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Medicare and CPAP machine purchase
#1
Medicare and CPAP machine purchase
I've been using a CPAP machine for 2 years now a Resmed S9. I purchased this machine myself as the insurance company refused to pay for it because I purchased it before they authorized it. Now I'm on medicare and I got a new prescription for a Resmed Airsense 10 machine. The problem is everyone on the internet that I have contacted say they can't accept Medicare. Does medicare cover the machine? I did the sleep study two years ago and now I can't sleep without my machine, my S9 is acting up. I think it is in the power connecter inside the machine.
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#2
RE: Medicare and CPAP machine purchase
Medicare will rent to own through an approved DME. You have to meet certain requirements. You can either look them up at the medicare site or call them for all the details.
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#3
RE: Medicare and CPAP machine purchase
Hi wjl408,
WELCOME! to the forum.!
Good luck as you continue CPAP therapy and also with getting your insurance problems resolved.
Hang in there for more answers to your question.
trish6hundred
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#4
RE: Medicare and CPAP machine purchase
Yes, Medicare covers the Airsense 10 Autoset. You'll need a Medicare contracted durable medical equipment (DME) provider.

When you've figured out which DME to get the prescription sent to, start boning up on how to prevent them from ripping you off when you go to pick up the machine, 'cos you'll want a brand new one, not one they pretend is new.
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#5
RE: Medicare and CPAP machine purchase
This link will help you determine if you are in a Competitive Bid area (original Medicare only - if you have an Advantage Plan, you need to call them). https://www.medicare.gov/supplierdirectory/search.html

Once you've selected a DME, then contact them and go over what you would like. They will contact your doctor for the paperwork that they need (copy of sleep study, doctors prescription, doctor's notes). Make sure that you are clear with your doctor what machine you want (See the list in the links above). Even if you currently don't use the AUTO function, you want an auto machine because your needs may change.

I don't know if you bought your machine new or used. If it has less than say 7,000 hours, you might consider looking under the Supplier button up above and consider getting it fixed. Alternatively, sell the humidifier and other parts and buy another on Craigslist for $300 or less.
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#6
RE: Medicare and CPAP machine purchase
Yes Medicare will cover.  But you will have to meet there rules.

Go to this site (official Medicare Site.  Medicare DME Supplier Directory
Enter your zip code then select "Continuous Positive Airway Pressure (CPAP) Devices"
I can't post the results here but is a list of DMEs that you must use for Medicare coverage.

Medicare CPAP Qualifications
CPAP Qualifications (E0601) Patient must meet all the following criteria to qualify for an E0601 device (CPAP)

  • Patient has had a face-to-face clinical evaluation by treating physician prior to sleep test.

  • Patient has had a sleep test which meets Medicare Requirements.
    • that meets either of the following criteria:
      • AHI/RDI3 is ≥ 15 events per hour with minimum of 30 events; or,
      • AHI/RDI is ≥ 5 and ≤ 14 events per hour with minimum of 10 events and documentation of excessive daytime sleepiness, impaired cognition, mood disorders, insomnia, hypertension, ischemic heart disease or history of stroke. See back for additional information.
  • Diagnosed with OSA (ICD-9 code of 327.23)
  • Patient and/or caregiver has received instruction from the supplier of the CPAP device and accessories in the proper use and care of the equipment.
And then there is compliance, min of 4 hrs use for 21 of 30 days, easy since you are going to use this every day for a number of years.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: Medicare and CPAP machine purchase
Medicare will require documentation from your Doctor and DME. First, be sure you have a copy of your
prescription and sleep study and that your Doctor has forwarded the correct paperwork to the DME you choose.

If you have a Medicare Advantage plan, call and obtain a list of the DME providers they contract with in your area.

When your dealing with Medicare, you have to follow their rules and have all your ducks in order, especially if you want them to pay for your machine.

And yes, you can purchase online, but Medicare is unlikely to pay for it.

Also keep in mind that Medicare usually pays rent to the DME for 13 months, and after that time, you own the machine.
Good luck and let us know what you end up doing.
OpalRose
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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