DMEs

[lrob123]

I don't know if this is getting too off-topic (if so, please ignore this question), but Pugsy it would be helpful if you could explain why "the supplement would cost me an arm and a leg because I got Medicare prior to age 65. I am 68 now but the fact that I got on Medicare prior to age 65 is baggage I will carry my entire life and the prices for supplements are sky high for me."

I'm getting close to that age and am wondering why going on Medicare prior to age 65 continues to hurt you at age 68 and beyond? Is there an aspect of Medicare that is something like Social Security where if you take it early, it permanently lowers the benefit amounts thereafter? Are you 'safe' from whatever this problem is if you start Medicare at 65, or is there a benefit to waiting longer like I think is true for Social Security?

Medicare sounds complicated! I will have to learn all about this within the next few years. I wish we had Medicare for all, the same for everyone and all doctors/DMEs, but simplified, not several tiers for haves and have nots e.g. part D/B/Advantage/gap whatever those are.

[Pugsy]

I don't know if this is getting too off-topic (if so, please ignore this question), but Pugsy it would be helpful if you could explain why "the supplement would cost me an arm and a leg because I got Medicare prior to age 65. I am 68 now but the fact that I got on Medicare prior to age 65 is baggage I will carry my entire life and the prices for supplements are sky high for me."

I'm getting close to that age and am wondering why going on Medicare prior to age 65 continues to hurt you at age 68 and beyond? Is there an aspect of Medicare that is something like Social Security where if you take it early, it permanently lowers the benefit amounts thereafter? Are you 'safe' from whatever this problem is if you start Medicare at 65, or is there a benefit to waiting longer like I think is true for Social Security?

Medicare sounds complicated! I will have to learn all about this within the next few years. I wish we had Medicare for all, the same for everyone and all doctors/DMEs, but simplified, not several tiers for haves and have nots e.g. part D/B/Advantage/gap whatever those are.

The short version is that for traditional supplement policies....those medigap plans that pay after Medicare pays...they don't really want people who got on Medicare prior to age 65 so they price them very high. They only want healthy people and if you went on Medicare prior to age 65 they assume you aren't very healthy. They can't deny the coverage really but they can sure make it costly to get.
Medicare doesn't cost me any more than anyone else but the Medigap plans in the area where I live, are quite pricey for me if I wanted to get one. In my area there is a question "when did you go on Medicare"...and when it works out prior to age 65 you get a different rate structure.
Last I checked it was roughly 300 a month for a medigap supplement. Someone going on Medicare at age 65 and getting a supplement...they won't be charged 300 a month. That's what I meant. That "when did you go on Medicare" question will haunt me forever.
It has nothing to do with Medicare itself or my Medicare coverage though.. It's just those insurance companies only wanting to insure "healthy" people and they assume that someone who got Medicare prior to age 65 aren't healthy. This is only the supplemental policies. There was a time when I had Medicare only...it paid like it pays for everyone else.

Now it might be different in other areas of the country but that's the way it is where I live. And some counties you can do one thing or get something and the next county over you can. Big mess really.

I am okay with it though. The Medicare Advantage plan works out nicely for me. It includes all the meds I take and they cost me next to nothing and in the event I have something happen that is a rather large expense or could be...it's not that bad.
A few years ago I fell and broke my wrist...bad enough to require surgery. I added up all my out of pocket expenses that my Advantage plan said was my share to pay and it totaled $769. That's the ER visit and the specialist visit and the surgery in the surgery center.
If I had bought a medigap plan that year at 300 a month...that's 3,600 for the year. I still saved money on the deal and that was my worst year ever in terms of health costs out of pocket. My next worst year was $400 out of pocket for some special joint injections done in the surgery center. My PCP doctor visits...$5 this year...last year they didn't cost anything. That's okay...I see him only 4 times a year.
Next year they might go back to no PCP fee or they might raise it a little...doesn't matter.
I figure I have saved over 36,000 for sure out of pocket expenses over the last 10 plus years and spent maybe 2,000 total out of pocket.
I am way ahead of the game in my book.

Now if I was in bad health and looking at a lot of hospital stays...that's where the Advantage plan isn't so nice but even then it has a cap on out of pocket expenses. The cap isn't that much more than what a traditional medigap policy would cost me over that year. It's a risk that I assume....so far I have been betting I won't need that extra coverage and winning the bet.

Now someone not in my shoes (or living where I live) that goes on Medicare at the age 65....different story in terms of costs and risks and that's why people have to put a pencil to it and look at their overall health.
I pay nothing for my Advantage plan a month...nothing...it includes excellent medication coverage. $3 a month for each of the meds I take regularly which is really only 3.

