Medicare

[Kim A]

I will be getting on Medicare this next year and was wondering if there is something I need to do before hand. I have been buying everything out of pocket except for the doctor visits. Thanks for your help. Kim

[chunkyfrog]

Call your state's bureau of insurance, and ask about free IMPARTIAL insurance counseling for seniors. SHIIP in many states.

[Kim A]

Thanks I will check it out.

[Hopeful50]

Medicare will pay for CPAP supplies, but they do require a yearly doctor visit and a new prescription each year. They also require you to use certain DME vendors, which vary for each area.

[Pugsy]

Medicare will pay for CPAP supplies, but they do require a yearly doctor visit and a new prescription each year. They also require you to use certain DME vendors, which vary for each area.

Who told you that?

Been 9 years on the same prescription for me....Medicare pays for what I get.
Haven't seen the sleep doc since Aug 2009.
I still get my supplies from the same DME that I started with. My two masks every year and occasionally something else.

I keep seeing people say this and all I get is "my doctor said" or "my DME said"...

[LSAT]

Medicare requirements...https://www.cms.gov/Outreach-and-Educat ... 905064.pdf

[klm49]

I will be getting on Medicare this next year and was wondering if there is something I need to do before hand. I have been buying everything out of pocket except for the doctor visits. Thanks for your help. Kim

If you get a supplemental policy make sure it will pick up the cost of what Medicare doesn't pay (20%).

[Pugsy]

Medicare requirements...https://www.cms.gov/Outreach-and-Educat ... 905064.pdf

From the above document page 7 where it talks about long term and/or patients past the initial compliance period (which is 91 days).

Medicarestuff.JPG

I assume a statement from the supplier is sufficient that the patient continues to use the supplies. It says "doctor or supplier".
I didn't see any 1 year doctor visit mentioned anywhere and I didn't see new RX every 12 months anywhere either.

So Medicare doesn't create the limitation but some DMEs and doctors associated with DMEs or sleep centers might make their own in house rules...they can do that.
They blame it on the insurance or Medicare...and that's the part that irks me. I would respect them more if they just told the truth.."this is how we do it and our rules".
If they just told the truth then I could decide if I wanted to continue to use them for supplies per their in house rules or take my business elsewhere but when they lie to me...my business goes elsewhere because I don't like being lied to.

[chunkyfrog]

The lies usually come from the top, and the employee speaking to the client
may not know the truth unless they are TOLD--or shown verifying hardcopy.
Often this is more trouble than it is worth; and it is usually easier to go elsewhere.
Too often lying is an integral part of a business plan. Avoid such businesses!

[ChicagoGranny]

On the other hand, it would seem certain that DMEs sometimes get screwed out of payments if they don't have strict rules.

[Kim A]

Thanks for the info. So far I have bought my machine from someone here and my supplies from Cpap.com. Just wondering if I will need to buy my things from a different supplier.

[Kim A]

Looking at supplement plans right now.

[Pugsy]

If you want to use insurance for your cpap stuff you will need to find a supplier that works with insurance/Medicare.
Cpap.com doesn't and even if you could file the forms yourself Medicare wouldn't pay you back.

Here's Medicare's replacement allowance schedule.

[Kim A]

Thanks Pugsy.

[CPAPforever]

DME will require copy of sleep study (and meet all Medicare documentation requirements to start CPAP). Some people who started CPAP before Medicare end up having new sleep study because missing some of the required documentation. Ridiculous but hard, unbending rules. Goggle "Medicare CPAP documentation requirements"

Also need compliance letter and of medical necessity from MD.