New CPAP user, a few questions

[Steerpike58]

Hi Everyone!

I was recently diagnosed by my doctor as having 'severe sleep apnea' (30.5 episodes), based on wearing a 'WatchPat' device for one night. Last week, I was given a CPAP machine by my sleep specialist for a week as a trial (ResMed AirSense 10 AutoSet). I'm coming to the end of that trial now, and will be seeing the sleep specialist again tomorrow. I need to prepare for that meeting to make the most of it. I was given both a 'nasal' mask, and a 'nose/mouth' mask. I've found that I can use the nasal mask somewhat successfully, so I don't appear to be 'mouth breathing'. I tried the 'nose/mouth' mask but didn't find it as easy to wear.

To my surprise, the noise is not bad, the hose doesn't get in the way, and I'm able to comfortably lie on my side - so that's all good!

However, a serious problem seems to be, I'm finding my nose is very dry, to the point where I feel my nose 'wheezing' and struggling to pass air. I note that they did not give me a humidifier attachment, and didn't even mention such a possibility during the initial consultation. So I feel pretty sure that I need to request a humidifier, and extend the trial another week.

Another issue I'm finding is, my nostrils are generally getting clogged/blocked. This has been a problem for some time, and I've been using a NeilMed Sinus Rinse bottle, and 'BreathRite' strips to help with this, but the CPAP machine is making the situation worse (I'm not currently experiencing allergies). The extreme drying from the machine is making the blockage worse, and I can no longer wear the 'BreathRite' stips because they interfere with the seal on the mask around the nose. Do I need to be pursuing my 'nasal blockage' as a separate issue with my doctor or should I expect my sleep specialist to take this into consideration? (If the air can't get past my nostrils, what good is the CPAP machine?)

I'm also noticing a desire to 'burp' up air. The scenario is this - I woke up this morning, with the CPAP going full-force at about 15 cm. My mouth was fully closed. Every few minutes, I got the urge to 'burp' (exhale) air that was - presumably' - getting into my stomach. Does this indicate excess pressure? Of course, each time I open my mouth to allow this air to escape, I run into the problems of having an open mouth, which is not fun when you are wearing a nasal mask.

On a separate matter, I have read the Newbie information page, and some of the Wiki, but I was confused by one seemingly obvious issue - AHI. On this page - wiki/index.php/Apnea_Hypopnea_Index it says:
---------------------------------
AHI (Apnea Hypopnea Index) is the number of apneas and hypopneas per hour. Or an index for sleep apnea. 5-20 mild, 21-50 moderate, above 50 severe.

Then, same page - Good AHI vs. Bad AHI
Less than 5 events (apnea or hypopnea) per hour is considered normal. 5 or more events per hour is considered Mild sleep apnea 15+ considered Moderate 30+ considered Severe
----------------------------------
I was told my my doctor that my 'AHI' was 30.5 and called it 'Severe', and that's borne out by the second item above, so what is the reference to 50 being severe? Seems like the page is defining AHI twice with two scales. I'm obviously mis-reading the page, but I can't make sense of it!

Thanks for your interest and help!

[Rock Star]

By all means request a humidifier. Also insist on an *Auto* cpap it will give you more pressure options. Oh and check the most popular cpaps and masks at cpap.com

[Rock Star]

I'm also noticing a desire to 'burp' up air.

Follow the thread linked here for ideas on swallowing air.
viewtopic/t187007/Aerophagia-and-low-pr ... sleep.html

[Respirator99]

An AHI of 30 or above is usually considered severe, eg: https://www.hopkinsmedicine.org/health/ ... 20and%2030

Obstructive sleep apnea is classified by severity:

• Severe obstructive sleep apnea means that your AHI is greater than 30 (more than 30 episodes per hour)
  Moderate obstructive sleep apnea means that your AHI is between 15 and 30
  Mild obstructive sleep apnea means that your AHI is between 5 and 15

I suspect the reference to AHI > 50 being severe is either a typo or based on some report or other that is not in accordance with usual practice.

In any case, AHI is a pretty rough measure of how badly you are affected by apnea. It ignores factors such as the duration of events and how they are clustered. Take it as a guideline only.

