H&J DME Accepted Insurances
In network provider for Medicare, NY Medicaid and most private insurances.
We are also a Medicare competitive bid winner in the prefabricated knee brace category.
Accepted Insurance Plans
We accept a wide range of insurance plans to cover your durable medical equipment (DME) and supplies. Click on each plan to view comprehensive details. Use the search bar to quickly find a plan.
Major Insurance Providers
Pros: Extensive national network, broad coverage options.
Cons: Some items may need pre‑authorization; plan details vary by region.
Ideal For: Individuals seeking a large network and multiple plan types (Employer, Individual, Medicare Advantage).
Eligibility & Documentation:
- Employer: Must meet employer criteria.
- Individual/Family: ACA enrollment periods; income/residency documents may be needed.
- Medicare Advantage: Have Medicare A & B and live in plan area.
Premiums vary by plan type and region.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
For employer or marketplace plans, you’ll generally meet a deductible first. Afterward, co‑pays or co‑insurance apply until you reach your out‑of‑pocket maximum. For Medicare Advantage, the Part B deductible and co‑insurance rules apply. Check your Summary of Benefits or Evidence of Coverage for exact amounts.
Telehealth Services:
Aetna often provides telehealth options for consultations and follow‑ups. You may discuss DME needs, get prescriptions, or obtain referrals remotely.
Coverage Limits and Exclusions:
DME must be medically necessary. Some items may have yearly quantity limits or may not be covered if considered “convenience” items.
Prior Authorizations & Referrals:
Certain DME may require prior authorization. A doctor’s prescription or referral might be needed.
How to Verify Coverage:
Check your member handbook or call Aetna member services.
Claim Submission Tips:
Usually, DME suppliers bill Aetna directly. Keep copies of prescriptions and approval letters.
Pros: Low or no out‑of‑pocket cost for eligible individuals.
Cons: Eligibility rules vary by state.
Ideal For: Low‑income individuals/families who qualify for Medicaid.
Eligibility & Documentation:
- Must meet state Medicaid income/resource criteria.
Generally, minimal or no premiums for Medicaid beneficiaries.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
Medicaid typically imposes little to no deductibles or co‑pays for DME. Out‑of‑pocket costs are minimal.
Telehealth Services:
Aetna Better Health may offer telehealth for consultations or follow‑ups. This can help quickly secure medical orders or verify DME needs.
Coverage Limits and Exclusions:
Coverage follows Medicaid guidelines. Some items may require medical justification; certain non‑essential items might not be covered.
Prior Authorizations & Referrals:
Many DME items need prior authorization. A doctor’s order is typically required.
How to Verify Coverage:
Review your Medicaid benefits handbook or call Aetna Better Health member services.
Claim Submission Tips:
Your DME supplier usually handles claims. Keep approval letters on file.
Pros: Large network, preventive health emphasis.
Cons: Some DME may need pre‑authorization; costs vary.
Ideal For: Those seeking a well‑known brand and diverse plan options.
Eligibility & Documentation:
- Employer: Meet employer eligibility rules.
- Individual/Family: ACA enrollment; provide residency/income for subsidies.
- Medicare Advantage: Have A & B, reside in service area.
Premiums depend on plan type and region.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
For commercial and marketplace plans, you’ll usually have a deductible, then pay co‑pays or co‑insurance until reaching the out‑of‑pocket maximum. Medicare Advantage may involve the Part B deductible and a set co‑insurance for DME. Refer to your Summary of Benefits or Evidence of Coverage.
Telehealth Services:
Anthem often includes telehealth benefits; you can consult providers virtually for DME‑related needs.
Coverage Limits and Exclusions:
Coverage typically extends to medically necessary DME. Some equipment may have annual quantity limits.
Prior Authorizations & Referrals:
Certain DME may require prior authorization or a referral.
How to Verify Coverage:
Check your Summary of Benefits or call Anthem BCBS member services.
Claim Submission Tips:
Suppliers typically bill Anthem directly. Keep prescriptions and authorization letters.
Pros: Global network, various plan options.
Cons: Some plans may have higher premiums or require referrals.
Ideal For: Those needing coverage in multiple locations.
