The new Dream Station

[dinycat]

Silly question: does Medicare help pay for the new machine?

[palerider]

Silly question: does Medicare help pay for the new machine?

In what circumstances.

[dinycat]

I mean will I have to pay a lot for the new machine? I'm on Medicare and supplemental Blue Cross insurances.

[LSAT]

With the supplement, you may not have to pay anything for the new machine. Medicare pays 80%, your supplement should pay the rest.

[dinycat]

Thanks, LSAT. I didn't have to pay anything when I was first diagnosed and got the PR System One, but was not on Medicare then. That was almost 7 years ago. Now, on Medicare, I don't want to pursue the new Dream Station that costs $800 plus if Medicare balks.

Thanks for answering my question.

dinycat

[Bookbear]

Policies (including the supplementals) vary widely. Recently many insurance companies are requiring that patients rent their machines and provide monthly compliance data to them (not the doctor) rather than paying for a machine outright. The rental periods run from 13 to 16 months, and you end up paying more in the rental fees over the period than you would simply buying the unit out of pocket... sometimes by a factor or 2 or 3 times the actual retail cost. Be sure you check with the insurance company and get copy of the pricing schedule before you sign anything. The same holds true for supplies (filters, mask cushions, head gear, etc.). Many of us have found that the insurance co-pays for them are often more than what you would pay for the same item purchased without insurance.

Good luck!

[D.H.]

If you've been using CPAP for seven years, I think that you'll met the compliance requirement (if any) with flying colors. The only thing is that you have to use the new machine during the compliance period.

[Okie bipap]

When purchasing through Medicare, you do a 13 month rent to own program. Medicare will probably require a copy of your original sleep study before agreeing to purchase the machine. You also need to check with Blue Cross to see what their policy is for purchasing a machine. Under basic Medicare, you are responsible for 20% of the negotiated price for the machine. My wife recently finished her 13 month rent to own program on her Resmed Air Curve 10 VAUTO machine, and her portion of the monthly rental would have been $18.50 a month for 13 months, but our supplemental insurance picked up her portion. If you decide to get a new machine through Medicare, make sure your doctor writes a prescription for the make and model machine you want. Other wise, you will be at the mercy of the DME.

[LSAT]

Policies (including the supplementals) vary widely. Recently many insurance companies are requiring that patients rent their machines and provide monthly compliance data to them (not the doctor) rather than paying for a machine outright. The rental periods run from 13 to 16 months, and you end up paying more in the rental fees over the period than you would simply buying the unit out of pocket... sometimes by a factor or 2 or 3 times the actual retail cost. Be sure you check with the insurance company and get copy of the pricing schedule before you sign anything. The same holds true for supplies (filters, mask cushions, head gear, etc.). Many of us have found that the insurance co-pays for them are often more than what you would pay for the same item purchased without insurance.

Good luck!

The cost of a machine to a Medicare patient is <$200...(about $15 monthly for 12-13 months). . If there is a supplemental plan in force it may cover the $200. There is no point to even investigating an out of pocket purchase.

[Bookbear]

Actually, this is incorrect. Medicare costs to patients DO vary. Of course, it is possible that things may be different in your county/state, but here in San Bernardino County in California, Medicare has an exclusive contract with SG Homecare for cpap machines and supplies (I believe there several counties where Medicare is 'trying out' this policy). SG Healthcare requires all Medicare cpap patients, with or without a Medicare supplement policy, to rent for 13 months. With my policy (UHC AARP Medicare Complete), I my copay 20% of the monthly cost. They quoted me a monthly copay cost of $102.93, for 13 months for a total of $1338.09. At that point I would own the machine. The machine they would provide is a AirStart 10 with build in humidifier, compliance data only. I can get this machine at cpap.com for less than $300. Note that if my $102.93 actually represents my 20% copay, then UHC is paying $411.72 per month. I seriously doubt that UHC is actually paying that. SG Healthcare says there is no way they will sell a cpap through insurance coverage. They say it it not their policy but the insurance companies who will no longer will "pay for a machine that is not used". One thing that is OK is the cost of supplies, which almost always comes out that my 20% copay equals what I would pay at cpap.com.

My insurance used to go with LifeCare Solutions, and their prices were much less, but still way more than I would pay out of pocket with insurance.

I buy all my cpap stuff (inc. machines) out of pocket. In the end, it's cheaper.... and MUCH less aggravating.

[Pugsy]

With my policy (UHC AARP Medicare Complete), I my copay 20% of the monthly cost. They quoted me a monthly copay cost of $102.93, for 13 months for a total of $1338.09. At that point I would own the machine.

I currently have the same Medicare Advantage plan.
They changed the 13 month rent to own to a perpetual rental and you never own it.
A lot of the Medicare Advantage plans are going this way with DME provided equipment and not just cpap stuff.

I am changing to something else. Not because of the perpetual rental thing but because I am fed up with the unreasonable restrictions and delays they force me to have with procedures that I need.
The one I am changing to...another Medicare Advantage plan and perpetual rental thing but that doesn't matter since I always buy my machines privately. It doesn't have the time restrictions and forced delays plus my co pay for the procedures and the facility fee is $50 less.

[dkperkins65]

I have medicare my DME said I needed to pay 477 for set up and 88 per month, my part. That seems excessive. Does anyone have a comment about this?

[Okie bipap]

It sounds excessive to me. My wife got her machine last year (a Resmed AirCurve 10 VAUTO) and we had not set up charge, and our portion of the 13 month rental was less than 20 dollars a month. If you pay $88 a month for 13 months, you are paying $1144 which is much more than you can purchase the machine for from cpap.com. Add the $477 to that and you are up to $1621. FIND A DIFFERENT DME.!!!!!!

[Pugsy]

I have medicare my DME said I needed to pay 477 for set up and 88 per month, my part. That seems excessive. Does anyone have a comment about this?

Exactly which model? Which HCPCS code is being used? Call the DME up and ask them.
It's excessive for a cpap/apap...might not be so excessive for an ASV type of machine.
It all depends on which code is being used.
Medicare has different allowed amounts for the 3 different HCPCS codes.