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Medicare changed coverage for ResMed masks
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Wildfire Offline

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Posts: 3
Joined: Feb 2015

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: ResMed AirFit
Humidifier: ResMed H5i
CPAP Pressure: 5-12
CPAP Software: ResScan SleepyHead

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Sex: Male
Location: Texas

Post: #1
Money Medicare changed coverage for ResMed masks
After trying numerous CPAP masks from different companies over the years, I finally found one that fits and doesn't leak: ResMed AirFit full face mask.
Medicare and AARP covered the cost with no copay by me.
However, when I went to get my 3-months replacement, my Medical Equipment supplier told me that Medicare no longer covers so-called Premium masks. Starting now, I would have to pay the full cost to the supplier who then would file the claim for me and in due time Medicare would send me a check for the amount they covered.
According to the supplier it would amount to a net cost to me of about $80 where I paid nothing before.

However, the supplier had the 3B Elara Full Face CPAP mask which would be fully covered by Medicare/AARP without any cost to me.
A look at the mask shows the flimsy construction and trying it for several nights, I cannot get a proper seal no matter what I try.

My question is: Did Medicare in fact made changes in the last 3 months regarding coverage of CPAP masks by classifying ResMed and other well known brands as Premium masks?
08-21-2016 01:10 PM
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justMongo Offline

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Posts: 3,851
Joined: Sep 2013

Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: ResMed H5i
CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

Other Comments: μολὼν λαβέ

Sex: Male
Location: Калифорния

Post: #2
RE: Medicare changed coverage for ResMed masks
They're making up a story.

Medicare did another round of competitive bids for DME suppliers. Many lost their Medicare contracts; including mine.
Things changed on 01 July 2016. I can find no mention of so called premium masks. I am however, finding it difficult to find a new supplier.

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.
08-21-2016 01:52 PM
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FrankNichols Offline

Advisory Members

Posts: 714
Joined: Mar 2016

Machine: AirSense 10 Autoset
Mask Type: Full face mask
Mask Make & Model: Resmed F10 and/or P10
Humidifier: Builtin
CPAP Pressure: 17-19
CPAP Software: ResScan SleepyHead Other Software

Other Comments: I've figured out how to get my AHI down to 5, I quit sleeping!

Sex: Male
Location: Live Oak, Florida

Post: #3
RE: Medicare changed coverage for ResMed masks
Sounds like a tall tale to me, I would report them to Medicare.

I am not a Medical professional and I don't play one on the internet.
Started CPAP Therapy April 5, 2016
I'd Rather Be Sleeping
08-21-2016 02:00 PM
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robertbuckley Offline

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Posts: 99
Joined: Mar 2013

Machine: Resprionics BiPAP Auto SV Advanced
Mask Type: Full face mask
Mask Make & Model: ResMed AirFit F-10 Full Face
Humidifier: Resprionics System One
CPAP Pressure: EEP 15; PS 4 - 10
CPAP Software: SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: New York, NY

Post: #4
RE: Medicare changed coverage for ResMed masks
I just had an order filled 2 weeks ago for the F-10 under Medicare with no problem. Sounds like that the Elara is the mask the supplier wants to supply to you because they will make more. Which DME supplier do you use? You know what you like, and if you are not in the "rental" period anymore, just switch DMEs. You really don't even need one that is local, so long as they have a contract to service your area. You call, they fill. Mark your calendar for 3 months out, and call again. Even Apria does this with no hassles.
08-21-2016 02:08 PM
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srlevine1 Offline

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Posts: 227
Joined: Sep 2015

Machine: ResMed Airsense Autoset (S10)
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage Activa LT
Humidifier: Internal to S10
CPAP Pressure: 12-15.6
CPAP Software: ResScan SleepyHead Other Software

Other Comments:

Sex: Male
Location: Westlake Village, California USA

Post: #5
RE: Medicare changed coverage for ResMed masks
(08-21-2016 02:08 PM)robertbuckley Wrote:  I just had an order filled 2 weeks ago for the F-10 under Medicare with no problem. Sounds like that the Elara is the mask the supplier wants to supply to you because they will make more. Which DME supplier do you use? You know what you like, and if you are not in the "rental" period anymore, just switch DMEs. You really don't even need one that is local, so long as they have a contract to service your area. You call, they fill. Mark your calendar for 3 months out, and call again. Even Apria does this with no hassles.

Here in Westlake Village, California, APRIA is no longer the Medicare Supplier according to the latest round of bidding. However, they appear to be grandfathered into the program as long as I am in my "rental period" and then I may need to switch vendors. There does not appear to be any restriction on ResMed products when checking their on-line ordering site.

Considering the actual costs of the masks vs. retail, one might suspect that the DME is being incentivized to sell a particular mask. I would contact the DME and ask for a supervisor. Get their name, time, and date of the conversation. Get them to repeat the story. And then ask them if there is any reason you should not call the Medicare FraudTips Hotline at 1-800-447-8477. "Giving false information to any insurance company is fraud -- a crime that can result in criminal and civil penalties."

"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
(This post was last modified: 08-21-2016 02:44 PM by srlevine1.)
08-21-2016 02:43 PM
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Wildfire Offline

New Members

Posts: 3
Joined: Feb 2015

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: ResMed AirFit
Humidifier: ResMed H5i
CPAP Pressure: 5-12
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Texas

Post: #6
RE: Medicare changed coverage for ResMed masks
Looks like they make more money on that cheap mask which is $99 on the Internet.
I'll be looking around for another supplier.
No sense that I should be paying $80 out of my pocket with Medicare we
Hen I paid nothing 3 months ago
08-21-2016 04:12 PM
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trish6hundred Offline

Advisory Members

Posts: 6,446
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #7
RE: Medicare changed coverage for ResMed masks
Hi Wildfire,
WELCOME! to the forum.!
Good luck to you with your CPAP therapy and with getting the situation with your supplies straightened out.

trish6hundred
08-21-2016 04:12 PM
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Wildfire Offline

New Members

Posts: 3
Joined: Feb 2015

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: ResMed AirFit
Humidifier: ResMed H5i
CPAP Pressure: 5-12
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Texas

Post: #8
RE: Medicare changed coverage for ResMed masks
Thanks everybody for answering my question. Obviously Medicare has no restrictions on ResMed and that Premium BS is the supplier's own invention.
They are not the only ones in this area; I'll be looking for more consumer friendly folks.
In the meantime I have the 3B Elara to test some more while I continue using my full face ResMed AirFit a little longer.
(This post was last modified: 08-21-2016 04:54 PM by Wildfire.)
08-21-2016 04:46 PM
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pavel Offline

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Posts: 1
Joined: Feb 2013

Machine: resmed s9
Mask Type: Full face mask
Mask Make & Model: resmed
Humidifier: resmed
CPAP Pressure: 16
CPAP Software: Not using software

Other Comments:

Sex: Male
Location:

Post: #9
RE: Medicare changed coverage for ResMed masks
Medicare covers my F10s at 80% rate and that only leaves a small amount to pay. (as of 7/2016)
09-02-2016 01:36 PM
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