Medicare Question

I'm sure someone here can answer a question I have about Medicare and CPAPs.

I've been using an APAP (Resmed) for the past 4.5 years (nearly 100% compliant thanks to tips and tricks learned on this web site)...machine, masks, software etc. paid for out of pocket because of high insurance deductible. As of last month, I am now on Medicare and will be seeing my PCP next month for the first time since insurance change.

So, now my question:

Even though my 4.5 year old APAP is still working properly, will there be any problem getting Medicare to approve a new APAP if so prescribed by my PCP (who is always willing to go along with whatever equipment I feel is best suited for me). Also, is there any chance Medicare would pay for the software as I'm sure my old program will not be compatible with a new machine.

Medicare has a general replacement schedule of every 5 years unless the cpap breaks and costs more than replacement cost to repair. Since you paid for yours out-of-pocket I would think you would not have any problems getting medicare to pay. EXCEPT medicare for me required a copy of my sleep study as well as the script in order to get it approved. Getting an apap is generally up to the Doctor and the DME. Medacare has one code that covers cpap or apap. Bipap is the only other code.

Don't think you will have any luck getting medicare to pay for the software. I got turned down flat when I asked. But what the heck you never know and I never hurts to ask as long as you don't get your hopes up to high.

Jerry

I had asked this specific question recently to the insurance company, the one which was approaching me for medicare. According to them, when you start medicare, none of the previous DME from previous insurance is counted in the medicare schedules, as long as you have a new prescription after you start medicare. Hope they are right

Apparantly that is the case when you go from insurance company to another too --- they compensate this to some extend with the the deductibles starting over again.

read - I realize it is a year old post but has this changed with medicare getting tighter?

viewtopic/t36824/viewtopic.php?p=227148#p227148

If Medicare won't provide an xPAP w/o another sleep study, what the hay, its been 4 1/2 years so it wouldn't be all that bad an idea to have at least a new titration.

The Resmed S8s are still compatible w/the AutoScan 5.7 software, and frankly, ResScan 3.5 isn't all that much of an improvement. On the other hand, if you get a Resmed S8 II you will need at least ResScan 3.4 and if you have Vista on your PC you will need ResScan 3.5 And, nope, Medicare isn't gonna pay for the software and cable reader.

If your doctor scripts an autoPAP you should have no problem. Unless the local DME supplier you go with decides to be real PITAs. Your problem won't be w/Medicare it will be w/the local DME supplier. Most alll local DME suppliers accept Medicare so your only restriction on choice of local supplier will be if you have secondary insurance and what local suppliers your secondary insurance is contracted with. Medicare does insist on a 13 month capped rental.