Medicare insanity

michiganjim · Post by **michiganjim** » Fri Nov 23, 2018 9:05 am

I've been using a CPAP for 15+ yrs. During that time, I've had several machines as the wore our or made noises. When not repairable in the past, insurance and in for the last one, Medicare paid (I'm 73) for the cost of a new machine. (might have been a co-pay but I don't remember)

My current machine, ResMed Series II is 6 or 7 yrs old and has begun making a bothersome noise. Checking with my supplier today yields that Medicare will not purchase a new machine. Rather, they will "rent" a machine for 12 months for me. This, apparently because they want to make sure the machine will alleviate my sleep apnea. Worse, the cost of the rental over the year greatly exceeds the cost of a new machine, if purchased on the open market. I'm assuming if Medicare were to purchase a new machine, their "negotiated" prices with suppliers would probably be two to three times the cost on the open market.

I would blame Obamacare rules, but apparently this is not part of that. It is just your regular old F****d up, inefficient, corrupt and stupid government process. The overpaid, lazy government workers who administer this are part of the swamp that infect every part of government.

Pugsy · Post by **Pugsy** » Fri Nov 23, 2018 9:12 am

Medicare does do the rent to own thing for 13 months but the rental payments shouldn't add up to more than retail cost.
It's a rent to own thing and the amount you pay for rental is based on Medicare's approved amount. Not the pie in the sky amount the DME wants to bill out.

How much is the DME wanting you to pay each month?
Do you have regular Medicare...if so, do you have a regular supplement with it?
Or do you have some sort of Medicare Advantage plan...if so which one in what state?

LSAT · Post by **LSAT** » Fri Nov 23, 2018 9:27 am

Pugsy is right...With medicare, you should pay about $13-$15 per month for 12-13 months. Then you own it. The first month you will need to pay an up front fee for the humidifier...even though it may be built in the unit. For get the amount that the DME bills...Medicare will pay a pre determined, much lower, amount.

Okie bipap · Post by **Okie bipap** » Fri Nov 23, 2018 11:44 am

My wife recently finished her rent to own program on her bilevel machine using Medicare. Her portion of the rental was less than $19 per month for 13 months. We paid less than $275 for her machine and humidifier which currently sell for over $1700. You will be responsible for 20% of the Medicare negotiated price, not the inflated DME price of the machine.

greatunclebill · Post by **greatunclebill** » Fri Nov 23, 2018 11:48 am

also, you want the resmed 10 airsense autoset. no matter which cpap/apap you get, medicare pays a set single amount for all of them, so get the best. don't let them trick you with higher costs, etc. they get what resmed approves and that is all. you will have a small co-pay that LSAT already mentioned. if you have a medicare advantage plan, it will probably cover the copay.

palerider · Post by **palerider** » Fri Nov 23, 2018 11:51 am

michiganjim wrote: ↑
Fri Nov 23, 2018 9:05 am
I would blame Obamacare rules, but apparently this is not part of that.

Oh, go ahead, everybody else blindly ASSumes everything is Obama's fault.

bwexler · Post by **bwexler** » Fri Nov 23, 2018 2:54 pm

Medicare does require a 13 monthly rental payments to own your machine.
A Medicare SUPPLEMENT MAY pay your copay or coinsurance portion.

A Medicare advantage plan sets their own rules, which must be approved by CME.

My medicare Advantage plans for 2017, 2018 and 2019 state very clearly that I will never own my CPAP, machine. I will be responsible for monthly rental copays as long as I use my machine.

The only way to know for sure is to read YOUR Evidence Of Coverage document. I have yet to find an insurance agent or DME that can accurately answer the question. Most don't even understand the question.

My Advantage plan in 2010 when I got my first APAP required 11 monthly payments. However since the were less than an arbitrary threshold ($100) they covered the entire cost.
In 2013 when I switched to an ASV machine the same was true. Since Obamacare has been fully implemented CPAP is only one of several cost increases that have personally affected my wallet.

Wulfman... · Post by **Wulfman...** » Fri Nov 23, 2018 2:58 pm

michiganjim wrote: ↑
Fri Nov 23, 2018 9:05 am
I've been using a CPAP for 15+ yrs. During that time, I've had several machines as the wore our or made noises. When not repairable in the past, insurance and in for the last one, Medicare paid (I'm 73) for the cost of a new machine. (might have been a co-pay but I don't remember)

My current machine, ResMed Series II is 6 or 7 yrs old and has begun making a bothersome noise. Checking with my supplier today yields that Medicare will not purchase a new machine. Rather, they will "rent" a machine for 12 months for me. This, apparently because they want to make sure the machine will alleviate my sleep apnea. Worse, the cost of the rental over the year greatly exceeds the cost of a new machine, if purchased on the open market. I'm assuming if Medicare were to purchase a new machine, their "negotiated" prices with suppliers would probably be two to three times the cost on the open market.

