Quantcast

Bookmark and Share
General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Guest
Also Posted As:
(ejackson1200)
 

Re: Medicare & Machine Replacement?

Postby Guest on Sun Mar 12, 2017 8:19 am

ChicagoGranny wrote:
DHKaplan wrote:I have Medicare Advantage and my doctor told me that he changes out machines after 5 years even if they are working fine. Just had my first change over and never had any problems with insurance or the DME provider.

+1
It should be noted that a doc can indeed write an order for anything but that does NOT mean the insurance will pay for it even if it is Advantage.
Personally, I would rather buy a cpap on Craigslist than pay a DME for a cpap my insurance will not cover. But hey that's the frugal in me.

User avatar
ChicagoGranny
 
Posts: 5539
Joined: Sun Jan 29, 2012 1:43 pm
Gender: None specified

Re: Medicare & Machine Replacement?

Postby ChicagoGranny on Sun Mar 12, 2017 8:28 am

Guest wrote:It should be noted that a doc can indeed write an order for anything but that does NOT mean the insurance will pay for it even if it is Advantage.

You are a genius to have figured that out.

Guest wrote:Personally, I would rather buy a cpap on Craigslist than pay a DME for a cpap my insurance will not cover. But hey that's the frugal in me.

Do any thing you want in your private life.

Guest
Also Posted As:
(ejackson1200)
 

Re: Medicare & Machine Replacement?

Postby Guest on Sun Mar 12, 2017 8:36 am

ChicagoGranny wrote:

Re: Medicare & Machine Replacement?

Guest wrote:
It should be noted that a doc can indeed write an order for anything but that does NOT mean the insurance will pay for it even if it is Advantage.


You are a genius to have figured that out.
I also figured out that you did not figure that out. So yeah you do make me look smart.

User avatar
LSAT
 
Posts: 8472
Joined: Sun Nov 16, 2008 10:11 am
Location: SE Wisconsin
Gender: Male

Re: Medicare & Machine Replacement?

Postby LSAT on Sun Mar 12, 2017 9:15 am

Medicare vs Medicare Advantage Plans.....Taken from Medicare.gov
https://www.medicare.gov/sign-up-change ... -work.html

Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You'll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.

Medicare Advantage Plans cover everything that Medicare covers plus Prescription Drugs. With Medical Advantage Plans you do not need a Medicare Suppliment Plan or a Part D Plan. Medical Advantage Plane have no monthly premiums in some states and very low monthly premiums in others.....(My plan costs $24 mo). Medical Advantage Plans do have co-pays on some items.

_________________
Mask: Mirage Quattro™ Full Face CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: S9 Autoset...APAP Settings 11-15


S9 Autoset
Back up mask is another Quattro FF and an F20
Buckwheat Hull Pillow (CPAPfit) from http://www.pur-sleep.com/


User avatar
Pugsy
 
Posts: 38973
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA
Gender: Female

Re: Medicare & Machine Replacement?

Postby Pugsy on Sun Mar 12, 2017 9:30 am

Guest wrote:For those who like Advantage its fine as in the examples above she is happy to pay $700 - mine with co-pay I would pay Zero$ that makes me happy. So I guess it all depends on what makes you happy eh?


So you live in a state that has a Medicare Advantage plan that you don't pay anything for each month and pays 100% of everything...so everything is free? I am so happy you are that lucky to have such good coverage available.

That plan isn't offered where I live and I think the chance of my moving to be close to you are slim and none.

So I have 3 choices where I live and considering I am not yet 65 so I don't have access to all the supplements out there.
I can get a really expensive supplement that costs around $300 a month...$3600 a year...BTW that was 2009 rates and they haven't gotten any cheaper.

Or I can have a Medicare Advantage plan that at the time I had the $700 expense cost me nothing each month.

Or I can have just plain regular Medicare and regular Part B ..and pay 20% of everything and 100% of all my meds.

