Medicare CPAP costs

[MrLightRail]

Anyone clue me in on what it would cost to begin CPAP therapy via my Medicare Part C coverage? I did some looking around, and it appears to be 20% of Medicare's cost, but I don't have any dollar figures. I really need to know what my monthly costs would be so I can budget correctly, for the device and supplies. Hoping to find others who are doing the same, and get some roundabout figures on the costs involved.

[RogerSC]

I have Medicare and Medicare Supplement Plan F. Cpap hasn't cost me anything since I've been using these, just paying for Medicare Part B and the Supplement. Don't know about Medicare Advantage Plans (Part C), they all seemed to be different in terms of cost when I looked at them. You should get in touch with your Medicare Advantage Plan provider and see what they say.

[chunkyfrog]

Part C is different from original Medicare, with or without a supplement.
You need to contact your insurance company for those answers, as coverage and costs vary between insurers.
You also need to only use providers and suppliers in network--get a hard copy list.

[Pugsy]

https://www.cms.gov/Medicare/Medicare-F ... edule.html

You will have to do some digging but you can find a close approximation to the allowable amount per Medicare's schedule. It does vary a bit depending on where you live.

You have to search by HCPCS code and here are some common CPAP related item HCPCS codes.
page 4 of this document.
http://oig.hhs.gov/oei/reports/oei-07-12-00250.pdf

I have a Medicare Advantage plan and I only pay 20% of the allowed (per Medicare schedule) for my cpap supplies. Roughly $30 to $40 per mask (depends on the mask).
Check your plan for how it covers the cpap machine because some of the Medicare Advantage plans have a perpetual for life monthly rental. My plan converted to this "perpetual rental" I think 3 years ago.
It used to be a 13 month rental and then a person owns it and no more payments. I won't ever be using my insurance for a cpap machine if they don't change that "rent for life" thing.
Medicare Advantage plans can vary a lot between the companies....so look at your benefits closely.

I think that the bulk of the Medicare Advantage plans out there use the Medicare allowable fee as what they based their allowable amounts on but there's no guarantee that they will..
You need to look at your big thick booklet that explains in detail what is covered and how it is covered.

[idamtnboy]

Anyone clue me in on what it would cost to begin CPAP therapy via my Medicare Part C coverage? I did some looking around, and it appears to be 20% of Medicare's cost, but I don't have any dollar figures. I really need to know what my monthly costs would be so I can budget correctly, for the device and supplies. Hoping to find others who are doing the same, and get some roundabout figures on the costs involved.

What Chunky says. Think of your Medicare Advantage coverage as a regular type of medical insurance policy, because that's what it is. Medicare pays the ins co. to provide you with all of your coverage except hospice care. Therefore you need to contact them to find out what their coverage will provide for CPAP therapy.

[hobbs]

For what it is worth I just signed up for Medicare , B, D and F. From the research I did if you get REALLY sick, you better have F.

[chunkyfrog]

Precisely! I have had four surgeries for my breast cancer and reconstruction this year;
and my Plan F covered everything but my take-home meds. {{--under $20}}
Those premiums don't come close to what they save me most years, but this year, I'm glad to have it.
Using regular Medicare and my plan F supplement ensured me the best, fastest treatment.

[mike1953]

For what it is worth I just signed up for Medicare , B, D and F. From the research I did if you get REALLY sick, you better have F.

original poster cannot get a medigap policy because they are using a Advantage plan. But you are absolutely correct it they have major medical problems in the future they will have a lot of out of pocket expense. Also the Medicare subsidy (paying the Advantage Plan premium) is ending. Meaning those with Advantage plans will have to pay the monthly premium themselves.

[mike1953]

Anyone clue me in on what it would cost to begin CPAP therapy via my Medicare Part C coverage? I did some looking around, and it appears to be 20% of Medicare's cost, but I don't have any dollar figures. I really need to know what my monthly costs would be so I can budget correctly, for the device and supplies. Hoping to find others who are doing the same, and get some roundabout figures on the costs involved.

You need to contact your Advantage plan carrier. No one here can tell you your monthly costs. It is up to your plan.

[LSAT]

I have the AARP Medicare Complete Plan by United Healthcare. When I got my last S9 package which included AUTOSET, Humidifier, tube and case, I paid 12.57 a month for 13 months. I pay 20%..Insurance 80%...That calculates to a payment to DME of $817.05.

[hobbs]

For what it is worth I just signed up for Medicare , B, D and F. From the research I did if you get REALLY sick, you better have F.

But you are absolutely correct it they have major medical problems in the future they will have a lot of out of pocket expense. Also the Medicare subsidy (paying the Advantage Plan premium) is ending. Meaning those with Advantage plans will have to pay the monthly premium themselves.

My problem is the care you may or may not get when needed. I know someone who was on a Medicare HMO who was sent to USC Medical Center for treatment of Cancer and the doctor looked at the chart and asked "why are you here and not at the City of Hope". Fight as he did he never got to City of Hope. The way it was explained to me is when you are working and have an HMO the insurance company gives your group X$ a year for your care, but if you need expensive treatment the group can get more $ from the insurance company. A Medicare HMO gets X$ a year and no more no matter how sick you get and you cannot go out of network. I have a friend fighting with Kaiser right now over a bad outcome after hip surgery. He can walk, climb stairs and drive so they have no incentive to spend more on him.

[RogerSC]

For what it is worth I just signed up for Medicare , B, D and F. From the research I did if you get REALLY sick, you better have F.

original poster cannot get a medigap policy because they are using a Advantage plan. But you are absolutely correct it they have major medical problems in the future they will have a lot of out of pocket expense. Also the Medicare subsidy (paying the Advantage Plan premium) is ending. Meaning those with Advantage plans will have to pay the monthly premium themselves.

Well, what luck! We're in the Medicare open enrollment period, so the OP could change from the Medicare Advantage Plan (a Part C thing) to a Medicare Supplement Plan until December 7. That coverage wouldn't start until Jan. 1, 2016, of course, but they could set that up right now, after doing some research on Medicare Supplement plans.

[chunkyfrog]

Just a note on upgrading your Medicare coverage--you may need to undergo underwriting, a physical, etc.
You get what YOU pay for. (No such thing as "free")
I'd shudder to think where I'd be now if I were in an HMO/"Advantage" plan.
Probably still waiting, --for the ductectomy, insane from worry, etc.
It might not be DCIS, stage zero this late.

[LSAT]

Just a note on upgrading your Medicare coverage--you may need to undergo underwriting, a physical, etc.
You get what YOU pay for. (No such thing as "free")
I'd shudder to think where I'd be now if I were in an HMO/"Advantage" plan.
Probably still waiting, --for the ductectomy, insane from worry, etc.
It might not be DCIS, stage zero this late.

I don't believe there is any underwriting required for Medicare or Advantage plans during the open enrollment period.

[chunkyfrog]

My mother was not permitted to trade up, but that was awhile back.