Medicare allowable charge?

LSAT wrote: ↑

Tue Jan 29, 2019 8:27 pm

CpapUser100 wrote: ↑

Tue Jan 29, 2019 4:54 pm

Okie bipap wrote: ↑

Tue Jan 29, 2019 2:05 pm

What equipment are you looking for? You can often find items at Amazon or on eBay for less than the DME charges. You are going to need to pay the $185 part B deductible some time during the year and items purchased from Amazon or eBay will not count towards this deductible.

Yes, I've seen great prices on Amazon and Ebay. I am trying to figure out if it is cheaper to buy through Amazon and Ebay or to go through Medicare for my mask, headgear, and cushions in the long run. That's why I wanted to know how much Medicare would allow me to be charged. They don't make it easy to compare!

I have a new primary insurance that has a $500 deductible that my CPAP equipment is subject to. For probably the past 5 or 6 years I had 90% of my CPAP supplies covered with no deductible, so this is a huge change. If I buy out of pocket, I am hoping to not even hit the $185 Medicare Part B deductible this year.

You have Primary Insurance and Medicare?

I am not sure why this surprises you. Many (probably millions of) people do.* It is expensive but it makes sense for my particular health situation, which I would rather not go into. I was just trying to figure out how much Medicare would allow me to be charged for CPAP supplies. I do appreciate that you posted how much you were charged.

-I removed some of my personal info

You should drop your part B. Part B will not pay for anything at all when you have a primary insurance so you're wasting your money paying the premium. Call Medicare and ask, which is what you should have done in the first place. You should not need to spend $500 in a year on masks and things. I've been using the same mask and hose for years. Buy the stuff on eBay and drop your part B. You'll save a lot of money that way.

nobody wrote: ↑

Thu Jan 31, 2019 8:01 pm

You should drop your part B. Part B will not pay for anything at all when you have a primary insurance so you're wasting your money paying the premium. Call Medicare and ask, which is what you should have done in the first place. You should not need to spend $500 in a year on masks and things. I've been using the same mask and hose for years. Buy the stuff on eBay and drop your part B. You'll save a lot of money that way.

I would love to save the money that I'm spending on Medicare part B. My understanding is that if I drop it I will have to pay penalties if I go back on later. I have Medicare due to disability, not age, and primary insurance through my spouse's employer. I was on Medicare Part B before I was on my spouse's insurance and never canceled Medicare Part B because of the future penalties. (If I canceled, I would expect to go back on it at age 65.)

Medicare Part B does pay the 20% of doctor bills that my primary insurance does not cover. Once I hit Medicare's deductible I usually don't have to pay anything for the rest of the year. Unfortunately, this year my primary insurance applies a deductible to CPAP supplies.

RE: Just call Medicare and ask - Have you read the rest of my thread? I am not a complete idiot, nor am I a newcomer to CPAP. I've been using it for more than 15 years. I have no plans of spending $500 on CPAP equipment unless I get a new machine as well.

CpapUser100 wrote: ↑

Thu Jan 31, 2019 8:41 pm

nobody wrote: ↑

Thu Jan 31, 2019 8:01 pm

You should drop your part B. Part B will not pay for anything at all when you have a primary insurance so you're wasting your money paying the premium. Call Medicare and ask, which is what you should have done in the first place. You should not need to spend $500 in a year on masks and things. I've been using the same mask and hose for years. Buy the stuff on eBay and drop your part B. You'll save a lot of money that way.

I would love to save the money that I'm spending on Medicare part B. My understanding is that if I drop it I will have to pay penalties if I go back on later. I have Medicare due to disability, not age, and primary insurance through my spouse's employer. I was on Medicare Part B before I was on my spouse's insurance and never canceled Medicare Part B because of the future penalties. (If I canceled, I would expect to go back on it at age 65.)

Medicare Part B does pay the 20% of doctor bills that my primary insurance does not cover. Once I hit Medicare's deductible I usually don't have to pay anything for the rest of the year. Unfortunately, this year my primary insurance applies a deductible to CPAP supplies.

RE: Just call Medicare and ask - Have you read the rest of my thread? I am not a complete idiot, nor am I a newcomer to CPAP. I've been using it for more than 15 years. I have no plans of spending $500 on CPAP equipment unless I get a new machine as well.

There is no one on CPAP that needs $500 in supplies a year....new machine or old. I am on Medicare and even if I had no insurance and paid retail, I would not spend more than $150. As someone said before..Call Medicare and ask your questions...but I guess you know better.

CpapUser100 wrote: ↑

Thu Jan 31, 2019 8:41 pm

nobody wrote: ↑

Thu Jan 31, 2019 8:01 pm

You should drop your part B. Part B will not pay for anything at all when you have a primary insurance so you're wasting your money paying the premium. Call Medicare and ask, which is what you should have done in the first place. You should not need to spend $500 in a year on masks and things. I've been using the same mask and hose for years. Buy the stuff on eBay and drop your part B. You'll save a lot of money that way.

I would love to save the money that I'm spending on Medicare part B. My understanding is that if I drop it I will have to pay penalties if I go back on later. I have Medicare due to disability, not age, and primary insurance through my spouse's employer. I was on Medicare Part B before I was on my spouse's insurance and never canceled Medicare Part B because of the future penalties. (If I canceled, I would expect to go back on it at age 65.)