[Steerpike58]

By all means request a humidifier. Also insist on an *Auto* cpap it will give you more pressure options. Oh and check the most popular cpaps and masks at cpap.com

Thanks for the feedback. The machine they gave me was "ResMed AirSense 10 AutoSet". From what I'm reading and seeing about it, it's a pretty decent machine. It has a 'ramp up' feature, which either detects the onset of sleep (or, simply waits a while?), then ramps up from a low pressure (4.0) to 'anywhere between 5 and 20' (not sure if this is a pre-set amount determined by the sleep specialist, or dynamically adjusted by the machine based on what it senses in real-time); in my case, I noticed, circa 15 the one time I woke up and paid attention.

I see that it also has 'EPR' - "Expiratory pressure relief (EPR™) maintains the optimal treatment for the patient during inhalation and reduces pressure during exhalation." (that's from their marketing blurb). Reading other posts here on CPAPtalk, it sounds like EPR is an attempt to emulate, in part, 'bipap' functionality, presumably not as successfully and presumably at lower cost.

Would you call the "ResMed AirSense 10 AutoSet" an 'Auto' Cpap?

I'll be on medicare very soon (about to turn 65); I've heard that there is some coverage for CPAP machines. Do they typically let you choose any machine you want, and they make a fixed contribution, or if you want their contribution then do you have to stick to a limited range of models?

Thanks again!

[Steerpike58]

As mentioned above, the initial diagnosis was made with just one night's wearing of a 'WatchPAT device at home - I believe it was the WatchPAT 300. Also, while some online brochures suggest the WatchPAT has an 'extension' that attaches to the body for additional measurements, mine only came with the 'finger module'. Based on that, just how accurate is a WatchPAT supposed to be? They've now given me a trial with a CPAP machine, but I'm assuming that machine isn't able to do much analysis of my condition - won't measure oxygen levels, etc? Or does the CPAP machine do a good job of analyzing my condition?

Thanks!

[GrumpyHere]

Yes, the AutoSet is an “Auto”. It allows for lower pressure levels when you don’t need the extra support -> less aerophagia, the air swallowing you’re experiencing.

PATWatch is good enough for screening - your diagnosed AHI of 30.5 is far from the margins so that you needn’t worry about its accuracy.

The AutoSet doesn’t analyze your untreated condition. It can provide data of its treatment. There isn’t a blood-ox sensor by default. The ResMed sensor is very expensive. If you’re interested in your ox-levels, there many other option. Keep in mind that you can experience apneas without measurable blood-ox changes (with affordable sensors anyways.)

Ramping is a comfort feature. Many of us don’t find it unnecessary. During that phase the treatment algorithm isn’t engaged so no data is collected.
It CAN be of help for some people.

The starting pressure of 4 cm is uncomfortable for many because it feels like you’re not getting enough air. The usual suggestion is to start with 6-7 cm even with ramping.

With OSCAR software you can figure out where to set the treatment pressure so the AutoSet can best treatment your apneas.

But priority one is getting used to/finding the comfortable mask. It is the main reason why people give up on CPAP treatment. There are gazillion mask choices out there.

Good Luck.

[Respirator99]

By all means request a humidifier. Also insist on an *Auto* cpap it will give you more pressure options. Oh and check the most popular cpaps and masks at cpap.com

Thanks for the feedback. The machine they gave me was "ResMed AirSense 10 AutoSet". From what I'm reading and seeing about it, it's a pretty decent machine.

Yes, it's a very good machine. An old design but very competent and reliable.

It has a 'ramp up' feature, which either detects the onset of sleep (or, simply waits a while?), then ramps up from a low pressure (4.0) to 'anywhere between 5 and 20' (not sure if this is a pre-set amount determined by the sleep specialist, or dynamically adjusted by the machine based on what it senses in real-time); in my case, I noticed, circa 15 the one time I woke up and paid attention.

The ramp will start at a low pressure and gradually increase until it reaches your minimum set therapeutic pressure. Depending on the mode, it will either try to determine when you fall asleep (your breathing becomes more regular) or it ramps up over a set number of minutes. As Grumpyhere mentioned, too low an initial setting can leave you feeling starved for air. While the ramp is in operation, there is no detection of apneas or hypopneas. The standard recommendation is to do without ramp if you can, but to keep the ramp time as short as possible otherwise. The default period is 45 minutes, which is far too long for good therapy.

I see that it also has 'EPR' - "Expiratory pressure relief (EPR™) maintains the optimal treatment for the patient during inhalation and reduces pressure during exhalation." (that's from their marketing blurb). Reading other posts here on CPAPtalk, it sounds like EPR is an attempt to emulate, in part, 'bipap' functionality, presumably not as successfully and presumably at lower cost.

