CPAP Repair Cost - Me or Medicare?

[Grumpy48]

I'll preface that my CPAP machine has no problems and is functioning like the day I received it, but I'm wondering if it should fail what happens to get it repaired or replaced and would it be someone else that pays for the repair or replacement?

I'm on Medicare with a supplemental plan. The machine was 'rented' for the first 13 months per Medicare and I've now owned the machine about 2 1/2 years. The machine is past the (alleged Respironics) warranty of two years. Given that I own the machine and there is no longer a warranty, if the machine should fail, am I on the hook to pay for a repair or would/should my DME take care of the repair and bill it out to Medicare/Insurance?

The CPAP is a DreamStation 2 which is presumably no longer available. If it was not repairable can the DME replace it with a CPAP of their choosing or can I specify what the replacement would be?

I don't think I've seen this question asked here and knowing in advance what one might expect might help avoid the DME taking advantage of a situation to benefit themselves.

[chunkyfrog]

Unless something seems to be "off" don't worry about it.
Normal lifespan is close to the Medicare 5 year line.
Get a back up machine, and sleep well.
Cpap.com and secondwindcpap.com are excellent sources.
OOP, unfortunately, so buying local is beyond foolish.

[Janknitz]

I believe that part of the reason the DME gets paid more for the capitated rate of the CPAP machine than the retail price is that they have to provide service and repair for 5 years. So if something does go wrong, contact the DME.

Medicare only covers replacement after you’ve reached the estimated lifetime (five years for DME).10 Until then, Medicare will pay for repairs needed to meet that lifetime (which may include total replacement).

https://www.ncoa.org/adviser/sleep/does ... -machines/

[zonker]

<capitated rate>

thank you for making me learn a new word phrase today.

[prodigyplace]

I believe that part of the reason the DME gets paid more for the capitated rate of the CPAP machine than the retail price is that they have to provide service and repair for 5 years. So if something does go wrong, contact the DME.

Medicare only covers replacement after you’ve reached the estimated lifetime (five years for DME).10 Until then, Medicare will pay for repairs needed to meet that lifetime (which may include total replacement).

https://www.ncoa.org/adviser/sleep/does ... -machines/

I am sure they would charge their normal inflated prices. For supplies it is cheaper for me to buy them as needed than pay the 20% insurance copay of the DME prices.

[chunkyfrog]

I wonder how the 5 year built-in service plan with Medicare balances out
with the initial profit of cheaper machines versus reliability of resmed equipment.
Perhaps repair statistics can influence sales?
One can hope.

[Janknitz]

I am sure they would charge their normal inflated prices. For supplies it is cheaper for me to buy them as needed than pay the 20% insurance copay of the DME prices.

This has nothing to do with what DME's charge. The reimbursement amount is set by Medicare regardless of what the DME wants to charge. Medicare (and you with your co-pays) pays MORE than the retail price for a CPAP machine, but the DME is then on the hook for repairs for the next 5 years.

I have been buying my own supplies and one machine for a while now. It's cheaper than deductibles and co-payments and I don't have to play stupid DME games. I don't buy from DME's (except cpap.com).

Going on Medicare soon, I might use Medicare for supplies, but we'll see what the out of pocket will be first.

[Janknitz]

I wonder how the 5 year built-in service plan with Medicare balances out
with the initial profit of cheaper machines versus reliability of resmed equipment.
Perhaps repair statistics can influence sales?
One can hope.

The Respironics machine I had first (PRSI) was a dog. The known manufacturer's defect with the humidifier was never repaired (in part because the humidifiers failed because of a defect in the main unit, and all they did was replace the humidifier). But I don't see too many complaints about ResMed's. Not sure if the quality has improved with Respironics.

[Grumpy48]

I am sure they would charge their normal inflated prices. For supplies it is cheaper for me to buy them as needed than pay the 20% insurance copay of the DME prices.