Eligibility & Documentation:
- Employer: Meet employer criteria.
- Individual/Family: Enroll during ACA periods; income/residency documents as needed.
- Medicare Advantage: Have A & B, reside in plan area.
Premiums vary by plan type.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
After meeting your deductible, co‑pays or co‑insurance may apply. Out‑of‑pocket maximums limit yearly costs. Medicare Advantage members follow Part B rules plus plan specifics.
Telehealth Services:
Cigna typically offers telehealth; you can get consults, approvals, or prescriptions for DME items online.
Coverage Limits and Exclusions:
DME must be medically necessary; non‑essential items may be excluded.
Prior Authorizations & Referrals:
Some DME requires prior authorization and a physician’s order.
How to Verify Coverage:
Review your Explanation of Coverage or call Cigna member services.
Claim Submission Tips:
DME providers usually handle claims. Retain prescriptions and approvals.
Pros: Strong local network.
Cons: Coverage varies by tier; pre‑authorizations may apply.
Ideal For: NY residents seeking a well‑known, local plan.
Eligibility & Documentation:
- Employer: Follow employer eligibility rules.
- Individual/Family: ACA enrollment; NY residency/income for subsidies.
- Medicare Advantage: Have A & B, live in Empire’s NY service area.
Premiums differ by plan. Subsidies may apply for marketplace plans.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
You’ll typically meet a deductible, then pay co‑pays or co‑insurance for DME. Medicare Advantage members may owe Part B cost‑sharing; annual out‑of‑pocket maximums limit expenses.
Telehealth Services:
Empire often includes telehealth options for DME prescriptions or follow‑ups.
Coverage Limits and Exclusions:
DME must be medically necessary; non‑essential or comfort items may not be covered.
Prior Authorizations & Referrals:
Some DME requires prior authorization and a doctor’s prescription.
How to Verify Coverage:
Review plan materials or call Empire BCBS member services.
Claim Submission Tips:
Suppliers typically bill directly. Keep medical necessity documents.
Pros: Affordable state‑sponsored options.
Cons: Regional limitations in NY.
Ideal For: NY residents seeking cost‑effective coverage through public programs.
Eligibility & Documentation:
- Medicaid/CHP/Essential: Meet income/resource limits; provide residency/income proof.
- Medicare Advantage: Have A & B, live in service area.
Medicaid/CHP often have no or low premiums. Essential Plans and Medicare Advantage vary.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
Medicaid beneficiaries typically have minimal or no cost‑sharing. Essential and Medicare Advantage plans may have small co‑pays or co‑insurance.
Telehealth Services:
Fidelis often supports telehealth appointments. Members can get DME‑related consults or follow‑ups online, potentially with low or no co‑pay.
Coverage Limits and Exclusions:
DME must be medically necessary; certain limits apply.
Prior Authorizations & Referrals:
Many DME items require authorization and a doctor’s order.
How to Verify Coverage:
Check the member handbook or call Fidelis member services.
Claim Submission Tips:
Suppliers handle billing. Keep approval letters.
Pros: Senior‑focused plans, good support.
Cons: Availability varies by county.
Ideal For: Medicare beneficiaries seeking a range of plan options.
Eligibility & Documentation:
- Medicare Advantage: Have A & B, reside in Humana’s service area.
Monthly premiums may apply in addition to Part B.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
You may owe the Part B deductible if not already met, plus co‑insurance for DME. Humana Medicare Advantage plans have an annual out‑of‑pocket maximum.
Telehealth Services:
Humana often offers telehealth coverage; you can discuss DME needs, get prescriptions, or seek authorizations virtually.
Coverage Limits and Exclusions:
Only medically necessary DME is covered.
Prior Authorizations & Referrals:
Many DME items require prior authorization and a doctor’s prescription.
How to Verify Coverage:
Review your Evidence of Coverage or call Humana member services.
Claim Submission Tips:
Suppliers usually bill Humana. Keep Medicare and Humana IDs on hand.
Medicaid and Medicare
Pros: Comprehensive low‑cost coverage for eligible NY residents.
Cons: Limited regional availability.
Ideal For: Medicaid‑eligible individuals seeking managed care options.
