medicare and cpap

Does anyone know how medicare handles cpap machines and masks?
I have been on a machine for the past 5 years and would like to get a
new machine and finally have some help with the mask costs.

If Medicare did not pay for your current machine, you may be able to get a new one now.

Medicare sets the reimbursement rate for machines within the E0601 HCPCs code--this means that you may have ANY CPAP or APAP machine (but not a BiPAP or ASV) and Medicare will pay the same, flat amount no matter if it has the newest bells and whistles or it's an old brick--the DME's will try to tell you differently. No matter what the DME wants to charge for the machine and supplies, they can't get more than the Medicare rate (except if they do not accept assignment, see below).

Medicare pays for the machine on a "capped rental" basis. That means Medicare pays 80% of a set fee, you (and/or your insurer) pay the remaining 20%. After 13 months, the machine is yours.

Medicare purchases the mask, hose, filters, and humidifier, and has a schedule for regular replacement. Again, Medicare will pay only 80% of the fee that they set.

If the DME "accepts assignment", they can't charge you more than the 20% Medicare doesn't pay. If they do not accept assignment, they can charge you another 15% over and above the medicare fee.

Keep in mind that your Medicare supplment policy (also called Medi-gap) may have deals with "preferred providers" DME's where the insurer will pay more of the 20% than other DME's.

Welcome to the forum.