DME info please?

Premiums often vary by location; but are not tied to local COL (cost of living)
--but rather to political whims.

chunkyfrog wrote: ↑

Wed Mar 02, 2022 11:24 am

Premiums often vary by location; but are not tied to local COL (cost of living)

AFAIK, in order to participte in a Medicare Part C (otherwise known as Medicare Advantage Plans), you still have to begin with paying the monthly Medicare Part B premium (this is normally deducted from one's Social Security or Railroad Pension). The premium for 2022 is $170/mo.

Depending on the Medicare Advantage plan one chooses AND it's insured group location, a person might be entitled to have some or all of that premium returned (or as Bunko refers 'gets it back'). The entitlement to "get it back" is a function of the ratio of insurance companies policy payouts for actual care to the premiums collected. In general the rule is that insurance companies must payout to providers approximately 80% of the premiums collected.
If an insurance company fails that rule, they are required to return some part of the group's premiums to the insured.

It's not actually political whim, but rather accounting.

I will not "rent" anything. If I can't get what I want, or they want me to rent it, I will go buy it myself as I always have for the past 25 years.

Medicare doesn't "buy" a CPAP machine outright, and SCAN, as your Medicare provider, doesn't either. So if you want to use your benefit, your only option is to rent.

On traditional Medicare, there is a 13 month "capped rental" for a CPAP machine. That means you pay your 20% of the rental price monthly for 13 months, then the machine is YOURS. Advantage plans like Kaiser and SCAN have the option of perpetual rental. You pay your 20% of the rental price every month forever. You will never own the machine. Kaiser definitely does this, you will have to check with SCAN to find out if they do capped rentals or not. If I stick with Kaiser when I go on Medicare (doubtful) I will just save money and buy my own machine.

bucko wrote: ↑

Mon Feb 28, 2022 9:15 pm

.
. . .
I have been stuck in the US now for 2.5 years because I cannot return to my home in China. I got to the US 2 days prior to the shutdown Jan 2020 to attend to my Dad's death. So I am living out of a suitcase and paying outrageous rent, running through all my retirement $$ just to survive here.

Thanks

California is not an affordable state to live.
Not as bad as several others, but the rest are trying to catch up.

Attached is the Medicare (Traditional or Original) claim statement for an Resmed Airsense 11 and humidifier for one month. Keep in mind that the Medicare Approved charge will vary in different areas of the country (but my slight experience is it doesn't vary wildly).

My cost for this rental is 11.50 per month. I expect the rental period to expire at the end of 13 months so the total cost (to me) for the CPAP and Humidifier is 149.50.

BTW, note that my responsibility is called "co-insurance".

My supplement covers the coinsurance--it is still coinsurance,
regardless of who pays it.

chunkyfrog wrote: ↑

Thu Mar 03, 2022 6:32 pm

My supplement covers the coinsurance--it is still coinsurance,
regardless of who pays it.

In that case you won't have to pay a dime. All you have to do is use it.

All you guys really came through again. Armed with this info I can move forward with my Dr. when we get to the point of getting my CPAP. RIght now he has ordered a home sleep study for me which will allow him to submit my prescription for a CPAP. Going forward, I will be able to work with him to get what I want and it looks like I'll be able to save some $$.

Thank you

chunkyfrog wrote: ↑

Thu Mar 03, 2022 6:32 pm

My supplement covers the coinsurance--it is still coinsurance,
regardless of who pays it.

I just wanted to clarify that Medicare calls the amount remaining to be paid "co-insurance" and not "co-pay".

As regards your supplement, I would consider that to be secondary insurance. But you may see it as a semantic difference.

And yes, my supplement covers the amount remaining from Medicare's payment, but that was a side issue and not germane to the discussion contrasting the OP's SCAN (apparently a medicare advantage network) and traditional medicare.

By the way, SCAN (the system that the OP is involved with) has a Facebook account. After reading the complaints and SCAN's attempt to answer subscriber's issues, I would not even consider signing up with them at regardless of the low premiums. (I do really wish the OP good luck !)