Eligibility & Documentation:
- Medicaid Managed Care: Meet NY Medicaid income/resource criteria.
Typically no premiums for Medicaid enrollees.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
Medicaid usually involves little to no cost‑sharing for DME.
Telehealth Services:
Affinity may offer telehealth visits for DME‑related consultations; confirm with member services.
Coverage Limits and Exclusions:
Must be medically necessary; certain limits apply based on Medicaid rules.
Prior Authorizations & Referrals:
Many DME requests require prior authorization and a doctor’s order.
How to Verify Coverage:
Check Affinity member materials or call member services.
Claim Submission Tips:
Suppliers file claims. Keep any approval letters.
Pros: Integrated, senior‑focused coverage.
Cons: Regional to NY.
Ideal For: NY seniors who are dual‑eligible.
Eligibility & Documentation:
- Medicare: Have A & B.
- Medicaid: Meet state criteria.
Dual‑eligibles often pay little to no premiums.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
Dual‑eligible plans usually have minimal out‑of‑pocket costs for DME due to Medicaid subsidies.
Telehealth Services:
AgeWell may provide telehealth for LTC and DME coordination; check with member services.
Coverage Limits and Exclusions:
DME must be medically necessary; certain limits may apply.
Prior Authorizations & Referrals:
Prior authorization is common; a physician’s order is typically required.
How to Verify Coverage:
Review plan materials or call AgeWell member services.
Claim Submission Tips:
Suppliers handle claims. Keep approval letters.
Pros: Strong in‑home support for chronic conditions.
Cons: Limited NY service area.
Ideal For: Those needing coordinated in‑home LTC.
Eligibility & Documentation:
- Medicare: Have A & B.
- Medicaid: Meet eligibility rules.
Dual‑eligibles often have minimal costs.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
Usually minimal or no out‑of‑pocket costs for DME, given dual coverage.
Telehealth Services:
AlphaCare may offer telehealth visits for DME needs; confirm with member services.
Coverage Limits and Exclusions:
DME must be needed for home care; some limits apply.
Prior Authorizations & Referrals:
A physician’s order and authorization are commonly required.
How to Verify Coverage:
Review AlphaCare materials or call member services.
Claim Submission Tips:
Suppliers bill directly. Keep documentation.
Pros: Excellent for LTC, integrated coverage.
Cons: Primarily for older adults in certain NY areas.
Ideal For: Seniors needing combined Medicare/Medicaid benefits.
Eligibility & Documentation:
- Medicare: A & B.
- Medicaid: Low‑income criteria.
Dual‑eligible seniors often have minimal premiums.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
For dual‑eligibles, cost‑sharing for DME is minimal or none.
Telehealth Services:
Elder Plan may support telehealth for LTC coordination and DME approvals; check member resources.
Coverage Limits and Exclusions:
DME must be medically necessary for LTC at home.
Prior Authorizations & Referrals:
Prior authorization and a doctor’s prescription are likely needed.
How to Verify Coverage:
Check Elder Plan documents or call member services.
Claim Submission Tips:
Suppliers handle claims. Retain approvals.
Pros: Nationwide coverage.
Cons: Some cost‑sharing applies.
Ideal For: Individuals 65+ or those with qualifying disabilities.
Eligibility & Documentation:
- Age 65+ or qualifying disability, with Parts A & B.
Part B premiums apply.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
You must meet the Part B deductible, then typically pay 20% co‑insurance for DME. A Medigap or Medicare Advantage plan can lower out‑of‑pocket costs.
Telehealth Services:
Medicare covers certain telehealth services. For DME, you may consult virtually with a doctor for prescriptions or referrals.
Coverage Limits and Exclusions:
Only medically necessary DME is covered.
Prior Authorizations & Referrals:
Some DME may require prior authorization and a prescription.
How to Verify Coverage:
Consult “Medicare & You” or call Medicare.
Claim Submission Tips:
Medicare‑enrolled suppliers bill Medicare directly. Keep your Medicare ID handy.
Pros: Low‑cost coverage, local NYC focus.
Cons: Limited to NYC.
Ideal For: NYC residents seeking affordable coverage.
Eligibility & Documentation:
- Medicaid/CHP: Meet income limits.
