CPAP retail

[findingzzero]

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I've been using CPAP for almost 5 yrs. I still don't like it. How do I know it's been 5 yrs? My supplier told me I'm almost eligible for a new machine. I have a Respironics. Does eligible mean I get a break on the price? One thing that bothers me is how much markup the local supplier puts on equipt ordered thru them vs ordering elsewhere. For this markup they file the paperwork with Medicare. I don't like spending Medicare money with less scrutiny than i spend my own (OK some of it is mine and some is yours). When I look up a heated Resrpironics tube, I see it for $50. AHHE charges me/ Medicare $80. Anyone have a clue what AHHE pays for this stuff, or what the markup is? My old machine murmurs. Any suggestion for a new one? There's gotta be a better simpler solution..

[TropicalDiver]

The eligibility statement is in terms of insurance coverage. Not sure under Medicare but most private pay plans do not pay the billed price...for dme, hospitals, docs, etc.

You can always look at CPAP.com for prices. And, if out of pocket, used is a good option.

[LSAT]

I think the DME (supplier) is obligated to use Manufacturers Suggested Retail Price....Phillips and ResMed rules. If you are on Medicare your 20% for a new machine should be in the neighborhood of $150 (or less). Medicare pays much less than MSRP for machines and supplies....Your 20% is based upon the lower number.

[Okie bipap]

The DME will always show you a bill for a ridiculously large amount, but Medicare pays a set amount regardless of what the supplier bills them. You will be responsible only for 20% of what Medicare pays,not what the supplier puts on their bill. Medicare no longer replaces machines after five years. They will only replace a machine if it quits working and costs too much to fix. If your machine quits, you will need to send it in to an authorized repair facility and wait until they determine how much it will cost to repair. If the cost is not too much, Medicare will approve the repair. If the repair cost is too high, they will authorize the purchase of a new machine. Either way, you will be without a machine until either yours is repaired and returned or a new one is purchased. This is why we recommend everyone have a spare machine available for use.

[findingzzero]

Thanks all for the excellent info! Happy holidays!

[D.H.]

Yes, as far I can tell, you should base your decision on your out-of-pocket cost. They don't really pay the price stated.

For instance in 2005 (current plans don't look like this), the preferred DME charged $1500 for the CPAP I wanted, and an internet DME charged $500. My plan covered 90% of the preferred or 70% or the off-plan provider. The on-plan provider was being difficult to deal with, so I got it off plan for (approximately) the same amount. They didn't come to my house, but since it was my second machine, I didn't need their visit.