Not really. While there is some overlap in the capability of EPR and bilevel they are trying to achieve different ends. EPR is essentially a comfort feature, to be used if you find it difficult or uncomfortable to exhale against the pressure. Bilevel achieve this, but various types of bilevel machines are optimised for particular conditions such as COPD or central apnea. EPR lowers your exhale pressure, and it's the exhale pressure which protects against apnea. So it's a good idea to increase minimum pressure if invoking EPR.

Would you call the "ResMed AirSense 10 AutoSet" an 'Auto' Cpap?

Yes

I'll be on medicare very soon (about to turn 65); I've heard that there is some coverage for CPAP machines. Do they typically let you choose any machine you want, and they make a fixed contribution, or if you want their contribution then do you have to stick to a limited range of models?

Sorry, I can't answer that one.

[SleepGeek]

I'll be on medicare very soon (about to turn 65); I've heard that there is some coverage for CPAP machines. Do they typically let you choose any machine you want, and they make a fixed contribution, or if you want their contribution then do you have to stick to a limited range of models?

Sorry, I can't answer that one.

afaik Medicare requires 120 min of diagnostic. IF you get your cpap before medicare you may have to do another sleepstudy that meets their requirements for them to cover your supplies or just buy them on Amazon.

Also beware there is the Original Medicare (which I think it is better) covers 80% and doesn't care which brand your products are. Then there are the many Medicare *Advantage* plans which claim to save you money BUT restrict which products they will cover.

I find that to be a Dis-Advantage since something I'm using and happy with may not be covered by an *Advantage* plan. Also some *Advantage* plans require you to change plans should you move to another county or only cover ER visits when you travel.

Original Medicare will cover you anywhere in the US. If someone has used it outside the US I'm sure they will chime in.
Get yourself a Medicare Co-Pay plan and you won't have and Co-Pays - as long as Medicare pay they will cover the 20%.

[Steerpike58]

Last night (the last night of my trial) was the worst yet, by far. My nose was fully blocked in one nostril, and rinsing with 'NeilMed' nasal rinse wouldn't unblock it. I put on the mask, and - as people have helpfully pointed out here - the 'introductory' setting of '4' was not sufficient to give me enough air. Regardless, I soldiered on (I was determined to complete the trial!) and did what I would call 'flaring my nostrils' to try to get as much air as possible through them, which helped, but - I could not fall asleep doing that so it was a struggle. I probably drifted off at some point, because I noticed the CPAP machine had kicked into a higher setting (around 11, I saw on the screen) but now, while the forcing of air into my nose was good, the restriction on exhaling was troublesome. I found that side-sleeping was easier than back-sleeping, but still I couldn't get to sleep, and after about 90 minutes, I ripped it off in despair and gave up.

Note - I don't have access to the settings on the device so I can't change the initial value or ramp time (as far as I can tell; this seems to be 'locked' by the sleep center).

Should I be pursuing this 'blocked nose' phenomenon independently do you think? It's a similar feeling to how you feel when you have a cold, or allergies, but right now I am not feeling any allergies at all; my nose is simply blocked. The blockage moves from one side to the other through the night, seemingly under 'gravity' depending on what side I sleep on. But it always feels like one nostril or the other is blocked.

[ChicagoGranny]

I'll be on medicare very soon (about to turn 65); I've heard that there is some coverage for CPAP machines. Do they typically let you choose any machine you want, and they make a fixed contribution, or if you want their contribution then do you have to stick to a limited range of models?

Medicare does cover CPAP machines.

Contrary to another comment in this thread, WatchPat diagnostic studies are accepted by Medicare.

In its announcement, Itamar Medical was pleased to have found that the CMS singled out the Watch-PAT and distinguished it from others by creating a special category to fit this unique technology. Medicare will not cover devices that are considered to be Level IV devices with one or two channels. This means that physicians will be reimbursed by Medicare for using the Watch-PAT to diagnose obstructive sleep apnea in Medicare beneficiaries and for any subsequent CPAP therapy ordered based on the Watch-PAT results.https://www.meddeviceonline.com/doc/wat ... luded-0001

I was told my my doctor that my 'AHI' was 30.5 and called it 'Severe', and that's borne out by the second item above, so what is the reference to 50 being severe?

This is the kind of thing I don't worry about. You have sleep apnea. Your mental and physical health could benefit greatly from CPAP. Even people with an AHI of 10 are unhealthy enough that they could benefit greatly from CPAP.