- Medicare Advantage: Have A & B, NYC resident.
- Marketplace: ACA enrollment; residency/income proof.
Medicaid: minimal or no premium. Medicare Advantage/Marketplace: premiums vary.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
Medicaid members generally have low cost‑sharing. Medicare Advantage/Marketplace members have deductibles and co‑pays, limited by out‑of‑pocket maxima.
Telehealth Services:
MetroPlus often provides telehealth; you can address DME needs remotely.
Coverage Limits and Exclusions:
DME must be medically necessary; some limits apply.
Prior Authorizations & Referrals:
Many DME items require prior authorization.
How to Verify Coverage:
Check MetroPlus materials or call member services.
Claim Submission Tips:
Suppliers handle billing. Keep authorization letters.
Pros: No or minimal cost for eligible individuals.
Cons: Must meet strict income/resource guidelines.
Ideal For: Low‑income NY residents needing full coverage.
Eligibility & Documentation:
- Meet NY Medicaid income/resource limits.
Generally no premiums for qualifying individuals.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
Medicaid typically imposes no or very low cost‑sharing. DME often comes at no out‑of‑pocket cost if covered.
Telehealth Services:
NY Medicaid may support telehealth visits, making it easier to obtain prescriptions and approvals for DME.
Coverage Limits and Exclusions:
Must be medically necessary; some limits apply.
Prior Authorizations & Referrals:
Prior authorization often required; a doctor’s prescription is needed.
How to Verify Coverage:
Review official Medicaid materials or call the NY Medicaid helpline.
Claim Submission Tips:
Providers file claims. Keep approval letters.
Specialized Health Plans
Pros: Condition‑focused support.
Cons: Targeted eligibility, NY‑based.
Ideal For: Medicaid‑eligible individuals with specific health conditions.
Eligibility & Documentation:
- Must have HIV/AIDS or a similar chronic condition and meet Medicaid criteria.
Typically no premiums for Medicaid‑eligible enrollees.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
Minimal or no cost‑sharing for DME.
Telehealth Services:
Amida Care may provide telehealth options to manage DME‑related needs; contact member services.
Coverage Limits and Exclusions:
DME must be medically necessary; some limits may apply.
Prior Authorizations & Referrals:
Prior authorization and a doctor’s order are often required.
How to Verify Coverage:
Review Amida Care documents or call member services.
Claim Submission Tips:
Suppliers usually bill the plan directly. Keep records.
Pros: Preventive care emphasis, tech‑oriented.
Cons: Limited service areas.
Ideal For: Medicare beneficiaries wanting a modern approach.
Eligibility & Documentation:
- Medicare Advantage: Have A & B, reside in service area.
Premiums may apply alongside Part B.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
Part B deductible and co‑insurance may apply for DME; Clover Health caps annual out‑of‑pocket costs.
Telehealth Services:
Clover Health supports telehealth; you can get DME consultations, approvals, or prescriptions remotely.
Coverage Limits and Exclusions:
DME must be medically necessary.
Prior Authorizations & Referrals:
Prior authorization likely needed.
How to Verify Coverage:
Review your Evidence of Coverage or call Clover member services.
Claim Submission Tips:
Suppliers handle billing. Keep approvals.
Pros: Specialized, personalized care.
Cons: Strict eligibility.
Ideal For: Those needing tailored Medicaid LTC.
Eligibility & Documentation:
- Must have a qualifying disability and meet Medicaid rules.
No or minimal premiums for Medicaid‑eligible individuals.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
Typically no or very low cost‑sharing for DME under Medicaid guidelines.
Telehealth Services:
Telehealth may be offered to coordinate DME needs; confirm with Hamaspik member services.
Coverage Limits and Exclusions:
DME must be medically necessary; some limits apply.
Prior Authorizations & Referrals:
Prior authorization and specialist evaluation may be required.
How to Verify Coverage:
Check plan materials or call member services.
Claim Submission Tips:
Suppliers handle claims. Keep evaluation reports.
Pros: Integrated, patient‑centered approach.
Cons: Regional availability.
Ideal For: Those valuing coordinated care.
Eligibility & Documentation:
- Medicare Advantage: Have A & B.
- Employer Plans: Meet employer criteria.
