Medicare
Cost Estimator
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Out-of-Pocket Cost Comparison
To help illustrate the potential out-of-pocket cost to Medicare beneficiaries, we have put together cost comparisons for some of the most common product lines billed to Medicare.
In every example, the cost of directly purchasing the eligible equipment is more cost effective for the customer.
Example BHC retail prices posted here may reflect current retail pricing or be pricing exclusive to Medicare eligible beneficiaries, in those cases, proof of Medicare eligibility is required.
Standard Manual Wheelchair (K0001)
Total Out-of-Pocket Amount
| TOTAL MEDICARE RENTAL COST OVER 13 MONTHS | $715.00 |
|---|---|
| MEDICARE REIMBURSEMENT | $183.37* |
| CUSTOMER RESPONSIBILITY | $531.63 |
* Based on Medicare’s non-rural 2018 Fee Schedule
Detailed Medicare Cost Breakdown
| MONTH | MEDICARE RENTAL | REIMBURSEMENT AMOUNT* |
|---|---|---|
| 1 | $55.00 | $17.46 |
| 2 | $55.00 | $17.46 |
| 3 | $55.00 | $17.46 |
| 4 | $55.00 | $13.10 |
| 5 | $55.00 | $13.10 |
| 6 | $55.00 | $13.10 |
| 7 | $55.00 | $13.10 |
| 8 | $55.00 | $13.10 |
| 9 | $55.00 | $13.10 |
| 10 | $55.00 | $13.10 |
| 11 | $55.00 | $13.10 |
| 12 | $55.00 | $13.10 |
| 13 | $55.00 | $13.10 |
| SUB TOTALS | $715.00 | $183.37 |
| TOTAL CUSTOMER RESPONSIBILITY | $531.63 |
* Based on Medicare’s non-rural 2018 Fee Schedule
Homecare Full-Electric Bed (E0260)
Includes bed frame, bed rails, and basic innerspring mattress. Delivery and in home set up included.
Total Out-of-Pocket Amount
| TOTAL MEDICARE RENTAL COST OVER 13 MONTHS | $1950.00 |
|---|---|
| MEDICARE REIMBURSEMENT | $489.72* |
| CUSTOMER RESPONSIBILITY | $1460.28 |
* Based on Medicare’s non-rural 2018 Fee Schedule
Detailed Medicare Cost Breakdown
| MONTH | MEDICARE RENTAL | REIMBURSEMENT AMOUNT* |
|---|---|---|
| 1 | $150.00 | $46.64 |
| 2 | $150.00 | $46.64 |
| 3 | $150.00 | $46.64 |
| 4 | $150.00 | $34.98 |
| 5 | $150.00 | $34.98 |
| 6 | $150.00 | $34.98 |
| 7 | $150.00 | $34.98 |
| 8 | $150.00 | $34.98 |
| 9 | $150.00 | $34.98 |
| 10 | $150.00 | $34.98 |
| 11 | $150.00 | $34.98 |
| 12 | $150.00 | $34.98 |
| 13 | $150.00 | $34.98 |
| SUB TOTALS | $1950.00 | $489.72 |
| TOTAL CUSTOMER RESPONSIBILITY | $1460.28 |
* Based on Medicare’s non-rural 2018 Fee Schedule
Homecare Bariatric Bed (E0303)
Full-electric bariatric bed frame only. Mattress and bed rails available at additional cost.
Total Out-of-Pocket Amount
| TOTAL MEDICARE RENTAL COST OVER 13 MONTHS | $5200.00 |
|---|---|
| MEDICARE REIMBURSEMENT | $1234.93* |
| CUSTOMER RESPONSIBILITY | $3965.07 |
* Based on Medicare’s non-rural 2018 Fee Schedule
Detailed Medicare Cost Breakdown
| MONTH | MEDICARE RENTAL | REIMBURSEMENT AMOUNT* |
|---|---|---|
| 1 | $400.00 | $117.61 |
| 2 | $400.00 | $117.61 |
| 3 | $400.00 | $117.61 |
| 4 | $400.00 | $88.21 |
| 5 | $400.00 | $88.21 |
| 6 | $400.00 | $88.21 |
| 7 | $400.00 | $88.21 |
| 8 | $400.00 | $88.21 |
| 9 | $400.00 | $88.21 |
| 10 | $400.00 | $88.21 |
| 11 | $400.00 | $88.21 |
| 12 | $400.00 | $88.21 |
| 13 | $400.00 | $88.21 |
| SUB TOTALS | $5200.00 | $1234.93 |
| TOTAL CUSTOMER RESPONSIBILITY | $3965.07 |
* Based on Medicare’s non-rural 2018 Fee Schedule
Alternating Pressure Pad (E0181)
Total Out-of-Pocket Amount
| TOTAL MEDICARE RENTAL COST OVER 13 MONTHS | $364.00 |
|---|---|
| MEDICARE REIMBURSEMENT | $126.87* |
| CUSTOMER RESPONSIBILITY | $237.13 |
* Based on Medicare’s non-rural 2018 Fee Schedule
Detailed Medicare Cost Breakdown
| MONTH | MEDICARE RENTAL | REIMBURSEMENT AMOUNT* |
|---|---|---|
| 1 | $28.00 | $12.09 |
| 2 | $28.00 | $12.09 |
| 3 | $28.00 | $12.09 |
| 4 | $28.00 | $9.06 |
| 5 | $28.00 | $9.06 |
| 6 | $28.00 | $9.06 |
| 7 | $28.00 | $9.06 |
| 8 | $28.00 | $9.06 |
| 9 | $28.00 | $9.06 |
| 10 | $28.00 | $9.06 |
| 11 | $28.00 | $9.06 |
| 12 | $28.00 | $9.06 |
| 13 | $28.00 | $9.06 |
| SUB TOTALS | $364.00 | $126.87 |
| TOTAL CUSTOMER RESPONSIBILITY | $237.13 |
* Based on Medicare’s non-rural 2018 Fee Schedule
Low Air Loss Mattress (E0277)