Hmmm.....$3600 for sure pay or maybe pay something later and in my case $700.
Pretty much a no brainer...I saved $2900 that year and that's not even counting the prescription medication savings.

Medicare Advantage plans aren't all the same and they can and will vary by state and sometimes counties.

_________________
Machine: AirCurve™ 10 S BiLevel Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Actually using the AirCurve 10 ST but using it in S mode...have the S9 Adapt for backup right now.

Guest
Also Posted As:
(ejackson1200)
 

Re: Medicare & Machine Replacement?

Postby Guest on Sun Mar 12, 2017 9:53 am

Pugsy wrote:So you live in a state that has a Medicare Advantage plan that you don't pay anything for each month and pays 100% of everything
I thought it was established I don't have an Advantage Plan, I still do NOT.
Pugsy wrote:Medicare Advantage plans aren't all the same and they can and will vary by state and sometimes counties.
Finally, That is ALL I was saying.

Tho I would like to point out that once again the "regulars' have derailed this thread.
Hang Fire wrote:You can get some good help here, but not from those two unregistered guests - their posts each contain some bad advice. Wait to act until some of the registered regulars reply. It may be Monday because sometimes they don't post on the weekend. Sorry, but I have to leave and can't help you now.

User avatar
Pugsy
 
Posts: 38973
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA
Gender: Female

Re: Medicare & Machine Replacement?

Postby Pugsy on Sun Mar 12, 2017 10:04 am

Guest wrote:I thought it was established I don't have an Advantage Plan, I still do NOT.


Ah...so sorry...misunderstood this comment. The "mine" part in the same sentence when mentioning Advantage led me to believe you were talking about Advantage.

Guest wrote:
For those who like Advantage its fine as in the examples above she is happy to pay $700 - mine with co-pay I would pay Zero$ that makes me happy. So I guess it all depends on what makes you happy eh?



Guest wrote:Tho I would like to point out that once again the "regulars' have derailed this thread.


Yeah...well...you haven't been exactly innocent have you? Pot calling the kettle black?
GFAK.

_________________
Machine: AirCurve™ 10 S BiLevel Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Actually using the AirCurve 10 ST but using it in S mode...have the S9 Adapt for backup right now.

Guest
Also Posted As:
(ejackson1200)
 

Re: Medicare & Machine Replacement?

Postby Guest on Sun Mar 12, 2017 10:17 am

Pugsy wrote:Yeah...well...you haven't been exactly innocent have you? Pot calling the kettle black?
GFAK.
Now, now, no need to bring race into this.

It seems the "regulars" are not sleeping well.

User avatar
Pugsy
 
Posts: 38973
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA
Gender: Female

Re: Medicare & Machine Replacement?

Postby Pugsy on Sun Mar 12, 2017 10:25 am

Guest wrote:Now, now, no need to bring race into this.

It seems the "regulars" are not sleeping well.


I actually slept quite well last night thank you very much.

Get your mind out of the gutter....GFAK...Go Fly A Kite.
I figured that was nicer than telling you go crawl back under your rock.

_________________
Machine: AirCurve™ 10 S BiLevel Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear
Additional Comments: Actually using the AirCurve 10 ST but using it in S mode...have the S9 Adapt for backup right now.

MrKDilkington
 
Posts: 21
Joined: Tue Jul 28, 2015 8:43 pm
Gender: Male

Re: Medicare & Machine Replacement?

Postby MrKDilkington on Sun Mar 12, 2017 10:32 am

Guest wrote:So in summary -
What is wrong with buying a cpap from Craigslist?
Apparently not one of these posters is a veteran or knows anything about the VA
And now I question whether they even know how a DME or getting a cpap repaired works.

Maybe none of these negative posters (can't call them people) even uses a cpap - they are just here to cause trouble.

This place gets creepier everyday.