I would blame Obamacare rules, but apparently this is not part of that. It is just your regular old F****d up, inefficient, corrupt and stupid government process. The overpaid, lazy government workers who administer this are part of the swamp that infect every part of government.

Just buy one out-of-pocket and you won't have to deal with the Medicare/government red tape. You'll own it from the get-go and you won't have to jump through the hoops of needing to prove your use.
Most of the time, when you compare costs (insurance pays vs. out-of-pocket), it comes out about even. So save yourself the headaches.
There are many vendors (online and individuals) where you can find them VERY cost-effective. There are several individuals who sell them on the forum (when they have them) and online sellers like www.cpap.com and www.secondwindcpap.com

Just make sure you have a copy of your prescription if you're purchasing from an online seller.

Den

.

LSAT · Post by **LSAT** » Fri Nov 23, 2018 9:12 pm

Wulfman... wrote: ↑
Fri Nov 23, 2018 2:58 pm

michiganjim wrote: ↑
Fri Nov 23, 2018 9:05 am
I've been using a CPAP for 15+ yrs. During that time, I've had several machines as the wore our or made noises. When not repairable in the past, insurance and in for the last one, Medicare paid (I'm 73) for the cost of a new machine. (might have been a co-pay but I don't remember)

My current machine, ResMed Series II is 6 or 7 yrs old and has begun making a bothersome noise. Checking with my supplier today yields that Medicare will not purchase a new machine. Rather, they will "rent" a machine for 12 months for me. This, apparently because they want to make sure the machine will alleviate my sleep apnea. Worse, the cost of the rental over the year greatly exceeds the cost of a new machine, if purchased on the open market. I'm assuming if Medicare were to purchase a new machine, their "negotiated" prices with suppliers would probably be two to three times the cost on the open market.

I would blame Obamacare rules, but apparently this is not part of that. It is just your regular old F****d up, inefficient, corrupt and stupid government process. The overpaid, lazy government workers who administer this are part of the swamp that infect every part of government.
Just buy one out-of-pocket and you won't have to deal with the Medicare/government red tape. You'll own it from the get-go and you won't have to jump through the hoops of needing to prove your use.
Most of the time, when you compare costs (insurance pays vs. out-of-pocket), it comes out about even. So save yourself the headaches.
There are many vendors (online and individuals) where you can find them VERY cost-effective. There are several individuals who sell them on the forum (when they have them) and online sellers like www.cpap.com and www.secondwindcpap.com

Just make sure you have a copy of your prescription if you're purchasing from an online seller.

Den.

Sorry, but you are wrong Den....With Medicare or Medicare Complete, the cost to the patient will be < $200 including humidifier. There is no on line vendor that can match that.

Wulfman... · Post by **Wulfman...** » Fri Nov 23, 2018 9:33 pm

LSAT wrote: ↑
Fri Nov 23, 2018 9:12 pm
Sorry, but you are wrong Den....With Medicare or Medicare Complete, the cost to the patient will be < $200 including humidifier. There is no on line vendor that can match that.

Could be. Wouldn't be the first time. But........
It still wouldn't be an option I would consider. I will never go through a brick & mortar DME.

Den

.

Okie bipap · Post by **Okie bipap** » Fri Nov 23, 2018 10:28 pm

We have Medicare and Tricare for Life and our out of pocket cost for two Air Curve 10 VAUTO, masks, hoses, etc. has been zero. I have purchased two back up machines from private individuals and a few masks out of pocket. I have had my machine for over three years, and my wife has had her's a little over one year. My total out of pocket cost has been less than $1500 including the cost of the two back up machines.

Bigmike52 · Post by **Bigmike52** » Sat Nov 24, 2018 7:11 am

Medicare pays not only for the machine but also the supplies that come with the machine. (mask, hoses, cushions, etc.) You have paid into Medicare most of your life, if not all like myself. They are not "giving" you anything. Makes no sense to pay for your supplies by buying your own machine. That can run into the thousands.

Medicare insanity

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Machine	Mask