Experience Transitioning to Medicare

[BoomersRock]

Been on CPAP for many years. I retired this summer. In order to have Medicare pay for my supplies etc, do I need to start from scratch with another sleep study, doctor visit (not sure when I had my last study done)?

[Pugsy]

Not necessarily is another sleep study required. It depends on what kind of sleep study you had originally and are those records still available and if you are using the same DME for masks and other supplies they should have it on file.

Medicare has this question covered on their website for people who have been on cpap prior to becoming of Medicare age.

Give me a little bit and I will see if I can find it and get you a link so you can read up on the requirements.

[BoomersRock]

Thanks Pugsy!

[Pugsy]

This isn't the document I had in mind but it sort of covers the sleep study requirement.
I can't find what I was looking for.
https://www.cms.gov/medicare-coverage-d ... ?NCAId=204

You may need a face to face with your doctor (doesn't have to be a sleep doctor) to document that you still need cpap and use it and it is effective.

You might want to call up Medicare and get the latest most direct and correct information. There's a document somewhere at the medicare website that specifically addresses the requirements that people who are just now getting Medicare but have been on cpap for years...but I can't find it.

Check with your current DME to make sure they are Medicare participating providers too. Not all are especially if you live in a competitive bidding area.

[BoomersRock]

I received a letter from my DME. Although I won’t be back to MA till the spring, the list of Medicare requirements that they listed the one I am concerned with is this: “Medicare also requires a qualifying baseline sleep study, including signed interp.”

I don’t remember when I had last study. If they are requiring a new one, that would really slow things down getting supplies as well as my Airsense 10 needs to be repaired.

I found the Medicare site and they stress using their approved DMEs, but not much else.

[Okie bipap]

This document may answer some of your questions:

https://www.cms.gov/Outreach-and-Educat ... 905064.pdf

[chunkyfrog]

With original Medicare, my only requirement was current, ongoing use,
and documentation of a face to face meeting with my doctor, discussing same.
Of course, all things change.
Contact Medicare for the current rules.

[BoomersRock]

Thanks Okie. That document seems a bit more clearer.

I guess I need to wait till I can see my original respiratory doc this spring. The DME and the Doc’s nurse haven’t been very helpful on what Medicare needed from the doc. Thankfully I have backup mach8nes and supplies to last me till then.

[Neicy]

Hi Boomersrock,

I am also in MA and they are using my original study report and 99 year script from 2011. Switched to Medicare in July of 2016 and had a smooth transition with no problems and no mention of needing a new study. I was already using a supplier on their competative bidding list at the time. The only thing that changed was that my primary insurance became secondary and Medicare became primary for billing purposes. PM me if you need more specific answers.

[BoomersRock]

Thanks Neicy. I am sort of between a rock and a hard place. Came to Florida for the winter, cancelled my follow up with my respiratory doc because it didn’t seem it would do me any good without a new sleep study. Not sure the docs admin much less DME knew what they were talking about re the Medicare. Checked in with DME months before and no indication I had to return to doc before Medicare would pay. So unless I line up a new doc here, Take the chance of having to have another in house sleep study (had two in 12 years), I won’t get supplies until I return to MA.

[Neicy]

Well with the weather we're having here you don,t want to hurry back. I'm seeing -9 F. predicted for Saturday night!