The extreme drying from the machine

Definitely get an integrated CPAP humidifier. Start out with a moderate setting. You might have to do trial and error at lower and higher levels to find what is right for your case.

Another issue I'm finding is, my nostrils are generally getting clogged/blocked.

If this continues after you have the humidifier settings optimized, get a referral to an ENT. There are several things they can do to help.

then ramps up from a low pressure (4.0) to 'anywhere between 5 and 20' (not sure if this is a pre-set amount determined by the sleep specialist, or dynamically adjusted by the machine based on what it senses in real-time); in my case, I noticed, circa 15 the one time I woke up and paid attention.

Find some videos on youtube about getting into the clinician's menu and the reports that are on the machine display. All of the regulars here control their own settings using OSCAR as a guide. I will not let any medical professional touch my machine settings.

I note that they did not give me a humidifier attachment, and didn't even mention such a possibility during the initial consultation.

Assholes. Humidifiers should be standard issue. My trust of that provider fell 98%.

[Pugsy]

Note - I don't have access to the settings on the device so I can't change the initial value or ramp time (as far as I can tell; this seems to be 'locked' by the sleep center).

Well....actually you do have the power to unlock it and it isn't difficult at all but since last night was the last night of the trial it is a moot point but for future reference...you just have to know which combination of buttons to push to get into the clinical menu where you can change anything you want.

If your permanent machine is another ResMed AirSense 10 model.
See this provider manual for the secret handshake to get into clinical setup mode.
https://www.respshop.com/manuals/ResMed ... %20her.pdf

If you happen to get the later model ResMed AirSense 11 model
https://media.resmed.com/sites/3/202106 ... ER-ENG.pdf

(If the air can't get past my nostrils, what good is the CPAP machine?)

People use their mouths to get the pressurized air into the airway. There are 2 ways....air up through the nose and down the airway or in through the mouth/oral cavity and down the airway.

Should I be pursuing this 'blocked nose' phenomenon independently do you think? It's a similar feeling to how you feel when you have a cold, or allergies, but right now I am not feeling any allergies at all; my nose is simply blocked. The blockage moves from one side to the other through the night, seemingly under 'gravity' depending on what side I sleep on. But it always feels like one nostril or the other is blocked.

Google "nasal cycle" and see if maybe is part of your issues with congestion.
https://en.wikipedia.org/wiki/Nasal_cycle

Where are you located?

Lack of adequate humidity from the machine could be making the congestion worse.

[Steerpike58]

Thanks everyone for your great input! I'll put all my responses in one post in case it helps ...
==================================

...
The AutoSet doesn’t analyze your untreated condition. It can provide data of its treatment.

Is this pretty typical or do some machines also analyze the condition? If so, can you give me just one sample machine to read further on?

I've been reading here that there are various elements to the problem - central apneas, regular apneas, hypopneas, etc. Will my sleep specialst be able to see which of these (how many) I'm experiencing with the ResMed Airsense 10 Autoset? If not, how will my condition be diagnosed if all I started with was a WatchPAT session and a composite AHI of 30.3?

...
But priority one is getting used to/finding the comfortable mask. It is the main reason why people give up on CPAP treatment. There are gazillion mask choices out there.
...

I found both masks I was given (F&P Vitera for 'full face' (referred to as 'Simplus' in paperwork), and 'ResMed Airfit N20' for nasal mask) to be surprisingly comfortable, from a pure 'fit' perspective. I did notice that, with the full face Vitera, at high pressures, there was a constant 'whistle'/'whine' with air escaping around the seal, no matter what I did with the straps (but that could be an excessive pressure thing). (I generally have smooth skin, no beard). Neither mask did well with my 'breathRite' strips, but that seems somewhat understandable.

==========================

...afaik Medicare requires 120 min of diagnostic. IF you get your cpap before medicare you may have to do another sleepstudy that meets their requirements for them to cover your supplies or just buy them on Amazon.

Re: Buying on Amazon - I've read that you need an Rx for a CPAP machine, but then, I'm guessing that with the wonders of 'the internet', that's fallen by the wayside somewhat? (I buy eyeglasses online and there's no official Rx involved any longer). So can I just go ahead and buy the machine and supplies on Amazon without an Rx ?

Also beware there is the Original Medicare (which I think it is better) covers 80% and doesn't care which brand your products are. Then there are the many Medicare *Advantage* plans which claim to save you money BUT restrict which products they will cover.

I'm sure this is a loaded question, but at least superficially, I'm assuming there's a huge range in price of different CPAP machines; would 'Original Medicare' stump for 80% of 'any' choice, or would there be some caps involved? I can't imagine they'd stump for a 'Mercedes' version, for example, if a 'Chevy' version is available. I'm a techie nerd and would likely go for a machine with a lot of features, which would probably push the machine above what some might call 'reasonable'!

I find that to be a Dis-Advantage since something I'm using and happy with may not be covered by an *Advantage* plan. Also some *Advantage* plans require you to change plans should you move to another county or only cover ER visits when you travel.

Original Medicare will cover you anywhere in the US. If someone has used it outside the US I'm sure they will chime in.
Get yourself a Medicare Co-Pay plan and you won't have and Co-Pays - as long as Medicare pay they will cover the 20%.

Thanks for the general advice on Medicare; I'm working my way through all that mess currently. My partner is already on Medicare, and has an MA plan and couldn't be happier (and has had quite a few 'encounters'!) but I need to look into all aspects. I no longer spend long periods away from home base, and I buy travel-specific plans when I go overseas.

===================

...
If this continues after you have the humidifier settings optimized, get a referral to an ENT. There are several things they can do to help.

Yes, that sounds like a plan. I'm using Kaiser in NorCal for the first time ever this year, and they seem pretty stingy with referrals but - having said that - at least my doctor did get me set up with the 'WatchPAT' test, which put me on the path I'm now on. I've been complaining to my previous doctor for years about sleep and all he ever did was prescribe (very unsuccessful) sleep meds!

Find some videos on youtube about getting into the clinician's menu and the reports that are on the machine display. All of the regulars here control their own settings using OSCAR as a guide. I will not let any medical professional touch my machine settings.

Good advice! I do this with just about everything I own so why not the CPAP machine! Turns out I have one more night to go (I was wrong about the appointment being today ... ) so I may poke around.

Assholes. Humidifiers should be standard issue. My trust of that provider fell 98%.

My general opinion of Kaiser is not high; I will mention this tomorrow in the followup and see what their reasoning was.

Thanks for all the great input!

=============================

...
Well....actually you do have the power to unlock it and it isn't difficult at all but since last night was the last night of the trial it is a moot point but for future reference...you just have to know which combination of buttons to push to get into the clinical menu where you can change anything you want.

If your permanent machine is another ResMed AirSense 10 model.
See this provider manual for the secret handshake to get into clinical setup mode.
https://www.respshop.com/manuals/ResMed ... %20her.pdf

If you happen to get the later model ResMed AirSense 11 model
https://media.resmed.com/sites/3/202106 ... ER-ENG.pdf

Great info - thanks! I do have it for one more day (explained above) so I'll see if I have the time to experiment!

People use their mouths to get the pressurized air into the airway. There are 2 ways....air up through the nose and down the airway or in through the mouth/oral cavity and down the airway.

Obvious when you put it that way . I've been favoring the 'nasal' mask, and generally observing that I'm not breathing through the mouth, but - I guess I could switch to the face mask and intentionally breath through the mouth - honestly didn't think of that but makes sense. Is there a way to 'train' yourself to 'mouth breath'? Is that something that a lot of CPAP users do, intentionally? I was assuming the full-face mask was there mainly for those who couldn't keep their mouths closed from a 'pressure' perspective, not so they could breath through it (opening the mouth while using the nasal mask is ... interesting!).

Google "nasal cycle" and see if maybe is part of your issues with congestion.
https://en.wikipedia.org/wiki/Nasal_cycle

Ohhh - that's interesting! I'll need to dig further to figure out whether my situation is 'pathological' congestion or not. I'm hoping my sleep specialist will help me get a referral to an ENT one way or another as this seems as serious as the OSA to me (the 'BreathRite' strips and NeilMed Rinse have definitely improved my sleep recently).

Where are you located?
Lack of adequate humidity from the machine could be making the congestion worse.

I'm in the Bay Area, NorCal, but inland - not in foggy SF. So 'mild humidity' I'd say (not humid like Florida or NY, but not as dry as Arizona where I spent several years!).

[Pugsy]

Here's some information on how Medicare does things when it comes to cpap equipment.