Premiums vary by plan type.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
For Medicare Advantage, after meeting the Part B deductible (if applicable), co‑insurance applies until reaching the out‑of‑pocket maximum. Employer plans follow their own deductible/co‑pay structure.
Telehealth Services:
Telehealth may be available for DME assessments; contact member services to learn more.
Coverage Limits and Exclusions:
Only medically necessary DME covered.
Prior Authorizations & Referrals:
Prior authorization often required; referrals may be needed.
How to Verify Coverage:
Check plan materials or call member services.
Claim Submission Tips:
Suppliers bill the plan. Keep approvals.
Pros: Personalized LTC support at home.
Cons: Must qualify for nursing‑home level care.
Ideal For: Disabled or elderly needing in‑home care.
Eligibility & Documentation:
- Medicaid MLTC: Meet financial and functional criteria.
No premiums for Medicaid‑eligible individuals; DME typically low or no cost.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
Usually no deductible or co‑pays for Medicaid LTC plans.
Telehealth Services:
ISC may offer telehealth assessments for DME; this expedites approvals.
Coverage Limits and Exclusions:
DME must be crucial for in‑home care; some limits apply.
Prior Authorizations & Referrals:
Prior authorization often required; nurse assessments may be needed.
How to Verify Coverage:
Check ISC materials or call member services.
Claim Submission Tips:
Providers handle claims. Keep assessment reports.
Pros: Personalized home‑care plans.
Cons: Must need nursing‑home level care.
Ideal For: Chronically ill or disabled adults needing LTC at home.
Eligibility & Documentation:
- Medicaid financial and functional criteria required.
No premiums for Medicaid‑qualified individuals.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
Minimal to no cost‑sharing for DME under MLTC.
Telehealth Services:
Telehealth visits may be offered to assess DME needs; contact Integra.
Coverage Limits and Exclusions:
DME must support independence at home; some limits apply.
Prior Authorizations & Referrals:
Prior authorization and assessments needed.
How to Verify Coverage:
Review Integra materials or call member services.
Claim Submission Tips:
Providers submit claims. Keep authorization records.
Pros: Strong, negotiated benefits.
Cons: Limited to union members and dependents.
Ideal For: 1199SEIU members seeking comprehensive coverage.
Eligibility & Documentation:
- Must be an active union member or dependent. Show union ID/employment verification.
Minimal or no premiums depending on the union contract.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
Union plans often have low cost‑sharing for DME; check your union benefits guide.
Telehealth Services:
Many union plans include telehealth; check your benefits handbook.
Coverage Limits and Exclusions:
DME must be medically necessary.
Prior Authorizations & Referrals:
Prior authorization may be needed; a doctor’s referral might be required.
How to Verify Coverage:
Check the union benefits handbook or call member services.
Claim Submission Tips:
Suppliers bill the plan. Keep prescriptions.
Pros: Large networks, flexible benefits.
Cons: Must be covered through an employer/union partner.
Ideal For: Employees/union members under MagnaCare plans.
Eligibility & Documentation:
- Employer/Union‑based: Meet the organization’s criteria.
Costs vary by negotiated plan.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
Typically, a deductible applies, followed by co‑insurance or co‑pays. An out‑of‑pocket maximum limits costs.
Telehealth Services:
Many MagnaCare‑administered plans offer telehealth; confirm details with member services.
Coverage Limits and Exclusions:
DME must be medically necessary.
Prior Authorizations & Referrals:
Prior authorization is common for DME.
How to Verify Coverage:
Check employer’s HR portal or call MagnaCare member services.
Claim Submission Tips:
Suppliers bill the plan. Keep authorization docs.
Pros: Affordable, focusing on low‑income and senior populations.
Cons: Limited state availability.
Ideal For: Those seeking cost‑effective public or subsidized coverage.
Eligibility & Documentation:
- Medicaid/CHIP: Meet state income guidelines.
- Medicare Advantage: Have A & B, reside in service area.
- Marketplace: ACA enrollment periods, provide income/residency info.
Medicaid: no/low premium. Medicare Advantage/Marketplace vary.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
Medicaid beneficiaries often pay little to nothing for DME. Medicare Advantage/Marketplace enrollees have deductibles, co‑pays, and limited out‑of‑pocket maximums.
