Medicare & Insurance Information

This page provides general information only. Medicare, Medicaid, Medicare Advantage, and private-insurance coverage depends on the beneficiary, item, medical necessity, documentation, supplier status, plan rules, and applicable program requirements. Coverage is not guaranteed simply because a product is sold by MedEmp or commonly described as durable medical equipment.

1. Medicare Part B and Durable Medical Equipment

Original Medicare Part B may cover certain medically necessary durable medical equipment (DME) prescribed for use in the home. Depending on the equipment, Medicare requirements may include:

• a treating practitioner’s order or prescription;
• documentation supporting medical necessity;
• a face-to-face encounter;
• a written order before delivery;
• prior authorization;
• use of an enrolled Medicare supplier; or
• rental rather than immediate purchase.

Different rules apply to different items and HCPCS codes.

2. Medicare Costs
For qualifying Original Medicare DME, the Part B deductible generally applies. After the deductible, a beneficiary commonly pays 20% of the Medicare-approved amount when the supplier accepts Medicare assignment. Your actual responsibility can differ depending on assignment status, rental rules, secondary coverage, the specific product, and other circumstances.

Do not rely on a product’s retail price or an old reimbursement estimate to determine what Medicare will pay.

3. Assignment and Claim Submission
Whether MedEmp accepts Medicare assignment or assists with claim submission may depend on the product and transaction. Before purchasing an item that you expect Medicare to cover, confirm with MedEmp:

• whether the product is eligible for Medicare billing;
• whether MedEmp is billing Medicare for the transaction;
• whether MedEmp is accepting assignment;
• what documentation is required;
• whether the item must be rented rather than purchased; and
• what amount you may be responsible for.

When applicable, MedEmp may request information and documentation needed to prepare or submit a claim. Submission of a claim does not guarantee payment.

4. Medicare Advantage
Medicare Advantage plans may have different supplier networks, prior-authorization requirements, coverage rules, cost sharing, and claims procedures from Original Medicare. Contact your plan before purchasing if you intend to use Medicare Advantage benefits.

5. Prescriptions and Medical Necessity
A prescription or order does not by itself guarantee Medicare or insurance coverage. Coverage decisions may depend on whether the applicable medical-necessity criteria and documentation requirements are met.

6. Secondary Insurance
Secondary insurance may pay some or all of a beneficiary’s remaining cost sharing, depending on the plan. MedEmp cannot guarantee payment by a secondary insurer.

7. Virginia Medicaid
Virginia Medicaid requirements differ from Medicare requirements. Contact MedEmp before purchase if you intend to use Virginia Medicaid so that eligibility, product coverage, documentation, billing capability, and any authorization requirements can be confirmed.

8. Advance Beneficiary Notices and Other Documents
When required or appropriate, beneficiaries may be asked to review and sign Medicare or insurance notices concerning potential non-coverage or financial responsibility.

9. No Guarantee of Reimbursement
MedEmp does not guarantee Medicare, Medicaid, Medicare Advantage, or private-insurance reimbursement. Final coverage and payment decisions are made by the applicable payer according to its rules. For personal coverage information, contact Medicare, your health plan, or the applicable payer and discuss the specific product and HCPCS code involved.

10. Contact Us
For MedEmp billing or equipment questions:
Email: