Rental or Purchase of CPAP thru Medicare ???

[RJ]

Just received the tenth month purchase option letter for medicare capped rental items on the CPAP device. Would appreciate the Senior Citizens experience on whether it is better to purchase or continue to rent.
If I purchase I pay 20% of service charge each time equipment is serviced.
If rented my liability is 20% coinsurance on a maintenance and service fee twice a year, whether the unit needs service or not.
Your experience would be appreciated.
Thanks

[Slinky]

I just started on PAP 34 days ago. My DME told me Medicare rented for 15 months after which time it became my purchase. No mention was made of extended rental. Thanks for the heads up about this. I'll be following this thread to see what the recommendations are.

At this point I was looking forward to owning just to have the freedom to check out and possibly go w/a different DME.

If you rent for 15 months, then own, and the machines are warranteed for 2 years, how often is Medicare going to buy or rent another one for you? My nebulizer is 10 years old and works fine but it is huge compared to today's nebulizer. When I travel I look on these new nebulizers w/great longing. *sigh*
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[mattman]

Here is the Reader's Digest version:

X-PAP equipment is what is considered a 'capped rental' item. This means Medicare will only pay for a set amount of time before reaching what they consider the purchase price for the item.

At 10 months you get a letter describing your choices: Continue rental or choose to purchase the item.

If you choose the purchase option, rental payments continue to 13 (or 15 I don't remember off the top of my head) months and then STOP. At that point - you own the machine just as if you had paid cash up front. You flat out own the machine. You can do whatever the heck you want with it - it's yours. This also means that any future service or repairs are yours as well. Medicare will sometimes cover the repair costs but it can be a very serious hassle to do so (Remember - you have to have a prescription for ANYTHING billed to Medicare. So along with everything else you have to get a prescription from your doc for any repairs needed!)

If you choose the rental option, payments continue to (Whichever the first choice isn't - One is 13 months the other 15 and I don't remember if it was rent or purchase!) and then STOP. Yes even if you choose the rental options the rental payments stop (except for a very few specific cases which generally won't apply here). The provider CAN bill twice a year for maitenence and upkeep. Many providers don't bill these charges as they can be a real hassle to get paid. Usually it is a lot more trouble than it's worth. The biggest difference though is that any and all repairs are the responsibility of the provider with no paperwork needed.
I personally think this is the better route simply because it's less hassle for patients. Some people argue that the patients don't get to keep the machines this way. My response is when you are done with it, who cares what happens to it? Chances are we need this stuff until we die. Well when I'm dead I aint gonna care what's done with my CPAP stuff. Chances are by the time we are done with any given machine it's gonna be so old and so out of date no one wants it anyways.
Additionally, when you choose the rental option it is usually a LOT easier to switch equipment if your needs change.

DME is typically expected to have a usable life of 5 years (Hence the DURABLE part of DME). This means that except for extraordinary circumstances Medicare will not pay for new equipment less than 5 years from the first date of service. There are certainly exceptions to this. This does ALSO not mean that at 5 years and 1 day you can get a new machine. Anytime a new machine is needed, regardless of reason, there has to be justification. It's just that the bar is lower after 5 years. Basically what this means is that for less than 5 years - a provider has to have a book written with all sorts of supporting documentation from Doctors and Sleep Labs and all sorts of crap. Over 5 years you basically need a Sleep Study and a prescription along with a Letter of Medical Neccessity explaining what is wrong with the old unit.

I hope that helps.

mattman

[Slinky]

Thank you, Mattman, yes, it does help. I'm going to ask about my nebulizer tho. Curiosity has the better of me now. And come to think of it, since it is 10 years old Medicare didn't pay for it anyway. My then primary insurance did ... I understand these new nebulizers are not only smaller but they also dispense the medication more quickly ...

[RJ]

Talked with my supplier of the equipment and was told that the servicing twice a year would amount to approx $75 each service and my supplemental Ins would cover it. In fact he said in either case there would be no cost to me but it was somewhat more difficult getting Medicare and the ins to cover things if I owned it. Looks like I am going with Option #2, Medicare continues to make rental payments for an additional 5 rental months making a total of 15 months. I would continue to use the equipment but the title remains with my medical supplier. After 15 rental payments, even thought the supplier still owns the equipment, I can keep the item as long as the Doctor feels it is medical necessary. It appears the supplier makes his money on the servicing twice a year.
Thanks for the impute.

[mattman]

I understand these new nebulizers are not only smaller but they also dispense the medication more quickly ...

With almost all of them, you will still be looking at a 10-15 minute treatment time depending on your dosage.

However, there is one brand made by Pari called the ProNeb which has a much faster treatment time - usually around 7-8 minutes. It can be used in most cases though there are a few where it's contraindicated. Many companies do not carry the unit though as there is no seperate code for it and it is MUCH more expensive than a traditional nebulizer. I like it because it also uses 2 1-way valves to keep the medication from being wasted (Notice all that fog coming out the far side of your T-piece? That's medication darnit!)

Talk to your provider and your doc and see what they say!

mattman

[christinequilts]

RJ-
You just made it in under the wire for being able to make a choice one way or another. You must have gotten your CPAP at the end of Dec? January 1, 2006, the capped rental policy changed for CPAP & regular BiPAP and now Medicare only pays for 13 months & its all yours.

Q. How many rental payments have you received towards the CPAP device?
If the date of service is prior to January 1, 2006 and the beneficiary elected to rent the device, Medicare will make up to 15 rental payments towards a CPAP device. After the 15 rental payments, payments for maintenance and service can be made every six months. Suppliers must continue to provide the item without charge until medical necessity ends or Medicare coverage ceases.
Items provided on after January 1, 2006 are subject to the new capped rental provisions under the Deficit Reduction Act of 2005 (DRA). The DRA limits the total number of Medicare payments for capped rental items to 13 continuous months only and requires the supplier to transfer ownership for the capped rental equipment to the beneficiary. Medicare E0601-CPAP FAQ's

It looks somethings have been clarified as far as what happens long term with capped rental just a few days ago, some of which could be good (maintanence, replacement, equal or better if switch), but it also sounds like you're stuck with who you start with too:

Medicare will pay for reasonable and necessary maintenance and servicing of beneficiary-owned oxygen equipment and capped rental DME not covered by a supplier’s or manufacturer’s warranty...[Additional] safeguards...include requiring a supplier who furnishes rented oxygen equipment or a capped rental item in the first month to continue furnishing the item throughout the entire rental period and if suppliers switch out equipment that the replacement equipment be of same or greater value. Also in the final rule, suppliers may be responsible to replace equipment that does not last for the reasonable useful lifetime established for the equipment under the Medicare program. Changes for DME/HHC

Now if they can just figure out BiPAP STs, since they were not in the capped rental category until April 1, 2006...no one can figure it out so far, including my DME. It seems clear enough to me:

.....Since 1992, RADs (Respiratory Assist Device, Medicare term for BiPAP) that have a backup rate feature have been paid by Medicare on a continuous monthly rental basis for as long as the beneficiary uses this device (as in forever & ever)... Under the new rule, beneficiaries using RADs may elect to take over ownership of the equipment after renting it for 13 months. The rule also allows for a transition period for devices which are currently being rented to Medicare beneficiaries so that rental months paid prior to April 1, 2006 will not count toward the rental payment cap. This final rule will apply to claims received on or after April 1, 2006. In the cases where beneficiaries received these items prior to April 1, 2006, only the rental payments for months after the effective date will count toward the 13 month cap. CMS News 1/26/06

To me, that means my DME should have continued billing monthly for 13 months, after April 1, 2006, and then I would own my machine, right? Instead they stopped monthly billing March 2006 & only just sent in the first semi-annual 'maintenance charge', and no one at Medicare can give me an answer until the claim goes through- UGHHHH! Either way, my DME has already received over $18,000...and they still 'own it'? But what do you expect when the Deficit Reduction Act of 2005 (DRA) that changed capped rental to 13 months, ownership only wasn't signed into law by Bush until February 8, 2006, retroactive to January 1, 2006, and in the mean time, on January 27, 2006, the revision of BiPAP ST from frequent and substantial service to capped rental had been proposed in 2003, became a final ruling, to be effective April 1, 2006...talk about a comedy of something...