Total Out-of-Pocket Amount
| TOTAL MEDICARE RENTAL COST OVER 13 MONTHS | $5135.00 |
|---|---|
| MEDICARE REIMBURSEMENT | $1411.62* |
| CUSTOMER RESPONSIBILITY | $3723.38 |
* Based on Medicare’s non-rural 2018 Fee Schedule
Detailed Medicare Cost Breakdown
| MONTH | MEDICARE RENTAL | REIMBURSEMENT AMOUNT* |
|---|---|---|
| 1 | $395.00 | $134.44 |
| 2 | $395.00 | $134.44 |
| 3 | $395.00 | $134.44 |
| 4 | $395.00 | $100.83 |
| 5 | $395.00 | $100.83 |
| 6 | $395.00 | $100.83 |
| 7 | $395.00 | $100.83 |
| 8 | $395.00 | $100.83 |
| 9 | $395.00 | $100.83 |
| 10 | $395.00 | $100.83 |
| 11 | $395.00 | $100.83 |
| 12 | $395.00 | $100.83 |
| 13 | $395.00 | $100.83 |
| SUB TOTALS | $5135.00 | $1411.62 |
| TOTAL CUSTOMER RESPONSIBILITY | $3723.38 |
* Based on Medicare’s non-rural 2018 Fee Schedule
Manual Patient Lift (E0630)
Total Out-of-Pocket Amount
| TOTAL MEDICARE RENTAL COST OVER 13 MONTHS | $1625.00 |
|---|---|
| MEDICARE REIMBURSEMENT | $451.08* |
| CUSTOMER RESPONSIBILITY | $1173.92 |
* Based on Medicare’s non-rural 2018 Fee Schedule
Detailed Medicare Cost Breakdown
| MONTH | MEDICARE RENTAL | REIMBURSEMENT AMOUNT* |
|---|---|---|
| 1 | $125.00 | $42.96 |
| 2 | $125.00 | $42.96 |
| 3 | $125.00 | $42.96 |
| 4 | $125.00 | $32.22 |
| 5 | $125.00 | $32.22 |
| 6 | $125.00 | $32.22 |
| 7 | $125.00 | $32.22 |
| 8 | $125.00 | $32.22 |
| 9 | $125.00 | $32.22 |
| 10 | $125.00 | $32.22 |
| 11 | $125.00 | $32.22 |
| 12 | $125.00 | $32.22 |
| 13 | $125.00 | $32.22 |
| SUB TOTALS | $1625.00 | $451.08 |
| TOTAL CUSTOMER RESPONSIBILITY | $1173.92 |
* Based on Medicare’s non-rural 2018 Fee Schedule
| DIRECT PURCHASE | BILLING TO MEDICARE | |
|---|---|---|
| PRESCRIPTION AND/OR PRIOR-AUTHORIZATION REQUIRED | No** | Yes |
| CHOICE OF EQUIPMENT | Yes | Limited to available eligible equipment |
| HOW QUICKLY IS THE EQUIPMENT AVAILABLE TO YOU? | Immediately | Up to 6 weeks OR until approval is secured |
| AVAILABLE TO INDIVIDUALS IN NURSING HOMES, SKILLED NURSING FACILITIES, HOME HEALTH FACILITIES OR HOSPICE FACILITIES | Yes | No – Medicare expects beneficiaries in facility care to use the equipment available at their facility |
** By law Bellevue Healthcare is required to collect a valid prescription or written order from your physician for certain equipment, such as oxygen therapy equipment and supplies, even when purchased privately.
Direct Purchase
- No prescription required**
- Your equipment is available when you need it
- You choose the equipment you want to use
- In most cases less out-of-pocket cost than billing through Medicare
Through Medicare
- Prescription and/or Prior Authorization required
- Collecting the required documentation can take 4-6 weeks
- Most equipment is covered as a rental only
- Provides coverage for available eligible equipment = no choice
- If your claim is rejected, additional time, stress, and additional cost of appealing
Definitions
Allowable Amount
Capped Rental
In a Capped Rental Medicare will pay a monthly rental fee for eligible equipment for a period not to exceed 13 months, after which the ownership of the equipment is transferred to the Medicare beneficiary and it becomes the beneficiary’s responsibility to arrange for any required equipment service or repair.
Charge Amount
The charge amount is the amount the provider (in this case Bellevue Healthcare) is charging to the insurance company. Usually because of contracted rates, the amount you charge an insurance company is not what you expect to be reimbursed for. The expected rate is the amount that you expect to receive as reimbursement.
Managed Medicare
Also referred to as “managed care plans” such as a health maintenance organization (HMO) plans, a Preferred Provider Organization (PPO) plans, or Point of Service (POS) plans. These plans are offered through private insurance companies and are not part of Original Medicare
Original Medicare
Refers Medicare Part A and Part B
Medicare Part C or Advantage Plans (like HMO or PPO) offered through private insurance companies are not part of Original Medicare.