I have Medicare, should I use it?

admiralross · Post by **admiralross** » Mon Sep 10, 2007 4:59 pm

Hello All!

I post a few weeks ago about my situation. I'm at a point where I will not be able to purchase my equipment on my own. At this point I'm between a rock and a hard place. Hate to surrender to Medicare. I know that I won't be happy. I rather have control of what machine I purchase and what I and how I use the data that is contained within. They will charge me $492 for 2 x sleep studies. Then a rental fee $16. But all of this was in NY. I'm here in IN. Wondering how much different state to state it really is? Is it really worth to wrestle with Medicare and their impossible to meet compliancy issues? And there is only one DME in town here and they suck from what rumor has it. I'll have to wrestle with them too. At this point I just wait to my tax return comes and suffer til then. I'm just so frustrated with the way things are going.

amos · Post by **amos** » Mon Sep 10, 2007 6:47 pm

If you are eligible for Medicare, my advice is "yes" take it. Medicare has a set price for cpap machines and accessories and then pays 80% of that figure. Medicare does not determine the brand of equipment that you receive. That will be between you and the DME. The DME must dispense the type of machine that the doctor writes the script for.

For me compliance was set when the DME called and asked if I were using it. You do not have to use the local DME. You can use one online if you wish.

Amos

RosemaryB · Post by **RosemaryB** » Mon Sep 10, 2007 6:59 pm

I have a friend with Medicare and suggested that he contact BillMyInsurance.com (an affiliate of our host, cpap.com). He did so, and found that they would work with him via Medicare. I suspect that would be the same for you. They are very cooperative from what I hear in helping you get a good machine.

Slinky · Post by **Slinky** » Mon Sep 10, 2007 7:00 pm

First off: are you sure you are talking Medicare or are you talking Medicaid?

I can't speak for Medicaid, but Medicare coverage is very good for xPAPs. They do pay only 80% and you are responsible for the other 20% but Medicare provides good coverage up to 80% for CPAP equipment and supplies. They often provide BETTER coverage than some insurances for CPAP equipment as a matter of fact.

The insurance companies base the amount that they will pay on the Medicare allowed amount so don't let the DME suppliers BS you one iota on that. The bulk of these DME suppliers' income is derived from Medicare, not private insurances and self-payers.

For instance in Michigan: Medicare purchases your xPAP via a 13 month capped rental. The billable amount is $135 a month for those 13 months. The Medicare allowed amount is $74.96 a month. (Multiply that by 13, then look to see what you can buy a fully data capable Respironics Auto w/C-Flex for at cpap.com). Medicare PAYS $59.97 a month for any straight or auto CPAP (the bi-levels and VPAPs, etc. are a different code). You or your secondary insurance are then responsible for $14.99 a month for that 13 months.

nightingale · Post by **nightingale** » Mon Sep 10, 2007 7:01 pm

I am in NC, and my DME accepts Medicare and my supplemental (State Farm), and I have had no out of pocket thus far. Compliance is documented by read-out from your machine.

Good luck.

Nightingale

admiralross · Post by **admiralross** » Mon Sep 10, 2007 7:04 pm

amos wrote:If you are eligible for Medicare, my advice is "yes" take it. Medicare has a set price for cpap machines and accessories and then pays 80% of that figure. Medicare does not determine the brand of equipment that you receive. That will be between you and the DME. The DME must dispense the type of machine that the doctor writes the script for.

For me compliance was set when the DME called and asked if I were using it. You do not have to use the local DME. You can use one online if you wish.

Thanks for replying. I'll check into it tomorrow. Medicare will allow me to choose CPAP.com? if so then I can deal with that.

Slinky · Post by **Slinky** » Mon Sep 10, 2007 7:07 pm

No, cpap.com does not deal w/Medicare. BUT - their sister, company, billmyinsurance.com or cpapforseniors.com does. I forget which of the two. I suspect it is cpapforseniors.com that deals w/Medicare. Both are cpap.com affiliates.

Also, do not be put out that cpapforseniors.com or billmyinsurance.com, whichever it is that deals w/Medicare, charges more for the same items than cpap.com does. That has to do w/federal regulations. I think that they CAN NOT charge under Medicare set fees if they accept Medicare. I don't know if they might or can "forgive" the 20% copay or how they work other than that because they do accept Medicare they HAVE to charge more than cpap.com does. Maybe part of it is just that they have to recoup all the extra paperwork, etc. expenses. If nothing else there is no hassle w/them to get the xPAP you want in line w/your doctor's script as there usually is w/a local DME.

admiralross · Post by **admiralross** » Tue Sep 11, 2007 5:56 am

nightingale wrote:I am in NC, and my DME accepts Medicare and my supplemental (State Farm), and I have had no out of pocket thus far. Compliance is documented by read-out from your machine.

Yeah, I remember that. They told me 28hrs per week.

dllfo · Post by **dllfo** » Tue Sep 11, 2007 4:42 pm

You might consider supplemental medical insurance. Clear Horizons or something like that.

If you are actually retired military, go to the MOAA website, check out their
supplemental plans.

Retired military also get Tricare For Life, which means you are pretty much doing ok. Medicare says no to about 20-30% of the medical items I need or use, but Tricare For Life pays 75% for them.

Military were promised medical care for life when I came on active duty July 1, 1963 (yes, I was almost 2 at the time)....then, being the government, they
reneged. Somehow, we got it back. Not the best care, but free is good.

admiralross · Post by **admiralross** » Tue Sep 11, 2007 4:58 pm

dllfo wrote:You might consider supplemental medical insurance. Clear Horizons or something like that.

If you are actually retired military, go to the MOAA website, check out their
supplemental plans.

HA! Retired Military only wish! Nope, not me. I had dreams of Air Force & Nasa. However, the Lord had other plans for me! That was a lifelong dream when I was a kid.

Slinky · Post by **Slinky** » Tue Sep 11, 2007 5:04 pm

The military, the police, the firefighters - our HEROES - at least until the government starts working on the budget. Then what happens to our heroes? Heroes to us, the general population, YES, but to our government, whether federal, state or local ???? .... pardon me whilst I upchuck!! Wanna talk about two-faced and reneging?? Our government are the masters!! The pros!! The epitome!

oceanpearl · Post by **oceanpearl** » Tue Sep 11, 2007 5:12 pm

A group of retired military officers sued the U.S. govt and won the suit. Tricare for life was reinstituted by order of the supreme court.

admiralross · Post by **admiralross** » Tue Sep 11, 2007 5:15 pm

Slinky wrote:The military, the police, the firefighters - our HEROES - at least until the government starts working on the budget. Then what happens to our heroes? Heroes to us, the general population, YES, but to our government, whether federal, state or local ???? .... pardon me whilst I upchuck!! Wanna talk about two-faced and reneging?? Our government are the masters!! The pros!! The epitome!

A discussion for another time perhaps. I LOVE my country and for what it stands for but our wonderful government has tarnished that image over the centuries. It saddens me deeply especially TODAY 9/11. I'd have a LONG story to tell about it but this isn't the place.

RosemaryB · Post by **RosemaryB** » Tue Sep 11, 2007 5:28 pm

If it's Medicare, you can go to cpapforseniors.com (that's what my friend did). He called them then filled out the form online and it was very quick and easy. Then he spoke with them at length about his coverage and the machine he could get, etc. They are very low pressure and straightforward. It's a good company to deal with.

Mask

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