This has nothing to do with what DME's charge. The reimbursement amount is set by Medicare regardless of what the DME wants to charge. Medicare (and you with your co-pays) pays MORE than the retail price for a CPAP machine, but the DME is then on the hook for repairs for the next 5 years.

I have been buying my own supplies and one machine for a while now. It's cheaper than deductibles and co-payments and I don't have to play stupid DME games. I don't buy from DME's (except cpap.com).

Going on Medicare soon, I might use Medicare for supplies, but we'll see what the out of pocket will be first.

Medicare summary shown below for CPAP supplies from DME. Mask and headgear assembled (F&P Vitera full face) in same package are billed separately. Other supplies are for a Respironics DS2. The supplied filters from the DME are Sunset brand and not Respironics. My Medicare supplemental insurance covers in full what I would have had to pay for what Medicare didn't.

My first CPAP was a Respironics DS1 which was a 13 month 'rental' from the DME One month rental my Medicare supplemental also covered this in full.
"1 Continuous positive airway Yes $175.00 $31.49 $25.19 $6.30 A,B
pressure (cpap) device
(E0601-RRKJKX) Rental (dme)
Total for Claim #xxxxxxxxxx Supplier charged $175.00, Medicare approved $31.49, Medicare Paid $25.19, You may be billed $6.30"

I don't believe out of pocket could be any cheaper(?)

[prodigyplace]

I wonder how the 5 year built-in service plan with Medicare balances out
with the initial profit of cheaper machines versus reliability of resmed equipment.
Perhaps repair statistics can influence sales?
One can hope.

The Respironics machine I had first (PRSI) was a dog. The known manufacturer's defect with the humidifier was never repaired (in part because the humidifiers failed because of a defect in the main unit, and all they did was replace the humidifier). But I don't see too many complaints about ResMed's. Not sure if the quality has improved with Respironics.

In my case, it was other medical insurance through my employer. Last year, because annual out of pocket maximum for medical was met, I got an AirSense 11 with no copay.

[Janknitz]

Medicare summary shown below for CPAP supplies from DME. Mask and headgear assembled (F&P Vitera full face) in same package are billed separately. Other supplies are for a Respironics DS2. The supplied filters from the DME are Sunset brand and not Respironics. My Medicare supplemental insurance covers in full what I would have had to pay for what Medicare didn't.

My first CPAP was a Respironics DS1 which was a 13 month 'rental' from the DME One month rental my Medicare supplemental also covered this in full.
"1 Continuous positive airway Yes $175.00 $31.49 $25.19 $6.30 A,B
pressure (cpap) device
(E0601-RRKJKX) Rental (dme)
Total for Claim #xxxxxxxxxx Supplier charged $175.00, Medicare approved $31.49, Medicare Paid $25.19, You may be billed $6.30"

I don't believe out of pocket could be any cheaper(?)

That's good to know. I will be new to Medicare in November. My co-pays--when I had CPAP coverage--were higher than most supplies cost online although my machine and first mask was far less. I bought my newest machine on a Black Friday sale at CPAP.com and I think that cost less than Medicare deductibles and co-pays, plus no hassle or stupid DME games.

[springman946]

insurance should cover the cost of a replacement machine

[ChicagoGranny]

Medicare summary shown below for CPAP supplies from DME.

Those may vary by region, e.g., higher prices in rural areas.

[ChicagoGranny]

I'm wondering if it should fail what happens to get it repaired or replaced and would it be someone else that pays for the repair or replacement?

Shouldn't you be more concerned about not having a backup machine?

[Grumpy48]

I'm wondering if it should fail what happens to get it repaired or replaced and would it be someone else that pays for the repair or replacement?

Shouldn't you be more concerned about not having a backup machine?

I do already have a backup machine, an AS10 that I bought (LSAT) out of pocket, but if my DME supplied CPAP failed before the 5 year replacement time I would want it repaired or replaced so I still have two working CPAP's. I just wasn't sure who would bear the cost since I own it, whether it would be me, the DME, or billed back to Medicare/insurance.