From Utqiagvik, Alaska, the northernmost city in the United States to Supai, Arizona, a town at the bottom of the Grand Canyon reachable only by foot, mule or helicopter, seniors depend on Medicare to receive the medical supplies they rely on to live safely and independently. Cancer survivors depend on ostomy supplies to manage life after surgery. Older Americans living with chronic conditions depend on catheters and other urological products to maintain their health and quality of life.
For seniors living in rural and remote communities, where the nearest pharmacy, medical supply store, or hospital may be hours away, reliable access to these products can mean the difference between managing a condition at home and facing a medical emergency.
Yet, a proposed change to Medicare threatens to disrupt that access for some of the patients who can least afford it.
As a champion for America’s seniors, and as someone who was closely involved in advancing the Medicare Modernization Act of 2003, I understand firsthand the importance of ensuring Medicare remains both financially sustainable and responsible to the needs of the people it serves. The goal of Medicare reform has always been, and should continue to be, to strengthen the program for seniors, not create new barriers between patients and their care.
This is why the Center for Medicare and Medicaid Services (CMS) plans to expand its Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program in 2028 to include urological and ostomy supplies is deeply concerning.
On paper, competitive bidding promises savings. However, in practice, it limits local and small suppliers, leaving patients to deal with the aftermath. We must consider what happens to a senior who cannot get the specific supplies they need to manage their condition, the cancer survivor whose delivery is delayed, or the rural patient who has no alternatives when their supplier goes away.
One of the most notable expansions of this policy is the establishment of a nationwide Remote Item Delivery (RID) competitive bidding area, a significant departure from how patients previously received these supplies. This shift to a national delivery system means that suppliers will be expected to serve the entire country, from the deserts to downtown.
While this may sound efficient, it raises serious concerns about continuity of patient care in rural communities. For someone living in a remote community in Alaska, rural Arizona, or other underserved community, they may have no alternative and be required to wait with uncertainty over when their critical care products will arrive.
For those in some of the nation's hardest to reach towns, this change threatens reliable access to life saving medical supplies. A 2025 study found that under the proposed changes, 45% of medical suppliers would shrink their operation, especially in rural or underserved areas. Medicare beneficiaries should not have to ponder the risks to their care due to delayed deliveries or uncertainty about whether their essential products will arrive on time.
We also cannot lose sight of the fact that for patients using ostomy and urology supplies, poorly fitted non-personalized medical supplies can present life threatening issues, like skin breakdown, leaks, infections and even hospitilization. For rural families, where the closest hospitals and specialized care may be hours away, a complication that would be an inconvenience in the city can quickly become a life-threatening emergency.
There is precedent for taking additional time to evaluate the impact and consequences of competitive bidding. CMS has paused competitive bidding before, most recently in 2023, due to feasibility and industry concerns. Recent bipartisan legislation, the Access to Medical Supplies Act (H.R. 10787), also reflects recognition among policymakers that there may be potential harms of these changes for patients.
For millions of Americans on Medicare, it is more than an insurance program. It is the foundation through which they manage serious health conditions, maintain their independence, and age with dignity. No senior should have to worry that the medical supplies they rely on will stop coming because their community is difficult or expensive to serve, and no patient should face a preventable medical emergency because a policy didn’t account for the realities of rural healthcare.
Jim Martin is Chairman and President of the 60 Plus Association.