So don't feel sorry for me whining about having trouble getting the Bleep ports covered....my choice to use them and if it took food off my table I could use something else. It doesn't though. I bitch just because the lazy ass DME makes it so difficult for me to get something my insurance would pay for. I still have that Medicare insurance amount coming out of my Soc Security check (long complicated story about who actually gets that amount when someone uses an Advantage plan) each month just like everyone else. I still pay for my insurance in that regard. I would kinda like to use it since I pay for it and I bitch when I can't because of a lazy DME. My insurance would pay for it...the DME just won't order it.

If I was on traditional medicare...that same amount would come out and I would need some sort of medigap plan and probably a part D drug plan....both would cost extra on top of the monthly amount coming out of my check to pay for Medicare.
So I opt for the Advantage plan where all I pay is that monthly Medicare deduction from my check.... and save the cost that a medigap plan and/or part D plan would cost me by having it included in the advantage plan.

[Janknitz]

Pugsy, I didn't know about your insurance background. I bow to your expertise!

The short version is that for traditional supplement policies....those medigap plans that pay after Medicare pays...they don't really want people who got on Medicare prior to age 65 so they price them very high. They only want healthy people and if you went on Medicare prior to age 65 they assume you aren't very healthy. They can't deny the coverage really but they can sure make it costly to get.
Medicare doesn't cost me any more than anyone else but the Medigap plans in the area where I live, are quite pricey for me if I wanted to get one. In my area there is a question "when did you go on Medicare"...and when it works out prior to age 65 you get a different rate structure.
Last I checked it was roughly 300 a month for a medigap supplement. Someone going on Medicare at age 65 and getting a supplement...they won't be charged 300 a month. That's what I meant. That "when did you go on Medicare" question will haunt me forever.
It has nothing to do with Medicare itself or my Medicare coverage though.. It's just those insurance companies only wanting to insure "healthy" people and they assume that someone who got Medicare prior to age 65 aren't healthy. This is only the supplemental policies. There was a time when I had Medicare only...it paid like it pays for everyone else.

Now I'm confused! If you turn 65 and you choose a Medigap supplement during your initial enrollment period, they aren't underwriting you.

But can they do it if you already have a Medigap before age 65??? I thought you could switch to any equal or lesser original plan without underwriting in open enrollment unless you're on an advantage plan. Or is that specific to your state?

[Pugsy]

Now I'm confused! If you turn 65 and you choose a Medigap supplement during your initial enrollment period, they aren't underwriting you.

But can they do it if you already have a Medigap before age 65??? I thought you could switch to any equal or lesser original plan without underwriting in open enrollment unless you're on an advantage plan. Or is that specific to your state?

Back when I sold insurance and medigap policies .. (both pre and after the selling of the alphabet plans)
there were very few companies selling any gap coverage to people under 65 with Medicare. Most companies simply didn't even offer it (and the one that did was cost prohibitive for most people) but then came the alphabet plans and things got a little tougher for the insurance companies and they had to come up with all those standardize plans. They are still targeted to age 65 or above first getting on Medicare..not so much for the under 65 people.
In the state that I live in there is a question "when did you get Medicare"...and for most people it means nothing when they got it at age 65 or later...in reality it's a screening tool for insurance companies and if someone puts down a year that adds up to meaning getting Medicare prior to age 65 it triggers a different rate structure and opens up a whole new can of worms. It's not fair but no one ever said insurance companies were fair.
So yes...some underwriting is still involved for people like me.

For years I went along happily with Medicare only because I really didn't need a medigap policy. What little expenses I had rarely even met the part B deductible and it wasn't a big deal. No hospitalizations or anything like that....
I went on Medicare in 2005 I think it was...then in early 2009 the probability of sleep apnea reared its ugly head and I knew I was looking at some probable significant out of pocket expenses what with sleep studies and all that and the 20% of some big numbers.
So I beat feet to my insurance buddy friend (used to actually be in partnership with him back when I sold insurance) and we discussed my options. I still wasn't age 65 at that time....the only insurance company selling any medigap plans (even the alphabet plans) to anyone under age 65 was a company charging $375 a month. I forget which plan that was...didn't matter once my friend explained that the Advantage plan would take me and no pre existing conditions and I would have coverage for that up coming sleep study and all that.
I happened to be in his office on the last day for open enrollment for that company...Feb 28, 2009. Cost was back then I think $21 a month and included meds and all that. Over the years it changed monthly fees and coverage and I changed every year if it was more cost effective for me to change.

Fast forward to 3 years ago when I turned 65...and when it came time to evaluate during open enrollment options again...and we looked at traditional medigap plans instead of the advantage plans....the rate structure in my state still allowed for a higher rate since I had been on Medicare for several years. I forget exactly how much it was but it was over twice what it would have been if I had just turned 65 and just went on Medicare. Duh....lets see pay nothing per month and sometimes pay 20% of the allowed amount for my cpap stuff and have my meds covered....or pay well over 200 a month just so the insurance pays the 20% and I have to buy a Part D as well.