Medicare Part B does pay the 20% of doctor bills that my primary insurance does not cover. Once I hit Medicare's deductible I usually don't have to pay anything for the rest of the year. Unfortunately, this year my primary insurance applies a deductible to CPAP supplies.

RE: Just call Medicare and ask - Have you read the rest of my thread? I am not a complete idiot, nor am I a newcomer to CPAP. I've been using it for more than 15 years. I have no plans of spending $500 on CPAP equipment unless I get a new machine as well.

No you will NOT pay a penalty. You just let social security know that you are on your spouse's insurance. That exempts you from future penalties. Again, I'm sure if you call them they will tell you that. I am surprised that Medicare pays anything as that is not what they told me when I dealt with this situation a few years ago. I suspect you don't understand your actual situation with these insurance but who knows. Seems odd that you're worried about it if they supposedly pick up everything beyond the deductible that you'll pay for doctor visits anyway.

nobody wrote: ↑

Thu Jan 31, 2019 9:18 pm

am surprised that Medicare pays anything as that is not what they told me when I dealt with this situation a few years ago

My husband has Medicare Part B and still works and still has his employer provided insurance as his primary insurance.
It comes with a $2500 deductible.
Last year he had a minor surgical procedure done in the office and the cost was well below the 2500 deductible.
Medicare Part B is secondary and it did pick up and pay for the procedure less the Part B deductible.

So you can have both and Medicare being secondary will pay once the primary has been filed and EOB shows applied to deductible.

I was told there are some limited circumstances it might pay but that for the most part it wouldn't. I'm guessing your husband had a procedure that wasn't covered by the primary at all and it is covered by Medicare. That's one situation they told me would probably be covered. But things like co-pays and coinsurance wouldn't be covered. They told me anything that would be covered by the primary would not be covered by part B, even if there were copays or coinsurance. The situation where it might apply is the Medicare savings program, which is for low income people. Unless something has changed since I talked to them about this.

nobody wrote: ↑

Thu Jan 31, 2019 9:41 pm

'm guessing your husband had a procedure that wasn't covered by the primary at all and it is covered by Medicare.

You would be guessing wrong. I got the EOB from the primary carrier insurance company showing the amount applied towards the deductible which happened to be around $1200.

Dealing with insurance and Medicare the last couple of weeks has felt like a full full time job and has been stressful. I am not sure why this thread has become contentious but this whole situation just makes me want to cry.

Pugsy, I am not sure how I could convince people that Medicare Part B does pay out even if you have a primary insurance, so thanks for your post.

Nobody, I think you have been given inaccurate information. Medicare Part B has covered a lot of stuff over the years where I otherwise would have had to pay co-pays. I am not talking about Medicare part A or a Medicare savings program. Just plain Medicare Part B.

I have asked questions of Medicare many times this month alone. Unfortunately, Medicare reps often give out incorrect information. Medicare itself can be very complicated and it can be even worse when you add another insurer. I will look into potential Medicare Part B penalties again, but I think there is a difference based on whether you had insurance when you started Medicare Part B. What reps say doesn't really matter and you can get conflicting info from different reps. What matters is what the Medicare annual booklets say and what their web pages say. That is the official info. Too bad it can be so incredibly hard to interpret what the official print means sometimes.

LSAT, Are you saying that I can get a new CPAP machine, humidifier, and a year's worth of headgear and cushions for under $500.00 or even for $150? If so, I'd love to hear about it. Otherwise, maybe we should drop this thread. It's getting sarcastic and contentious and that just sucks.

This is not from the medicare website, so take it with a grain of salt, but this is the best I can do this late at night.

From: https://www.mymedicarematters.org/enrol ... and-risks/

Medicare Part B Penalty
If you sign up late for Medicare Part B, you will have to pay a late penalty premium every month for the rest of your life, along with your Part B premium. Your monthly Part B premium will go up 10% for each full 12-month period that you could have had Medicare Part B but did not take it. You will pay this higher premium as long as you have Medicare Part B.

You may not have to pay the penalty if you qualify for a Special Enrollment Period (SEP). You might qualify for an SEP if you had health insurance through your job or your spouse’s job when you were first eligible to sign up for Medicare Part B.

My understanding is that I do not qualify for an SEP because I was not covered by any insurance when I first became eligible for Medicare Part B. (This was before the ACA.) So if I drop Part B now, I would pay penalties when I picked it up later.



ETA - Here is a Medicare.gov official link, but it does not mention the circumstance(s) that exempt someone. https://www.medicare.gov/your-medicare- ... nt-penalty

That's talking about your intitial enrollment period which you've already passed. You would get another one (Sep) should you drop it and want to sign up later. You can sign up again any time you're still covered by your spouse's insurance OR within 8 months of it ending, and not get a penalty. But if you're getting things covered you have to decide whether it's worth it to drop. Depends how much you're going to spend in a year. Also if this is stressing you so much just order it through the insurance. Based on what you're saying you won't have to pay more than $185 for all your medical needs the rest of the year. Is saving a few on a hose and mask worth all the stress? I wouldn't think so?