Switching insurance, possibly Medicare, in machine rental period

[NewlyDiagnosed]

I recently (~2 months) switched to BiPAP, and it is working beautifully, much better than CPAP did.  Last year, I had great insurance coverage which paid most of the cost of the machine rental and the supplies after I met a $500 deductible.  I was nearing the end of the 10-month rental period when I made the switch, turning in the AirSense and getting a new AirCurve in exchange.  The insurance company does not pay anything (and I don't have to pay anything) during the current 3-month compliance period. 

Several things have changed now.  As of January 1, my employer-sponsored health insurance downgraded benefits.  I now have a $4000 deductible, which means that I will pay 100% of the cost of the machine rental and supplies (almost no other charges which would go toward the deductible).  One thing I don't know yet, but will find out on Monday, is what the rental cost of the BiPAP is.  The CPAP rental was $120/month, of which I paid about $20.  Depending on what this cost is, I may be better off just buying a machine online and paying out of pocket.

I am old enough for Medicare, so I have the option of enrolling and discontinuing my current health insurance.  Not sure how long it would take to do this, especially with SS staffing cuts.  I already have Part A, the one you get automatically.  Another wrinkle is that my job may end soon, as it is funded by NIH grants, thereby ending my current health insurance. 

I'm wondering whether anyone has transitioned to Medicare during the machine rental period.  Officially, the rental period has not started yet because there is a 3-month "free" period.  Do I have the option of handing the machine back to the DME without having to pay for it, if it turns out to be much more expensive to pay for it through insurance?  Would the DME seamlessly transfer billing to Medicare?

I am working with two DMEs, and both are great.  So is the company who manages sleep therapy compliance/billing for my insurance company (the first good experience I've ever had with an insurance company). I have a different DME for supplies because I use the Bleep Dreamports and my first DME doesn't provide them.

If I have to pay for this out of pocket, it's not the end of the world because the therapy is making a world of difference.  But if I can avoid multi-thousand dollar bills I'd prefer to do so.

[srlevine1]

When I transitioned from company-paid private insurance to Medicare, I was surprised to find that the insurance company had a specialist who eased the transition. They forwarded the results of my sleep study, the doctor's prescription, and DME details to Medicare, and the transfer was seamless. The compliance conditions remained the same. Likewise, my DME also had a specialist who dealt with Medicare issues.

So you might want to start by requesting advice from the DME who handles your machine and supplies.

Caveat: It is crucial that your DME be a Medicare provider; otherwise, you need to find another DME with a valid Medicare contract. You may wish to check the Medicare Supplier Directory for your area. https://www.medicare.gov/medical-equipment-suppliers/

Best wishes, Steve

[NewlyDiagnosed]

Thank you so much, Steve! That's very reassuring. Both DMEs deal with Medicare, so I'm OK there. I think that I will just go ahead and switch to Medicare as soon as possible, eliminating one source of uncertainty.

[Sleeprider]

Medicare is mostly an 80%/20% coverage, and you may purchase an Advantage Plan that takes care of prescriptions and backfills some costs, so your costs are likely to be less under Medicare. If you were diagnosed with OSA using an approved diagnostic test (PSG), and dispensed a device, Medicare will continue to approve the use of PAP. There is no requirement to undergo testing for bilevel, only that your doctor prescribes it to treat OSA with a medically necessary device. As srlevine1 said, you should ensure you are working with an approved Medicare Provider. You can use this form to find your supplier. https://www.medicare.gov/medical-equipment-suppliers/ Also, read about the roles of your DME supplier, sleep specialist and your treating physician in this wiki article. https://www.apneaboard.com/wiki/index.ph...Physicians

[NewlyDiagnosed]

Thank you, SleepRider! I am pretty sure that my employer offers an Advantage plan, will find out tomorrow. I've decided to go ahead and apply for Medicare Part B now, rather than waiting until my job ends (if it does) and then trying to make the change. I'm having some issues on the website, will post another thread with Medicare questions.

[Sleeprider]

You're generally required to sign up for Medicare Parts A and B during your Initial Enrollment Period, which begins three months before your 65th birthday, includes your birthday month, and ends three months after it, to avoid potential penalties. I don't know your age, but Medicare enrollment is not optional, even if you think you may have employer insurance. Your employer may supplement Medicare with an Advantage Plan or other benefits, but if you enroll later than your initial enrollment period, you can end up with penalties for Part B.

[NewlyDiagnosed]

I've had Part A for several years, because it's automatic. You are allowed to defer Part B while you have employer-based insurance. Otherwise you have to pay a penalty every month forever. There is a a general enrollment period every year from January - March, or you can use a special enrollment period after you lose your insurance. I'm trying to sort out the best/fastest way to apply at this point.

[Sleeprider]

That clears it up. Good luck. Time is running out for this year.

[NewlyDiagnosed]

I'm going to post some answers to questions I asked in this thread, in case it helps someone else. I learned that I should apply for Medicare Part B under the "Special Enrollment Period" even if I happen to apply during the General Enrollment window, because I am applying "late" with evidence of group coverage. I dropped off my application and documentation of the group insurance coverage at my local Medicare office, and within 1 week the policy was approved to start May 1 (as I'd requested), and I had a new letter and card. Now I have other questions about the transition that I will post in another thread.

[NewlyDiagnosed]

Actually, this seems to be the right thread.

My doctor prescribed a BiPAP in January, and I received it near the end of the month. I turned in my regular CPAP machine; I was about 6 months into the rental period. The new machine triggered another 3-month compliance period, and it will end about a week before the transition to Medicare. During this period, there are no charges for the machine to either my insurance or to me (this also happened last year with the first machine, 3 "free" months).

I called the DME today to ask about switching to Medicare. I asked if they could wait until after May 1 to start billing for the machine, and the rep said that would be no problem. He also said that I would need an appointment with my doctor and a letter, new prescription, etc., from her before Medicare would start paying. I happen to have a followup appt scheduled later this month, but the rep said that the appt had to be after Medicare coverage starts. I called and the first appt I could get was late June. I'm going to keep the appt later this month, explain the situation to the doctor, and ask if she would schedule a very brief appt to satisfy Medicare.

Has anyone else run into this requirement? I'm wondering what will happen if the DME has no one to bill for 2 months.

I'm also wondering if Medicare would require another compliance period. The DME rep said no, they would immediately start a 13-month rental period.