In my state and county...my being on Medicare prior to age 65 has branded me...now it is entirely possible that in another state or county...different story but it is what it is for me now. In Missouri not all plans are available in all counties nor at the same rates if they are available. Big frigging PITA mess and makes me glad I don't sell insurance anymore. I let my friend take care of it because he is like family and I know and trust him completely to advise what is in my best interest. He makes nothing at all when we change plans.
If things change I can always opt back in to regular Medicare and get a traditional medigap policy if I wish but so far my gamble and assuming the big risk if it should happen (mainly hospitalization co pay) has worked out to my advantage.

In the meantime I shop around every open enrollment period for whatever is the cheapest and covers what I need. It's worked well for me the last 11 years or so and I figure I have saved a boatload of money and had actually very little out of pocket expense.
I let my friend handle all the rules and regulations changes that I don't have to keep up with now. It was a pain back when I was in the business.....and I always kid him every time I change plans "this is what you get paid the big commissions for" and we both know he gets nothing beyond a tiny renewal commission when I change plans. The only real substantial commission comes with the first sale...renewals are pennies no matter if it is a change in plans or not.

If my health changes (or my mom's who I also have on an advantage plan) where it looks like traditional medicare and medigap would be a better financial choice...he has assured me that there are ways to make the change through an appeal process if we need to within a certain time frame even after open enrollment is over. Probably more for my mom than myself since she didn't go on Medicare until after age 65 but at her age now...88...those alphabet plans are pretty pricey. So we would still have to sharpen the pencil a bit to figure it all out. For me unless they change the rate structure for those people who got Medicare prior to age 65....it's probably never going to be an advantage for me to go traditional.
Or maybe if someday I move elsewhere and the rate structures are different but for now I have no plans to move.

[Deborah K.]

Hey, I'm so happy! I hired Aeroflow as my new DME and they are getting me the Bleep set up as well as taking over all my other pap supplies. Yay! Aeroflow has so far been really nice to work with, so I expect good things.

I emailed Stuart about where to get the new tube he has designed and the diffuser device. He is sending me both items himself, and I should have them by Monday! I can't believe it. He is a delight to work with and so generous. I have wanted to try the Bleep for a long while. I have read all the reviews on it on this board and elsewhere, plus every discussion I could find to read about it. I have high hopes that this will be a great maskless mask for me.

Can you tell I'm excited?

[Pugsy]

I so hope it works out well for you. If you run into trouble...contact me or heck even Stuart. That phone number for contact on his website is his personal cell number. If you can't find it...let me know and I will give it to you if you need or want it.
He is a real sweetheart isn't he? The new hose and diffuser just went public this week as a combination connector kit and next week the diffuser is going public all by itself.
The old hose wasn't bad but it was shorter and a problem for some people and not as flexible (but it was far from stiff) as this new longer more flexible hose. I really didn't have a problem with it all that much myself but I do really appreciate this new hose and I sent my P10 hose to Khauser to use because he was having a problem with the shorter hose. So I have been using the new longer hose for a little while. I was part of a demo testing trial of it not long ago and was supposed to return the demo stuff...then Stuart said just wait...so I stole it out of the box I was going to return when I mailed Khauser my P10. I think he will forgive me. I could have gone back to the shorter hose but I was kind spoiled.

I need to get off my lazy butt and see if the new supplier that takes insurance is in network for my insurance but right now I have to figure out who is going to do my taxes. As usual I have waited till the last minute (we always have to pay) and the person who used to do it retired...So I gotta get that sorted out first. I supposed I could do them myself but I just don't want to.

I sometimes use the P10 when it looks like I might have a bad night for some reason or a short night and I want to save the ports...or if I have a snotty nose because I know they won't stick. The P10 is nice enough but I just don't sleep as well with it as I do the Bleep.

The Bleep is a little fiddly at first. Be sure and watch all Stuart's videos as they will help.
I haven't done the hose buddy hanging thing....really I haven't felt the need. All my years on cpap I just haven't had a problem with the way I route the hose. So I figure if it ain't broke I don't need to fix it. Once the Bleep goes on and I lay down...it all pretty much disappears and I don't really feel like I have anything on my face. Doesn't pull or tug on my nose or anything like that.

Clean your face good...then use some alcohol for last step to remove as much of anything that is left. Be careful with whateverliqui you are using as soap. Khauser was using a really nice liquid soap but we figured out it some fragrance oil in it and that along with facial oils and alcohol...it wouldn't come off well enough. He's got really oil skin and the adhesive would fail in the middle of the night.

