Cpap and Medicare question

I was sort of shopping around for a dme the other day. I asked my current dme about getting a new auto cpap. I have had my current machine for over 5 years. They indicated that all that was needed was a script from my sleep doctor. I went to the other dme just to see what it was like, how they treated me, etc. I asked them the same question and they told me that it was a requirement of medicare that my current machine be broken in order to get a new one, even though it was over 5 years old. Anyone know which one is right. It just doesn't seem right that you wait till it breaks to get a new one?

Guest wrote:I was sort of shopping around for a dme the other day. I asked my current dme about getting a new auto cpap. I have had my current machine for over 5 years. They indicated that all that was needed was a script from my sleep doctor. I went to the other dme just to see what it was like, how they treated me, etc. I asked them the same question and they told me that it was a requirement of medicare that my current machine be broken in order to get a new one, even though it was over 5 years old. Anyone know which one is right. It just doesn't seem right that you wait till it breaks to get a new one?

Try this link and also read back through the thread from the beginning.
I think the answer is "it depends" on the circumstances.
And, if that doesn't answer your question, do a forum search on "Medicare" and start reading. Lots of discussions about it.

viewtopic/t108001/viewtopic.php?f=1&t=1 ... e#p1022742


Den

.

The five year rule may be in effect if the original machine was covered by Medicare; but for one's
FIRST Medicare machine, five years need not have passed.
At least, my previous machine was under FOUR years old, and working, except for an occasional data glitch.

Thanks for the help. Didn't realize I wasn't logged in.

Perhaps this will help....
https://www.cms.gov/Outreach-and-Educat ... 905064.pdf

My sleep Dr requested a new machine for me and I got one. Medicare has to be convinced of medical need. Talk to your Dr

Continuous Positive Airway Pressure (CPAP)
therapy
Medicare covers a 3-month trial of CPAP therapy if you’ve been
diagnosed with obstructive sleep apnea. Medicare may cover it
longer if you meet in person with your doctor, and your doctor
documents in your medical record that the CPAP therapy is
helping you.
You pay 20% of the Medicare-approved amount for rental of the
machine and purchase of related supplies (like masks and tubing),
and the Part B deductible applies. Medicare pays the supplier to
rent the machine for 13 months if you’ve been using it without
interruption. After you’ve rented the machine for 13 months, you
own it. Note: If you had a CPAP machine before you got Medicare,
Medicare may cover rental or a replacement CPAP machine and/or
CPAP accessories if you meet certain requirements.
If you live in certain areas of the country, you may have to use
specific suppliers for Medicare to pay for a CPAP machine and/or
accessories. See page 53 for more information.