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New to medicare - baconjurer - 02-10-2021
I'm new to Medicare as of February 1st. I've been using a sleep apnea machine for about 5 years now and want to continue. My machine is 2 to 3 years old and works fine. However, I was under the impression that I needed a new sleep study in order to get Medicare to cover my supplies. I've attempted to verify this through my doctor's office, my DME and a call to Medicare. I'm now very confused. I have an in-lab sleep study at Stanford scheduled for Sunday night because I thought I needed it for the supplies. I don't know what reason my doctor has indicated on the order. If not for the Medicare question, I don't think I'd be doing a repeat sleep study because I'm otherwise doing well. I'm beginning to worry that it won't be paid for by Medicare and my supplement. I cannot afford it on my own, obviously. I have not yet received that book Medicare sends out. I have traditional Medicare and a plan g supplement.
Does anyone know whether or not I have to have a new sleep study in order to get my supplies covered? Does Medicare pay for repeat sleep studies after 5 years? My original study was done at home in May 2016. Are there any other details I should know?
RE: New to medicare - Sleeprider - 02-10-2021
I had no requirement for a sleep study when I converted to Medicare. The DME is making noises it might be required when my machine is replaced. I have a copy of my original study results and will work with my doctor concerning the futility of a new study. Get your supplies together. Don't use a sleep specialist if you can help it, just use your regular doctor. Don't assume your DME knows anything. As long as you have a prescription, your supplies are covered under Medicare and your supplemental plan. You need to be sure your supplier is a Participating Provider. Search here https://www.medicare.gov/medical-equipment-suppliers/
DME coverage: https://www.medicare.gov/coverage/continuous-positive-airway-pressure-devices
If you had a CPAP machine before you got Medicare, Medicare may cover CPAP machine cost for replacement CPAP machine rental and/or CPAP accessories if you meet certain requirements.
RE: New to medicare - TiredOne789 - 02-10-2021
I went on Medicare in April 2019. I did not need a new sleep study. Medicare and my supplemental insurance, plan G, pay for my supplies. My doctor wrote a script/note that said I was benefitting from my treatment. He indicated to me that was all I needed. Someone from his office contacted my DME, Lincare (an approved Medicare supplier), and notified them of my change of insurance. I also let them know I had new insurance, i.e. Medicare. I gave them my Medicare and Supplemental Plan G information. Then NOTHING happened. There was a communication SNAFU between my doctor, Lincare's local office, and Lincare's national authorization department. I figured this out when I tried to order supplies and nothing happened. Then I contacted the local Lincare office manager, and they facilitated approving and changing my insurance request. That said, everything is working well now. The only thing I do differently is I call and order supplies and verify that they are needed, where before with my company's insurance, Lincare automatically shipped supplies to my house. I kept my current A10 for Her CPAP and have been promised I will get a new one in September 2021 when it's time. If your DME is an approved Medicare provider, it should be a matter of verifying that your doctor says you are benefitting from the therapy. I did not need a new sleep study. It just took patience and persistence. Good luck.
RE: New to medicare - SarcasticDave94 - 02-10-2021
I've been on Medicare for about a year with Lincare as my DME. No need to retest to maintain coverage. Somebody is trying to generate a boat payment if you ask me.