Planning for My Next Machine: An Insurance Puzzle UPDATED

OK, insurance experts, can you check my logic on this one?

1. IIRC private insurance companies, and Medicare, pay for a replacement CPAP machine every five years.
2. I got my first machine on 2/2011 through Apria with insurance coverage from Aetna, so first potential date of replacement is 2/2016.
3. My DH is 60, currently employed. If he retires now, he will get subsidized retiree coverage which also covers me.
3. I can stay on his coverage until 5/2018, when he turns 65 and by the terms of his coverage must enroll in Medicare (for which I won't be eligible until 6/2023).
4. Although I *can* get Aetna to pay for a new machine in 2/2016, I don't *have* to get a new machine then. As of this writing, my PR Series 50 machine is treating my plain-vanilla OSA effectively.

Because I went through a DME to get my original machine, every six months they still send me a ridiculous bill ($874), which is negotiated down to the Aetna "member rate" of $58.84, as part of a "maintenance contract" (ha!!), although they've done dick for me in three years (firmware upgrade? HAH). As Aetna explained, I never really own the machine completely outright.* This is a "capped rental," discussed ad nauseam in this thread: viewtopic.php?f=1&t=82725&p=750716&hilit=+rant#p750716

I confirmed on the phone today (1/13/2014) that if I buy my replacement blower through Apria in 2016 (assuming series 50 blowers are still available), and then lose my current insurance in 2018, I think I'm going to have to pay that ridiculous $846 on my own every six month without the benefit of the Aetna member rate (because I won't be an Aetna member).


If that's the case, wouldn't I be better off buying a new blower out-of-pocket from CPAP.com even if Aetna refuses to reimburse me a dime for it?

Am I missing something?

It all depends on some data not yet posted.
1) Is your treatment going well so that you do not need to replace your current machine with a different one such as a BiPAP, etc.?
2) Does Apria charge for all the accessories beyond the blower when the "sell" you a new machine?
3) Can you return the new machine or even the present machine to Apria and stop the billing?
4) Will your current machine still function well until 2018 - some do, some don't and you can't tell today?

Assuming that you can stop the billing and that Apria will charge you an original amount of $250 for the accessories to the new machine when you get it in Feb 2016, then the financial comparisons look like this. The price difference looks even better if your current humidifier will fit on the new Series 60 machine (about $250 less for purchase). If your current machine is a Series 50, it won't.


Replace 2016 Replace Now
Feb-14 $ 46.00 $ 703.80
Aug-14 $ 46.00
Feb-15 $ 46.00
Aug-15 $ 46.00
Feb-16 $ 250.00
Aug-16 $ 46.00
Feb-17 $ 46.00
Aug-17 $ 46.00
Feb-18 $ 46.00
Total $ 618.00 $ 703.80

Drowsy Dancer wrote:OK, insurance experts, can you check my logic on this one?

1. IIRC private insurance companies, and Medicare, pay for a replacement CPAP machine every five years.
2. I got my first machine on 2/2011, so expected date of replacement is 2/2016.
3. I can stay on my DH's insurance until 5/2018, when he turns 65 and must enroll in Medicare (for which I won't be eligible until 6/2023).

I used insurance coverage through Aetna to get my current machine from Apria, which means that every six months they still send me a ridiculous bill ($846), which is negotiated down to the Aetna "member rate" of around $46. As Aetna explained, I never really own the machine completely outright. I have a contract with the DME regarding the machine, and my husband's company has a contract with Aetna regarding coverage for the machine, but Aetna also has a contract with the DME that is incorporated in my contract by reference, but I've never seen it (I haven't gotten really aggressive trying to get a copy). This charge is for something like "maintenance" of the machine, although they've done dick for me in three years (firmware upgrade? HAH).

So here's my concern: if I buy my replacement machine through Apria in 2016, and then lose my current insurance in 2018, I think I'm going to have to pay that ridiculous $846 on my own without the benefit of the Aetna member rate (because I won't be an Aetna member). If that's the case, wouldn't I be better off buying a new machine out-of-pocket through my HSA from CPAP.com even if 100% of the cost of the machine applies to my high deductible?

Am I missing something?

Well you either own it or you lease it. You need a definitive answer on what is really going on here. So if you own the machine, when does that date of ownership fall. I leased the machine for three months, then when I was deemed compliant, the machine was paid off by blue cross and I 'owned' it free and clear.

