Suppliers that Choose to Grandfather - Round 2 (30-Day Notification to Beneficiary)

Sample Letter to Beneficiary from Supplier that Chooses to Grandfather
Our records show that our company, [insert supplier name], is currently furnishing you with rented
[insert name of equipment].
Starting July 1, 2013, there will be a new program called the Medicare Durable Medical Equipment,
Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. This program will
help you save money when you get certain Medicare-covered medical equipment and supplies. Under
this program, people with Original Medicare in your area will almost always need to buy or rent
certain medical equipment and supplies from suppliers that contract directly with Medicare to furnish
these items. Although we aren’t a Medicare contract supplier for your equipment under this program,
we qualify as a grandfathered supplier so you may continue to rent your equipment from us. This also
includes getting related accessories and supplies needed to operate the equipment for the remaining
rental months.
It is important for you to know that you may change suppliers. However, if you change suppliers, you
must get your [insert name of equipment] from a Medicare contract supplier for your area. To find a
Medicare contract supplier for [insert name of equipment], visit
www.medicare.gov/supplier/home.asp or call 1-800-MEDICARE (1-800-633-4227) and have your
ZIP code ready. TTY users should call 1-877-486-2048
If you choose to use a Medicare contract supplier instead of continuing to rent with us, the contract
supplier must provide you with the items included in its contract. [USE FOLLOWING SENTENCE FOR
RENTED DURABLE MEDICAL EQUIPMENT EXCEPT OXYGEN AND OXYGEN EQUIPMENT:] The
Medicare contract supplier will receive 13 additional months of rental payment for medical equipment.
[USE FOLLOWING SENTENCE FOR OXYGEN AND OXYGEN EQUIPMENT:] The Medicare contract
supplier will receive at least 10 months of rental payment for oxygen equipment. You or your secondary
insurer will be responsible for the 20 percent copayment for the monthly rental and any unmet Part B
annual deductible. If you continue to rent with us, you will be responsible for [insert # of months] of
monthly rental copayments and any unmet Part B annual deductible.
Please respond by checking the appropriate box below and mailing it to [insert supplier address] or
you may call us at [insert supplier phone number] to let us know if you would like to continue to
renting from us or switch to a contract supplier. Please respond by [insert date]. If you choose to
switch to a contract supplier, we will contact you to arrange a convenient time to pick up your
equipment.
If you have any questions, please call us at [insert supplier phone number] or call 1-800MEDICARE (1-800-633-4227).

Customer Name (please print) __________________________________ has decided to:
□ continue renting [insert name of equipment] from [insert supplier name]
□ NOT to continue renting [insert name of equipment] from [insert supplier name]
Signature _____________________________________________ Date ___________________