Medicare & CPAP Ownership at 13 Months?

Grumpy48 · Post by **Grumpy48** » Fri Jan 22, 2021 2:55 pm

From Medicare's site........

"Your costs in Original Medicare
You pay 20% of the Medicare-approved amount for rental of the machine and purchase of related supplies (like masks and tubing). The Part B Deductible applies. Medicare pays the Supplier to rent the machine for the 13 months if you’ve been using it without interruption. After you’ve rented the machine for 13 months, you own it.

Medicare will only cover your durable medical equipment (DME) if your doctor or supplier is enrolled in Medicare. If a DME supplier doesn't accept assignment, Medicare doesn't limit how much the supplier can charge you. You may also have to pay the entire bill (your share and Medicare's share) at the time you get the DME."

About April of this year after 13 months of use and rental paid by Medicare and my insurance, I'll supposedly 'own' my CPAP machine. If I own it, does that suggest that neither Medicare or my insurance no longer have any responsibility for it if it should need a repair or replacement? The Medicare site and my supplemental insurance plan documents don't seem to go beyond saying I'll 'own' the machine and don't say anything about repair or replacement if it should need it. My DME's website doesn't hit on this either and their office is a bit difficult to call into lately. Does Medicare and/or insurance help with repair/replacement cost or since I 'own' it, it's on me?

I did search on this forum, but search terms I tried didn't seem to find a relevant subject.

JLROhio · Post by **JLROhio** » Fri Jan 22, 2021 3:08 pm

...following! ( I know some (Pugsy) will have valuable info to provide here)

LSAT · Post by **LSAT** » Fri Jan 22, 2021 3:27 pm

Once you own the machine if falls under the manufacturers warranty. After that, Medicare may repair or replace depending on the individual situation. It's really no different that purchasing anything....it's covered for a specific period of time..not forever.

Okie bipap · Post by **Okie bipap** » Fri Jan 22, 2021 5:20 pm

After thirteen months you do own the machine. Medicare will repair or replace the machine when it fails. The decision whether to repair or replace the machine is made by Medicare after it has been evaluated and a cost estimate for the repair is obtained. If it cost too much to repair, it will be replaced. You may be without a machine while yours is evaluated and repaired, or replaced. Many of us have purchased back up machines to use during that period of time. I found my wife's back up machine here on the forum, and I found mine on Facebook Marketplace.

rdfry · Post by **rdfry** » Fri Jan 22, 2021 7:29 pm

Most have a 3 year warranty

Pugsy · Post by **Pugsy** » Fri Jan 22, 2021 7:35 pm

rdfry wrote: ↑
Fri Jan 22, 2021 7:29 pm
Most have a 3 year warranty

ResMed and Respironics have a 2 year warranty in the US.
Not sure about F & P or DiVilbiss.

Grumpy48 · Post by **Grumpy48** » Fri Jan 22, 2021 7:36 pm

I presume a warranty repair/replacement is handled through ones DME as the contact and not necessarily the manufacturer?

Okie bipap · Post by **Okie bipap** » Fri Jan 22, 2021 9:37 pm

You need to go through the DME. The manufacturers do no consider you to be their customer. The DME is their customer.

rdfry · Post by **rdfry** » Sun Jan 24, 2021 2:48 am

Pugsy wrote: ↑
Fri Jan 22, 2021 7:35 pm

rdfry wrote: ↑
Fri Jan 22, 2021 7:29 pm
Most have a 3 year warranty
ResMed and Respironics have a 2 year warranty in the US.
Not sure about F & P or DiVilbiss.

I swear the info that came with mine said 3 years, but I checked on Resmeds Web page and sure enough two measly years. I am just going to shutup, don't seem to know what the hell I'm talking about. 20 years of Cpap has rotted my brain.

chunkyfrog · Post by **chunkyfrog** » Sun Jan 24, 2021 3:24 pm

Just to be on the safe side, you can ask your health insurance if they cover it.
Alternatively, check your homeowner's or renter's insurance about coverage or a rider.
Medicare will do repair or replacement at their discretion--
but private insurance---maybe--maybe not--check with them, every year.

klm49 · Post by **klm49** » Sun Jan 24, 2021 3:37 pm

Grumpy48 wrote: ↑
Fri Jan 22, 2021 2:55 pm
From Medicare's site........

"Your costs in Original Medicare
You pay 20% of the Medicare-approved amount for rental of the machine and purchase of related supplies (like masks and tubing). The Part B Deductible applies. Medicare pays the Supplier to rent the machine for the 13 months if you’ve been using it without interruption. After you’ve rented the machine for 13 months, you own it.

