New machine

Ive been using my current cpap for over five years. I has been my understanding that after five years I’m elgible for a new machine so i called my supplier to make arrangements to do that. I was informed that I cant get a new cpap unless I can prove there is something wrong with the current machine. This year we changed to a new Medicare plan ( United Health Care). I’m wondering if this is a UHC rule? Other posters n this forum have indicated they have got new machines after five years with no problem. Any suggestions?

I did not have UHC when I got my previous machine, so I think that they consider the new one a "first" one. Also, the last one really was broken and the manufacturer (AEIO med) was out of business. That made any "authorized" repair impossible and the availability of parts for an "unauthorized" repair spotty.

I had an even older one that was my spare, but that one was not mentioned as it was eleven years old and not my "official" machine. However, it made life livable while I was waiting for the new machine.

First of all--WHO told you this? Insurance or the DME?
(DME's seem to have no problem with LYING.)
Maybe your UHC plan is Medicare "Advantage"?
UHC is notorious for less than stellar coverage--and Medicare "C" as a rule.
UHC is budget insurance, anyway--you get what you pay for.

Medicare's new rule is that you get a new machine when your's is worn out or broken. Apparently, the reason for this is that people were getting new machines when they only had a few hundred hours on them. This hasn't been applied to just cpap but to most durable medical equipment. How that is being applied for replacement seems to depend on the DME. I talked to my DME about 2 weeks ago (I was there getting bro's old bipap fixed). If the machine is 5 years old and can't be repaired on the spot, they will apply for you to get a replacement machine (Medicare did not extend coverage for repair beyond 5 years). If your machine has run 15,000 hours, it is 'worn out' and they will apply for you to get a replacement machine even if it continues to work great. If your machine is so old that they can't get replacement parts, even if you haven't met the 15,000 hours, they will apply for a replacement.

My DME may be different from yours. My current DME does everything but replace boards. Lincare did zero repairs on cpap machines - everything was sent out.

That all said, I have Medicare original and not an Advantage Plan. As others have pointed out, those plans can vary considerably from Medicare original. In addition, there seems to be quite a bit of variance as to how the DME interprets the new rules. They get audited, so they aren't going to make you a special case.

From what I understand, Sew Tired is correct as to the Medicare rules.

Also it applies to all of the supplies. You don't simply "get" 2 nasal pillows a month, new mask every 3 months, new headgear every 6 months. You have to allege that the supplies have worn out to get a replacement. This is to combat the automatic shipment of supplies that used to occur.

Our UHC plan is an advantage plan. It was the DME that told me this. From what SewTired said I guess im out of luck. Until it breaks.