Telehealth Services:
Molina typically supports telehealth visits; confirm coverage via member services.
Coverage Limits and Exclusions:
DME must be medically necessary.
Prior Authorizations & Referrals:
Prior authorization is common; a doctor’s order is required.
How to Verify Coverage:
Check your benefit documents or call member services.
Claim Submission Tips:
Suppliers handle billing. Keep approval letters.
Pros: Integrated coverage, low cost for seniors.
Cons: Must meet dual‑eligibility criteria.
Ideal For: NY seniors enrolled in Medicare and Medicaid.
Eligibility & Documentation:
- Dual‑eligible: Medicare A & B plus Medicaid eligibility.
Dual‑eligibles usually have minimal or no premiums.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
With dual eligibility, DME cost‑sharing is often negligible. Medicaid helps cover Medicare’s cost‑sharing.
Telehealth Services:
Telehealth may be available to manage DME needs from home; confirm details with member services.
Coverage Limits and Exclusions:
Must be medically necessary DME.
Prior Authorizations & Referrals:
Prior authorization and a doctor’s order likely needed.
How to Verify Coverage:
Check plan documents or call member services.
Claim Submission Tips:
Suppliers bill directly. Keep approvals.
Pros: Home health expertise, integrated LTC.
Cons: Limited NY regions.
Ideal For: Those needing comprehensive in‑home LTC coverage.
Eligibility & Documentation:
- Medicaid MLTC: Meet financial/functional criteria.
Minimal or no premiums for Medicaid‑qualified individuals.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
Typically minimal or no cost‑sharing for LTC‑related DME under Medicaid MLTC.
Telehealth Services:
VNS Choice may use telehealth for care coordination; you can request DME consultations remotely.
Coverage Limits and Exclusions:
DME must be essential for home care.
Prior Authorizations & Referrals:
Prior authorization is common, with nurse or physician assessment needed.
How to Verify Coverage:
Consult VNS Choice materials or call member services.
Claim Submission Tips:
Suppliers handle billing. Keep assessments and approvals.
Regional and Local Plans
Pros: Specialized elderly/long‑term care support.
Cons: Limited to NY regions.
Ideal For: Seniors needing PACE or MLTC in NY.
Eligibility & Documentation:
- PACE: 55+ and nursing‑home level care.
- MLTC: Medicaid‑eligible with LTC needs.
Often no or low premiums due to Medicaid eligibility.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
Minimal or no cost‑sharing for covered DME under PACE/MLTC programs.
Telehealth Services:
ArchCare may offer telehealth for consultations and care coordination, including DME needs.
Coverage Limits and Exclusions:
Only medically necessary DME. Some limits apply.
Prior Authorizations & Referrals:
Prior authorization is common; a care assessment may be required.
How to Verify Coverage:
Review ArchCare materials or call member services.
Claim Submission Tips:
Suppliers bill the plan. Keep approvals.
Pros: Strong local network.
Cons: Limited to Western NY region.
Ideal For: Western NY residents wanting community‑based coverage.
Eligibility & Documentation:
- Individual/Family: ACA enrollment, residency proof.
- Medicare Advantage: A & B, in coverage area.
Premiums vary by plan.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
Generally, you must meet a deductible, then pay co‑pays or co‑insurance for DME. Medicare Advantage includes Part B cost‑sharing. Out‑of‑pocket maximums limit total spending.
Telehealth Services:
BCBS of Western NY often includes telehealth; you can obtain DME‑related consultations online.
Coverage Limits and Exclusions:
DME must be medically necessary.
Prior Authorizations & Referrals:
Prior authorization may be required.
How to Verify Coverage:
Check Summary of Benefits or call member services.
Claim Submission Tips:
Suppliers bill directly. Keep prescriptions.
Pros: User‑friendly, preventive care focus.
Cons: Limited regional availability.
Ideal For: Those wanting a modern, simplified plan experience.
Eligibility & Documentation:
- Individual/Family: ACA enrollment.
- Medicare Advantage: A & B, reside in service area.
