Use My CPAP or the Medicare-Paid One?

[jimolson52]

I'm a US poster who has been CPAP'ing for 6 months using a used Airsense 10 machine bought on Craigslist. When my sleep doctor gave me a prescription no Midwest US DME had any Resmed machines. I know this because I called each of them.

Recently one local DME called saying they had an Airsense 11. I signed the papers and took it, thinking it will make a good back-up when my used Airsense dies. Additionally, I can get my expendables using Medicare subsidy.

I'm bringing my A10 with its SD memory card to my sleep doctor appointments. My AHI score has dropped from 20+ to <0.5, so my doc is pleased.

As long as I keep my sleep doctor happy, am I required to switch to the new subsidized Airsense 11 machine under Medicare reimbursement rules?

My old Airsense 10 is not reporting any data via cellular radio. It's sill configured with the former owner's identity.

[Pugsy]

As long as I keep my sleep doctor happy, am I required to switch to the new subsidized Airsense 11 machine under Medicare reimbursement rules?

You have to keep 2 people happy if you want Medicare to pay for your machine.
Your doctor AND Medicare.
This means that you will need to abide by Medicare's compliance usage rules for Medicare to pay their portion for the 13 months of the Medicare rent to own contract.

Now those rules are fairly simple.
1...you must see your doctor for a face to face meeting prior to the 91st day after starting cpap.
2...you and your doctor must state that "it's working well" or similar wording.
3...You must prove a certain amount of usage within that first 90 days...and that requirement is that you use the machine for at least 4 or more hours for 70% of the nights within a consecutive time frame....or 21 nights out of a 30 day segment within the 90 days. It must be with the machine that Medicare is paying for.
The DME is responsible for telling Medicare that you have use the machine the required number of hours.

After those requirements are met Medicare doesn't really care if you use "their" machine or your own machine bought privately.

[Dog Slobber]

I would switch to the new machine.

Not sure how old or what kind of shape your Air 10 is in, but. If it breaks you no longer have a spare, and have to buy another, if you want a spare.

If you start using your Air 11 and it fails (less likely), you can get it replaced under warranty and will still have your primary, with a spare.

[jas32]

Like someone else said, use the new machine. If Medicare is paying for it, they want to see compliance reports, meaning they want to make sure it’s being used a minimum 4 hrs per night, etc., otherwise they will take it away from you. I have Medicare advantage when I turned 65 and got a new machine. I was paying a copay for 13 months after which the machine was mine. At that point I could do whatever I want with the machine.

[chunkyfrog]

. . .
Medicare advantage when I turned 65 and got a new machine. I was paying a copay for 13 months after which the machine was mine.
. . .

Not all Advantage plans are this liberal--many have perpetual rental; but may include replacement or repair in case of failure.
Know what your plan covers, and what YOUR expenses are in the future.

[No snore]

Use the AS11 and keep the AS10 as a back up. Everyone needs to have a back up machine, as well as other supplies.