Medicare will only cover your durable medical equipment (DME) if your doctor or supplier is enrolled in Medicare. If a DME supplier doesn't accept assignment, Medicare doesn't limit how much the supplier can charge you. You may also have to pay the entire bill (your share and Medicare's share) at the time you get the DME."

About April of this year after 13 months of use and rental paid by Medicare and my insurance, I'll supposedly 'own' my CPAP machine. If I own it, does that suggest that neither Medicare or my insurance no longer have any responsibility for it if it should need a repair or replacement? The Medicare site and my supplemental insurance plan documents don't seem to go beyond saying I'll 'own' the machine and don't say anything about repair or replacement if it should need it. My DME's website doesn't hit on this either and their office is a bit difficult to call into lately. Does Medicare and/or insurance help with repair/replacement cost or since I 'own' it, it's on me?

I did search on this forum, but search terms I tried didn't seem to find a relevant subject.

Grumpy,
After about 4 yrs. and 10 mos. my Dreamstation quit working Fri. night. I will be contacting my DME Monday to see where we go. To complicate matters I was hoping to get a new Bi-Pap machine this Spring at my Sleep D. visit. She has said in past that I probably should be on one rather than an APAP but we needed to wait 5 yrs. I'll post back when I learn something. Last year the power supply quit and the DME told me it was not covered so I had to buy a new one. Fortunately I have a spare machine this time.

chunkyfrog · Post by **chunkyfrog** » Sun Jan 24, 2021 3:51 pm

Klm; time to call that doc, and make the necessary appointments--2 months out, if they insist.
Good luck with getting the appropriate machine this time.

klm49 · Post by **klm49** » Sun Jan 24, 2021 4:11 pm

chunkyfrog wrote: ↑
Sun Jan 24, 2021 3:51 pm
Klm; time to call that doc, and make the necessary appointments--2 months out, if they insist.
Good luck with getting the appropriate machine this time.

Appointment was already scheduled from last year but after I talk with DME I will call Sleep Dr. to see what to do.

klm49 · Post by **klm49** » Mon Jan 25, 2021 9:53 am

Grumpy48 wrote: ↑
Fri Jan 22, 2021 2:55 pm
From Medicare's site........

"Your costs in Original Medicare
You pay 20% of the Medicare-approved amount for rental of the machine and purchase of related supplies (like masks and tubing). The Part B Deductible applies. Medicare pays the Supplier to rent the machine for the 13 months if you’ve been using it without interruption. After you’ve rented the machine for 13 months, you own it.

Medicare will only cover your durable medical equipment (DME) if your doctor or supplier is enrolled in Medicare. If a DME supplier doesn't accept assignment, Medicare doesn't limit how much the supplier can charge you. You may also have to pay the entire bill (your share and Medicare's share) at the time you get the DME."

About April of this year after 13 months of use and rental paid by Medicare and my insurance, I'll supposedly 'own' my CPAP machine. If I own it, does that suggest that neither Medicare or my insurance no longer have any responsibility for it if it should need a repair or replacement? The Medicare site and my supplemental insurance plan documents don't seem to go beyond saying I'll 'own' the machine and don't say anything about repair or replacement if it should need it. My DME's website doesn't hit on this either and their office is a bit difficult to call into lately. Does Medicare and/or insurance help with repair/replacement cost or since I 'own' it, it's on me?

I did search on this forum, but search terms I tried didn't seem to find a relevant subject.

Grumpy,
Haven't gotten thru to my Sleep Dr. about my APAP that died yet, they must be busy or short handed.
I have talked to my DME and he said they do not do repairs with Medicare as Medicare does not reimburse enough. In other words, I'm on my own. I explained to him that my machine will be 5 yrs. old in April and that I see Sleep Dr. in March. Sleep Dr. told me on last visit that I probably should be on BIPAP and DME said that if she is changing machines that we could do that at any time. I'll post more when I get through to her.

SleepGeek · Post by **SleepGeek** » Mon Jan 25, 2021 10:34 am

imho you need another DME, IF you agree and don't mind a mail order Medicare supplier then give Verus Healthcare a call. They will ask you questions then contact your doc to get the info they need - then presto it comes in the mail. You can get any needed support right here.
The biggest thing with Medicare is the face to face Dr visits are documenting your need, use, and continued improvement.

They got me my 5yr replacement no problem.

HTH

https://verushealthcare.com/contact/

Medicare & CPAP Ownership at 13 Months?

Medicare & CPAP Ownership at 13 Months?

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