Competitive Bidding Is Back: What It Hits

Every few weeks now someone forwards me a headline about Medicare competitive bidding returning and asks whether their wheelchair is about to get worse.

Short answer: not your chair. Your supplies. And for a lot of wheelchair users, that's the bigger deal.

Here's the honest version.

What's actually in this round

CMS published the final rule (CMS-1828-F) on November 28, 2025, restarting the DMEPOS Competitive Bidding Program after several years on pause, with contracts and new payment amounts targeted to take effect no later than January 1, 2028.

The categories in the next round are: Class II continuous glucose monitors and insulin pumps, urological supplies, ostomy supplies, hydrophilic urinary catheters, off-the-shelf back braces, OTS knee braces, and OTS upper extremity braces.

Look at that list again if you use a chair. Catheters. Ostomy supplies. That's the daily infrastructure of life with a spinal cord injury, spina bifida, or MS. Nobody writes headlines about catheters, but this round hits them squarely.

What's not in it

CMS is not including the legacy categories — oxygen, CPAP, standard wheelchairs, hospital beds, walkers — in this round. CMS updated its fact sheet on December 9, 2025 to say that plainly, with off-the-shelf braces as the exception.

Complex rehab — Group 3 bases, custom ultralight manual chairs, seating and positioning — has never been bid, and it isn't now. CMS also permanently exempted manual complex rehab wheelchair accessories from bidding-derived pricing back in 2021. So if you're waiting on a custom chair, this rule does not change your funding path.

That protection is real, but it's narrow. It covers the chair. It doesn't cover what you put in your bladder four to six times a day.

Why the supply side is the part to watch

Two design choices in this rule matter more than the word "bidding" does.

First, this round runs partly as a Remote Item Delivery program — nationwide, not carved into local bidding areas. There's no moving to a different city to get a different supplier. CMS expects to award roughly ten combined contracts for CGMs and insulin pumps, eight each for urological and ostomy supplies, and six each for OTS upper extremity and knee braces — nationwide. Industry analysis using 2023 utilization data suggests fewer than ten suppliers will end up serving Medicare patients in ostomy, CGM/pump, and urological categories.

Second, the price is set off one product. Suppliers bid on a "lead item" in each category; the payment amount is set at the 75th percentile of winning bids, and every other item in the category is priced off a ratio to that lead item. For CGMs and insulin pumps, the lead item is A4239 with a bid limit of $273.28.

Put those together and you get the real risk: a supplier's payment for your category is fixed, but their cost isn't. The cheapest catheter in a category pays the same as the expensive one. That's not a conspiracy theory — it's arithmetic, and it's why product variety narrows under bidding.

This is the part I won't soften. If you use a coudé tip because you have a stricture or a history of false passages, or a hydrophilic or closed-system catheter because you've had repeated UTIs, being switched to a cheaper straight-tip product is not an inconvenience. It's urethral trauma, urosepsis, and hospital admissions. Same with ostomy: the wrong barrier for your stoma profile means leaks and peristomal skin breakdown.

What to do, and when

Get your product documented now, not in 2027. Pull your last invoice and write down the exact HCPCS code, manufacturer, and part number for every supply you use. Then get your urologist or ostomy nurse to put the clinical reason for that specific product in the chart — stricture, recurrent UTI, dexterity limits, stoma shape, skin reaction to a specific adhesive. Medical-necessity documentation written before a payment change is worth far more than documentation written after a denial.

Ask your supplier directly whether they're bidding, and in which categories. CMS's timeline had the bid window opening in late summer/early fall 2026. Your supplier knows by now. If they're not bidding, you'll be moving, and you want a year of runway, not a letter in December 2027.

Stock a small buffer of the product that works for you in the months before the switchover, within what your plan allows. Transitions generate paperwork gaps.

If you're on Medicare Advantage, ask your plan in writing whether its supply network and rates will follow the new amounts. Plans aren't bound to bid pricing the same way, but many peg to Medicare.

And say something. The proposed rule drew over 950,000 public comments, and CMS largely held its positions; industry and patient groups are pressing Congress and the administration to delay implementation over access and product-quality concerns. The dates CMS has published are target dates. Things can still move.

Bidding did lower Medicare spending in past rounds — that's true, and pretending otherwise doesn't help anyone. The fight isn't about saving money. It's about whether a pricing method built around one "lead item" can accommodate people whose bodies need the item that isn't the lead one.

---

Ready for a Chair That Actually Fits?

Competitive bidding doesn't touch custom ultra-lightweight chairs — but plenty of other things will try to talk you out of the right one. The right custom chair is specified around your body and your life, not around whatever a contract makes cheapest.

I work directly with clients to specify and order custom ultra-lightweight wheelchairs — no middlemen, no upsells, just the chair that fits your life.

Get started at wheelchair.direct — answer a few questions and I'll reach out personally.