If you have to lease the same machine in perpetuity, then fine -- give them back their stupid machine now, or whenever you feel ready to switch. What they're doing sounds like they're trying to scam you. You cant rope a person into a lease forever. Something doesn't make sense with what they are telling you. There has to be a date where the lease payments equal the machine cost and it's owed free and clear. Or that you can walk away from it without penalty.

2 Questions

Is it your husband's employer who is "FORCING" him to enroll in Medicare once he reaches age 65? If not, he can stay on his present insurance & NOT enroll in Medicare as long as he is gainfully employed & insured under a private plan. That is of course assuming his current insurance meets all of the Obamacare requirements.

Have you yet looked at the coverage options you have under Obamacare?

StuUnderPressure wrote:2 Questions

Is it your husband's employer who is "FORCING" him to enroll in Medicare once he reaches age 65? If not, he can stay on his present insurance & NOT enroll in Medicare as long as he is gainfully employed & insured under a private plan. That is of course assuming his current insurance meets all of the Obamacare requirements.

Have you yet looked at the coverage options you have under Obamacare?

Stu: The answer to the first question is yes. When he hits 65, he no longer will have company insurance. Also, once he retires, which I believe he will do somewhat before age 65, I don't think he intends to get another job for insurance purposes.

The answer to the second question is yes, but. The "but" is because the information available was a little skimpy. My concern is that things might change in two years.

You might call the insurance company to get a better understanding of what is going on with your machine (rental or purchased). Find out exactly what that $46.00 every 6 months is for. I just singed up with a new company for c-pap supplies and they are quoting me a $100 yr. out of pocket for supplies, which includes 4 new mask, new cushions every 2 weeks, humidifier tanks, hoses, filters and chin straps. Could that be what the $46 every six months is for?

woodworkerjunkie wrote:You might call the insurance company to get a better understanding of what is going on with your machine (rental or purchased). Find out exactly what that $46.00 every 6 months is for. I just singed up with a new company for c-pap supplies and they are quoting me a $100 yr. out of pocket for supplies, which includes 4 new mask, new cushions every 2 weeks, humidifier tanks, hoses, filters and chin straps. Could that be what the $46 every six months is for?

It is definitely not for new masks/cushions/etc.

I spent a fair amount of time a year or so ago quizzing the DME and the company and got somewhat murky answers (I posted a thread on the subject). I haven't pursued it partly because the 2x/year charge isn't very much.

JDS74 wrote: 1) Is your treatment going well so that you do not need to replace your current machine with a different one such as a BiPAP, etc.?

This is an excellent question and I should throw the answer into the mix: I have extremely boring plain vanilla OSA (thank GOD). Although severe, it is simple and treated very well by my current series 50.

I'm "eligible" for a replacement machine in 2016 per my current insurance, but not required to, and may not need to, buy one then.

Additional factor to consider:

Our gracious host does not sell the Series 50 blower without the humidifier, so at this point buying a new Series 50 blower and sending the one subject to a service contract back to Apria is not even an option.)
.
A Series 60 blower plus humidifier is listed for $747.80. at our gracious host's website.

As I see it, my best bet, if my machine does not break, to hang onto it until 2018. This costs me a maximum of $118/year (less if other medical expenses for the year satisfy the deductible). The last month I am covered under DH's insurance I should purchase a new blower and humidifier out of pocket and submit the claim to Aetna for reimbursement as an "out of network," for a cost of $299.12 to me (60% of $747.80), or if I can swing it, buy a new humidifier only through Apria (to get the in-network rate, unless the cost of the humidifier is inflated at Apria) and buy the blower through CPAP.com (to avoid the service contract).

Drowsy Dancer wrote:Additional factor to consider:

Our gracious host does not sell the Series 50 blower without the humidifier, so at this point buying a new Series 50 blower and sending the one subject to a service contract back to Apria is not even an option.)
.
A Series 60 blower plus humidifier is listed for $747.80. at our gracious host's website.

As I see it, my best bet, if my machine does not break, to hang onto it until 2018. This costs me a maximum of $118/year (less if other medical expenses for the year satisfy the deductible). The last month I am covered under DH's insurance I should purchase a new blower and humidifier out of pocket and submit the claim to Aetna for reimbursement as an "out of network," for a cost of $299.12 to me (60% of $747.80), or if I can swing it, buy a new humidifier only through Apria (to get the in-network rate, unless the cost of the humidifier is inflated at Apria) and buy the blower through CPAP.com (to avoid the service contract).

Have you checked the "SecondWindCPAP" website? I see they have a "gently used" DS550 blower for $369.00.