In my opinion there's nothing inherently wrong about advising to purchase a CPAP from craigslist, as long as you trust the seller. What is wrong, is as you know, giving that advice as an outsider. In general when you help and support others, it makes you feel good and it feels rewarding. You empathize with the other person and when their problem is addressed it makes you feel happy. Likewise, seeing familiar people or friends assist others gives you some satisfaction too, because you like those people. It might also validate your own opinions or feelings. All is good in the world. However, when someone you don't know gives that assistance, even if it's sound advice, you might not necessarily get that happy feeling you get from helping others yourself or seeing people you like give that assistance. You feel robbed of that satisfaction and will lash out so that the outsider is not likely to return. The lashing out feels good because you're actively working to keep those instances of feeling good to yourself and your friends, so you keep doing that whenever it happens. This is unfortunate because we're all just trying to help each other. If you simply disagreed with the advice you would explain why and leave out the personal attacks.

User avatar
Bobby269
 
Posts: 705
Joined: Sat Nov 27, 2010 11:12 am
Location: San Antonio Texas
Gender: Male

Re: Medicare & Machine Replacement?

Postby Bobby269 on Mon Mar 13, 2017 9:24 am

If he is a veteran the Va will help him. :D

_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Set to Apap 13.6/20. EPR 3, Climate line hose, ResScan 5.3 & Sleepyhead for Mac 1.0.0. Betta.1

User avatar
deedees5462
 
Posts: 12
Joined: Tue Mar 14, 2017 1:46 am
Gender: None specified

Re: Medicare & Machine Replacement?

Postby deedees5462 on Sat Mar 18, 2017 3:23 am

Hi, just to get back to Medicare Advantage Plans, I am under 65 and disabled. I had excellent insurance from my former employer. I wanted to have the same doctors, hospitals, scripts etc. I was advised by an office clerk in one of my doctors offices to get the advantage plan I am on. I checked with the plan and they went through my docs, scripts, preferred hospital etc and they were on the plan and it is an HMO. Anyhow this was very close to my old insurance and by the same company. My out of pocket is $2000.00 per year. No premiums. No copays even for specialists. I have many specialists and to get a referral, it takes about 2 days to 2 weeks. Also, my specialists usually get the referrals themselves and let me come without one. I pay nothing for hospital. ER $75.00 copay. DME is 20 percent. I can get a new cpap machine every 5 years. I realize I am very lucky. There are pros and cons about every way to go with medicare and what is right for one person is wrong for another. I came to this sight because I need support for apnea and hopefully I can help someone else. Good luck to the gentleman who is trying to replace his father's cpap. I forgot to say the scipts are covered on a tiered system and they just introduced a ppo dental plan that is an extra 33.40 a month. Vision coverage is also included. BTW if anyone is looking for dental aarp has a great dental plan if you have no dental and with cpap and all my meds I have had more than my fair share of dental problems.

_________________
Mask: Swift™ FX Nano For Her Nasal CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Resmed VPAP Adapt S9 SV Bilevel Machine

User avatar
ChicagoGranny
 
Posts: 5539
Joined: Sun Jan 29, 2012 1:43 pm
Gender: None specified

Re: Medicare & Machine Replacement?

Postby ChicagoGranny on Sat Mar 18, 2017 7:08 am

deedees5462 wrote:There are pros and cons about every way to go with medicare and what is right for one person is wrong for another.


Thank you for taking the time to write that. A few people on here have a knee-jerk reaction to the words "Medicare Advantage" and sound Chicken-Little alarms. The danger in this is someone having to make a decision might take these alarms and dismiss Advantage plans. Like you say, individual evaluation should be done of your options. Medicare Advantage plans would not be so popular if they did not work very well for many people.

User avatar
OboeVet
 
Posts: 85
Joined: Fri Jan 17, 2014 11:53 pm
Location: La Mesa, California
Gender: Male

Re: Medicare & Machine Replacement?

