Medicare Newbie

I turn 65 in about two months and I'm reading all I can about medicare plans. The stack of info grows exponentially. My main health concern is my sleep apnea. I wanted to throw this question out to the forum ...

Which plans give sleep apnea the most support? Any suggestions?? Any pitfalls to look out for?

I have Medicare with a United Health Care supplement. The supplement is costly, but it does cover everything I need - machine, mask, supplies, etc. Have your doctor write a prescription for one of the "good" machines suggested here, mine being one of them. The sleep study was covered also.

Most Advantage Care Plans and HMOs cover at least part of the expenses, altho they do have different requirements. You have to do some research and then decide what is right for you.

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Medicare advantage plans often restrict the type of equipment you can get and the DME vendors. Kaiser is particularly restrictive. So you may prefer a regular Medicare supplement. For more info contact the HICAP number on the back of your "Medicare and You" book for free help on evaluating and choosing plans.

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How frequently does Medicare replace nasal pillows? I've read 2 a month and I've read 1 a month. I can't seem to find a recent and definitive medicare replacement schedule.

SleepingUgly wrote:How frequently does Medicare replace nasal pillows? I've read 2 a month and I've read 1 a month. I can't seem to find a recent and definitive medicare replacement schedule.

According to this document http://www.nationwidemedical.com/wp-con ... gion-d.pdf, which was in the Medicare compliance topic just a couple of weeks ago, 2 per month. The Local Coverage Determination (LCD) does vary by region of the country, but I think for things like pillows it's most likely the same nationwide.

If you go to http://www.cms.gov and search for CPAP and Local Coverage Determination and your state you can find out for sure. But finding a specific LCD on the CMS site is a test of determination and will, but it can be done.

The level of difficulty in accessing the information:
The gatekeeper dwells therein.
It cannot harm you unless you give up.

My medicate advantage plan covers CPAP at 80% of the medicare approved prices. I have the AARP plan which has NO premiums but lots of co-pays.

JoyinSF wrote:Which plans give sleep apnea the most support? Any suggestions?? Any pitfalls to look out for?

Generally speaking, it is way less expensive to go the Medicare advantage plan. It is however correct that under that plan you do have less choice over who you can get your cpap and or cpod equipment from. In Colorado, Apria is the only provider that will deliver my oxygen that is approved by bcbs but there are others that have the basic equipment although they do not deliver and I am not about to lift two 150 pound lox tanks into my vehicle once a month to have them filled.

I had a regular supplement in 2008 and back then it cost me $150 a month and that added up to $1800 a year. I checked this year on the cost of a regular supplement with United Health Care during the period when Medicare permits you to change companies and the monthly cost would now be $185 or $2200 a year. With both the plan I had in 2008 and the current plan, there is no deductible and no co-pay so you need to figure how much you think you would pay in co pays and if you do have a deductable (most Medicare advantage plans do not have a deductable but that may vary in different States) which is nice.

Now I did keep careful track of my co-pays in past years because they are tax deductable and in the past years my co pays only amounted to around $380 a year. This year because of my 8 day hospitalization which cost me an additional $1700 plus the other regular co-pays so my out of pocked this year will be about and for this year, my co-pays have only amounted to $2080 an none of that includes the co-pays for prescription drugs. I am not sure if that applies in other areas but in mine all of the plans have drug co-pay, which is regulated by Medicare not the insurance companies.

The upshot JoyinSF (is that Joy in San Francisco? ) you need to find out what you will be paying annually with both and see where you stand. Things to consider are the probabilities of being hospitalized and any possible medical procedures you might need. You doctor can probably give you some guidance on that. Of course, some things you can never know about in advance like a sudden hospitalization which is usually the most expensive additional cost.

Nine of the companies really give you any added support for your sleep apnea; they just pay the doctor bills as they come in. Your doctor is the only one you can count on support from.

Good luck and take your time. It appears that you have plenty of time to make a decision but you do need to take control and do some research.

JoyinSF wrote:Which plans give sleep apnea the most support? Any suggestions?? Any pitfalls to look out for?

In case you aren't aware, you have the opportunity to change your Medicare insurance plans every year. If your experience with the one you choose doesn't work out real good you are stuck with them only until the end of the year. So whatever you choose now, you are not committed to it forever.