Premiums vary by plan type and location.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
For marketplace plans, meet your deductible, then pay co‑pays or co‑insurance until you hit the out‑of‑pocket max. Medicare Advantage: Part B rules apply with a plan‑specific maximum.
Telehealth Services:
Bright Healthcare supports telehealth appointments. This can speed up getting DME‑related prescriptions or approvals.
Coverage Limits and Exclusions:
Only medically necessary DME covered.
Prior Authorizations & Referrals:
Prior authorization often required.
How to Verify Coverage:
Review your Evidence of Coverage or call member services.
Claim Submission Tips:
Suppliers handle billing. Keep approvals.
Pros: Preventive care focus.
Cons: Availability changed; verify current offerings.
Ideal For: Those who previously accessed Care Connect’s model.
Eligibility & Documentation:
- Individual/Family: ACA enrollment if still available.
- Employer Plans: Follow employer rules.
Premiums vary; check current status.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
If still active, you would meet a deductible first, then co‑pays/co‑insurance apply. An out‑of‑pocket maximum caps yearly costs.
Telehealth Services:
If offered, telehealth can help with DME needs; verify if Care Connect still provides telehealth benefits.
Coverage Limits and Exclusions:
DME must be medically necessary.
Prior Authorizations & Referrals:
Likely needed for certain DME.
How to Verify Coverage:
If the plan still operates, contact member services or review documentation.
Claim Submission Tips:
Suppliers usually bill the plan. Keep approvals.
Pros: Local CT focus, strong preventive care.
Cons: Limited to Connecticut.
Ideal For: CT residents seeking a community‑oriented insurer.
Eligibility & Documentation:
- Individual/Family: ACA enrollment in CT.
- Employer: Meet employer criteria.
Premiums vary; subsidies may apply on the CT marketplace.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
Typically, you’ll face a deductible, then co‑pays or co‑insurance for DME. An annual out‑of‑pocket maximum caps costs.
Telehealth Services:
ConnectiCare usually supports telehealth visits, allowing remote DME‑related consultations at convenient rates.
Coverage Limits and Exclusions:
DME must be medically necessary.
Prior Authorizations & Referrals:
Prior authorization may be required.
How to Verify Coverage:
Check ConnectiCare materials or call member services.
Claim Submission Tips:
DME suppliers bill the plan. Keep medical necessity docs.
Additional Insurance Plans
Pros: Extensive national network.
Cons: Costs and coverage vary widely.
Ideal For: Those wanting nationwide coverage.
Eligibility & Documentation:
- Employer: Meet employer criteria.
- Individual/Family: ACA enrollment; subsidies possible.
- Medicare Advantage: A & B, reside in service area.
Varies by plan type.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
Commercial and marketplace plans have deductibles, co‑pays/co‑insurance, and an out‑of‑pocket max. Medicare Advantage includes Part B rules plus plan limits.
Telehealth Services:
UHC often provides telehealth; you can address DME needs remotely.
Coverage Limits and Exclusions:
Must be medically necessary DME.
Prior Authorizations & Referrals:
Prior authorization may be needed.
How to Verify Coverage:
Check your Summary of Benefits or call UHC member services.
Claim Submission Tips:
Suppliers bill UHC. Keep authorization letters.
Pros: Nationwide recognition, local presence.
Cons: Benefits vary by region.
Ideal For: Those looking for a trusted brand with local variations.
Eligibility & Documentation:
- Employer: Meet employer criteria.
- Individual/Family: ACA enrollment.
- Medicare Advantage: A & B, service area restrictions.
Premiums depend on local BCBS affiliate and plan type.
Deductibles, Co‑Pays, and Out‑of‑Pocket Costs:
Typically, a deductible applies, followed by co‑insurance or co‑pays. Out‑of‑pocket maximum limits expenses. Medicare Advantage follows Part B cost‑sharing plus plan rules.
Telehealth Services:
Most BCBS affiliates offer telehealth; this can help secure prescriptions or authorizations for DME remotely.
Coverage Limits and Exclusions:
Medically necessary DME only.
Prior Authorizations & Referrals:
Often required for certain DME items.
How to Verify Coverage:
Check local BCBS documents or call member services.
Claim Submission Tips:
Suppliers typically handle claims. Keep records.
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