Cost to get CPAP or BiPap through Medicare?

After reading many posts, it is clear that there is a standard rental rate if you go through Medicare to get a CPAP (and of course, after 13 months you own it). I will be getting a new CPap and my bro has a script to get his 6 year old BiPap replaced. Does anybody know what these current rates are (or at least last year's rates?).

The only way to find out is to call your insurance company. Every company has a different pay scale. Even the same company may be different in different states. As you said...Medicare is standardized...you are responsible for 20% of the allowable rate. For the machine it is about $13 month. Other items are charged up front.

I appreciate your response. Trying to get the info out of the supplemental insurance company is like pulling teeth. Sometimes you get a lot of help. Other times it's a total runaround.

It seems that part of the problem is that you can choose to go to a place that accepts Medicare assignment or one that doesn't (i.e. they can charge more than Medicare allows). There was a link in the "manual" that led me to the Medicare page where I found out that we live in a Competitive Bidding Area and lo and behold, found two places that specifically list the machines we are interested in. Yay!!! Both are some distance, but those Bipap machines are much pricier, so I'm glad to see that it is not that far for that.

Medicare supplement policies offered by the various insurance companies are all tied to what Medicare allows.
The supplement companies won't ever have a pay schedule for anything until Medicare pays and they don't keep a list of what Medicare allows for so and so equipment. They prefer to keep it simple and pay once they get a notice that Medicare either paid or applied the charges to the deductible.

There is a way to find out what Medicare allows in your area but you have to dig deep in the fee schedules and find your particular area. It's usually a downloadable pdf document that you have to sort through.
I thought I had a link to the starting point of where you have to start digging but I can't seem to locate it at the moment.

If you have Medicare and a Medicare supplement...you shouldn't ever do business with a DME that isn't a Medicare participating provider unless your supplement covers the excess above what Medicare allows.

Go here and download DME15-A. Unzip the file and you'll find various documents. The rate schedules for the various states are in an Excel spreadsheet. E601 for a basic CPAP/APAP, E470 for a bilevel, and E471 for a bilevel with backup breathing rate (also ASV). That'll get you the rental rates, of which you'll pay 20%. A supplemental policy may cover some or all of that.

Edit: I used the wrong codes for the bipaps and corrected them now.

I was told that the first two payments for the 13 month rental are higher, I think to pay for the humidifier. ???

The first payment is usually higher to pay for the mask, which is an outright purchase vs a rental.

The humidifier is built into the ResMed AirSense/AirCurve models, but the heated tube is optional. With Respironics 60 series, there's a non-humidified version with an "S" suffix, a humidity-only model with the "HS" suffix, and a model that provides humidity AND supports (and comes with) a heated tube with a "TS" suffix. The latter model also comes with an 80 watt power supply vs a 60 watt for the others.

Mine was $110 first payment $21 a month after

k_ogre wrote:Mine was $110 first payment $21 a month after

Did you get a heated air tube with that?

Your monthly payments indicate the DME is getting about 5 times that total, $105/month for 13 months, or $1365 total. That's typical for a E0601 in most states.

My monthly charge for S9 Autoset with humidifier is $9.50 for CPAP and $3.07 for humidifier...Total $12.57 month. That means the DME is getting $62.85 month or $817.05 total for 13 months. The cpap.com price for S9 Autoset and Humidifier is currently $883.00. Evidently the DME is not making the tons of money that many people complain about. (Bi-paps will cost more.)

Mine has not cost me anything.
My part B is a Plan F--expensive, but intuition told me I'd need it, some day.
Who knew it would be so soon?

k_ogre wrote:Mine was $110 first payment $21 a month after

It doesn't appear that you are on Medicare...

Turns out my biggest concern may simply getting a DME that I can work with. We are in a Medicare Competitive Bidding Area and Apria has a terrible reputation. Lincare has complaints, but they seem to be far less and more office specific. Haven't seen anything bad about the local office, so I'm crossing my fingers - my bro needs a new Bipap machine and I'll have to arrange an appointment next week. I don't have a script for my machine yet, so we will see what happens. I expect I will get some of my supplies from cpap.com.

yes to getting the heated tube and yes to medicare

medicare and TRICARE for life is easy to figure out. medicare pays 80% and tricare for life takes care of the 20%. Tricare for life also covers the medicare annual deductible. no more medical out of pocket.