Medicare approves an allowed amount for whatever equipment and if deductible has been met will pay 80% of the ALLOWED amount. Please note that the allowed amount and the billed amount is usually entirely different.
DMEs/doctors bill out the pie in the sky amount and Medicare reduces that billed amount to the ALLOWED amount and pays from that amount. Your portion (or your secondary supplement insurance portion is 20% of the billed amount.

Medicare actually pays by the HCPCS billing code numbers.
Not by brand name or model name.
Most likely you will be given some sort of regular cpap/apap machine which is the E0601 code.
Doesn't matter the brand or model...Medicare ALLOWS the same amount for fixed cpap or auto adjusting capapable/apap machine. Doctors/DMEs usually choose and usually they want to dispense the brand and model that makes them the most money because remember....Medicare is going to pay the same no matter if it is a compact car or a big old caddy.
Now you can get around them choosing by asking your doctor to write the order for so and so brand and so and so model and then sign it with "dispense as written"...then the DME/supplier can't substitute a "cheaper" machine.
Typically regular Medicare does a 13 month capped rental so the payments are spread out over 13 months and then you own it and no more monthly payments. There are also some compliance usage requirements that have to be met for Medicare to pay....like a face to face with the doctor before the 90 th day of use and a certain minimum number of hours it needs to be used during that 90 day time period. The requirement is 70% of a consecutive 30 day time frame that you use the machine at least 4 hours. So 21 out of 30 days you need to use the machine at least 4 hours.

Be careful with Medicare Advantage plans....they will do the allowed amount as well but a lot of them are going to what we call a perpetual rental thing (not all of them will do it though) where you have to pay the 20% co pay forever and never actually own the machine. Be sure and check the Evidence of Coverage for any Medicare Advantage plan you might be thinking of. You will have to ask for this document....it's not usually part of the sales brochure stuff. I have a Medicare Advantage plan...when I first got it years ago it did the 13 month capped rental thing but a few years ago it changed to perpetual rental.

https://www.sleeprestfully.com/HCPCS/

CPAP/BiLevel Michine HCPCS Codes:

E0601 Continuous airway pressure device (CPAP/APAP)

E0470 Respiratory assist device, bi-level pressure capability, without backup rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)

E0471 Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with continuous positive airway pressure device)

E0472 Respiratory assist device, bi-level pressure capability, with backup rate feature, used with invasive interface, e.g., tracheostomy tube (intermittent assist device with continuous positive airway pressure device)

BTW a lot of insurance companies (non medicare) still use the general Medicare equipment allowance schedule and that all use HCPCS billing codes.

I was assuming the full-face mask was there mainly for those who couldn't keep their mouths closed from a 'pressure' perspective,

No, full face masks are for people who can't breathe just through their nose and keep their mouths shut.
Has nothing to do with the pressures at all.
Mouth opening breathing can allow the air pressure to escape out the mouth and fail to proceed down the airway and this can cause sub optimal therapy because adequate pressure isn't maintained.

You might be able to "train" yourself to keep the mouth shut but only if you can get comfortable just breathing through your nose all night. It's not so easy though but it can be done or at least limited to very minor mouth breathing with a nasal mask and not a full face mask.

[SleepGeek]

Re: Buying on Amazon - I've read that you need an Rx for a CPAP machine, but then, I'm guessing that with the wonders of 'the internet', that's fallen by the wayside somewhat? (I buy eyeglasses online and there's no official Rx involved any longer). So can I just go ahead and buy the machine and supplies on Amazon without an Rx ?

I was referring to supplies on Amazon. Tho you can find cpaps in other places like FB Market place.

I'm sure this is a loaded question, but at least superficially, I'm assuming there's a huge range in price of different CPAP machines; would 'Original Medicare' stump for 80% of 'any' choice, or would there be some caps involved? I can't imagine they'd stump for a 'Mercedes' version, for example, if a 'Chevy' version is available. I'm a techie nerd and would likely go for a machine with a lot of features, which would probably push the machine above what some might call 'reasonable'!

Medicare, like any insurance or MA plan, has negotiated prices they will pay regardless what kind of price the biller sends. They pay by billing codes and not make or model. So they pay 80% of the negotiated price. Check your previous insurance bills or partners MA plan.

Thanks for the general advice on Medicare; I'm working my way through all that mess currently. My partner is already on Medicare, and has an MA plan and couldn't be happier (and has had quite a few 'encounters'!) but I need to look into all aspects. I no longer spend long periods away from home base, and I buy travel-specific plans when I go overseas.

So go with your partners MA plan, NP.