If you want to just a nighttime moisture cream....just don't put it up where the adhesive ports will be going. That's what I do....stick the ports on and then apply my night cream avoid the adhesive parts. Next morning when I take them off I add a bit of moisturizer on that area.

Here's my usual routing after the cleaning.
1...trim the adhesive a little because I don't need them quite that long. Save the trimmed off piece in case you get a wrinkle in the adhesive...those wrinkles can let air escape and it's highly annoying....so you put one of those little trimmed off pieces over the end of the wrinkle.
2...then after the ports are stuck on I take the end of my fingers and block the hole and blow through my nose to check for leaks.
3...then I attach the connector part to the port opening. This was always where I had the most problem. Sometimes you just don't hear all areas click in because it goes so fast. I used to do it facing a mirror and doing it backwards in the mirror was a bit weird for me so I got to where I didn't look in the mirror and just connected them without trying to look.
4...once connected I take the palm of my hand and place it over the end of the hose and try to breathe in or out.....If you don't have the ports connected completely you will know it because air will leak out and you most likely will not only hear it but feel it as well.

Good luck...keep me posted and don't hesitate for one second if you run into trouble or have a problem to ask for help.

[Deborah K.]

Thanks for all your advice Pugsy! I very much appreciate it. I have watched all of Stuart's (and some other peoples') videos, so I think I have a pretty fair idea of how to handle the fiddly-ness of the Bleep. I expect it will take some getting used to - not so much the actual use of the device, more the oddness of putting it on correctly. And yes, I agree about Stuart. He is a dream to deal with. He was simply delightful and so very helpful to talk with in emails.

I also enjoyed Lanky Lefty's half hour review of the Bleep. He too provided lots of useful advice. His final assessment was that if every mask cost five bucks then this would be the best one to buy - no brainer.

[Pugsy]

I also enjoyed Lanky Lefty's half hour review of the Bleep.

Isn't Jason a hoot. I had my husband watch that review and he was laughing his ass off and saying it "almost" made him want to try the Bleep. You would have to know my husband...he won't even touch my mask. I guess he's afraid he will catch OSA if he touches it.
Some years ago he asked me what it felt like to have the nasal pillows against my nose and I offered to show him....OMG...no way in hell would he even put one in his hand. Funnier than all get out.

Yes...the attaching process is the most fiddly but with time and experience it becomes second nature.
I can do it all in less than 10 seconds now and only look in the mirror for initial adhesive placement so I can get the holes centered properly. I can't yet do that without looking.

Stuart is a really nice man...and we all know he wants to sell his Bleep but even above that...he wants people to be successful with cpap therapy no matter what mask they use and if the Bleep isn't the best choice for a person he knows that it isn't for everyone for any number of reasons.
But if someone really wants to make the Bleep work for any reason and they are having problems making it work......he will bend over backwards in an effort to figure out some way to make it work.

[Deborah K.]

"I need to get off my lazy butt and see if the new supplier that takes insurance is in network for my insurance..." Pugsy

Pugsy,

I talked with Jim Pencak at Aeroflow (800-480-5491, extension 3379) and HE contacted my insurance and my doctor for me to get the approval (insurance co) and prescription (doctor) to get everything going for me. I didn't have to do a thing. I thought I'd have to at least contact my prior DME, but he said Nope; I didn't have to talk to them at all. What I'm saying is that switching, which I thought would be a pain in the neck, ended up being a piece of cake. Probably it would be for you too.

[Pugsy]

"I need to get off my lazy butt and see if the new supplier that takes insurance is in network for my insurance..." Pugsy

Pugsy,

I talked with Jim Pencak at Aeroflow (800-480-5491, extension 3379) and HE contacted my insurance and my doctor for me to get the approval (insurance co) and prescription (doctor) to get everything going for me. I didn't have to do a thing. I thought I'd have to at least contact my prior DME, but he said Nope; I didn't have to talk to them at all. What I'm saying is that switching, which I thought would be a pain in the neck, ended up being a piece of cake. Probably it would be for you too.

Yeah, I know....I went through it with Nationwide to find out my insurance plan is out of network...and I suspect it will be with Aeroflow as well. I got a weird little half assed HMO hybrid kind of plan...So once I find out that it's out of network then the real work begins to appeal to my insurance to make an exception since current DME is being a butthead and won't supply it out of greed and laziness.
I could change plans this fall...and I might do just that but I have to put a pencil to things. A plan that is in network might cost me more somewhere else in coverage or monthly premium than the Bleep out of pocket ends up costing.

Just got a lot of other irons in the fire right now. You know how it goes.

[tlohse]

I have used Lincare and Aerocare. Both are okay.