Postby OboeVet on Sat Mar 18, 2017 8:24 am

kalatraza wrote:Hi! Hoping you can help me figure out what I can do to help my dad out in Iowa. He has severe sleep apnea. His cpap machine is 7 years old. A month ago, the machine quit working in the middle of the night. It was frightening to both him and my mom because he started coughing with the full face mask on and had a lot of trouble getting his breath back. He took the machine into the DME and they gave him a loner. When he picked the machine up they said there wasn't anything wrong with it. Fast foreward to this week when it stopped working again. Now the DME is going to send the machine into the manufacturer because it is apparently repairable.

The machine is old. It does not automatically adjust and that would be better for dad. Any of dad's doctors would agree.

I asked the DME what needed to happen to get a new machine. We just don't trust this old one now! Too scary. :( They said as long as the cost of repairing the old one is less than the new machine, Medicare will not allow a new machine.

Do I have any options here?

--Dad has Medicare, BCBS Medigap, and Veterans "coverage"
--I can come up with some cash to cover what isn't paid by his plans but not enough to just buy the machine outright
--His doctors are wonderful and will help in any way needed, but they aren't good at negotiating DME world

Thanks for any assistance you can provide.

PS. I also would very much like to get a backup battery because they live in a rural area where the power goes out all the time.... no clue how to go about that process.

If you mean he has Department of Veterans Affairs (aka "VA") healthcare, there is NO OUT IF POCKET! My machine and supplies are provided because I am rated as 20% "Service Connected" for orthopedic injuries. Also, Veterans with co-diagnoses of Post Traumatic Stress (PTS) and Obstructive Sleep Apnea (OSA) get service connected CPAP-APAP. Find a local Veterans Service Organization (VSO) like Disabled American Veterans (DAV) or American Legion to help you advocate for your dad.

(VA told me they expect to replace my machine every 5 years, and want to check it annually.)

Hope for the best!

Don D
US Army 1968-1971, Vietnam

Sent from my SAMSUNG-SM-G900A using Tapatalk

_________________
Mask: Simplus Full Face CPAP Mask with Headgear
Humidifier: PR System One 50 Series Heated Humidifier
Additional Comments: I only look at little screen on machine, let doc analyse details. Now machine set up for me.
Using Tapatalk

Guest
Also Posted As:
(ejackson1200)
 

Re: Medicare & Machine Replacement?

Postby Guest on Sat Mar 18, 2017 8:28 am

ChicagoGranny wrote:deedees5462 wrote:
There are pros and cons about every way to go with medicare and what is right for one person is wrong for another.
I thought that was said early-on here and not what the OP was asking but since you brought it up again...

it is worth mentioning Advantage and Supplements are very often confused but also very different. The bottom line is once you sign up for either you still have Medicare but have to follow your plans rules. Since the chosen plan is working for the same Medicare money how do you think they are making money? Will they make choices that are in your best interest or in the interest of their bottom line?

If you have a condition that fixes your costs under a different plan and are happy with it then by all means do it. I do know that if you have a problem with a provider that Medicare can and will make an unbiased ruling w/o considering the providers bottom line but will consider your care and bottom line within their rules.

Rules for Medicare Advantage Plans
Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.

However, each Medicare Advantage Plan can charge different out-of-pocket costs. Each plan can also have different rules for how you get services, like:

Whether you need a referral to see a specialist
If you have to go to doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care

These rules can change each year.

And then there are Medigap policies which cannot be used with Advantage plans but only with original Medicare.

So choosing healthcare is a very personal thing. There is no one size fits all and I don't think anyone said that. But did say "Caveat Emptor" or Buyer Beware, do your homework first.

To get back on track Medicare (and other Insurances normally will follow Medicare guidelines) no longer recommends a 5yr cpap replacement if the cpap still functions. I just would not wait for it to fail as that will likely cause unplanned delays, discomfort, and irritation so I would keep a spare on hand just for those reasons alone. Remember Murphys Law.

When choosing a spare always consider the brand and model you are familiar with - well unless that one is a brick and provides nothing but hours of use.

PreviousNext

Return to CPAP and Sleep Apnea (CLICK HERE TO READ POSTS)

Who is online

Users browsing this forum: ajack, Bill44133 and 27 guests