect yourself from health care fraud, visit Medicare.gov or contact your local Senior Medicare Patrol (SMP). To find the SMP in your state, go to the SMP Locator at smpresource.org.