Switching insurance, possibly Medicare, in machine rental period

[srlevine1]

For Medicare CPAP therapy, a compliance visit is required between 31 and 90 days after starting treatment, and while in-person visits are standard, some providers may offer telehealth options, including video visits, to review CPAP usage data and assess the therapy's effectiveness. 

Ask your doctor if they will accept an OSCAR report.

[NewlyDiagnosed]

I take it Medicare defines starting treatment as the first day of coverage, that is, May 1 for me rather than January, when I actually started using the machine? The DME rep said it had to be after May 1, but did not mention waiting at least a month.

Thanks.

[jsmit86]

A couple of points. If it's a new machine, I know that medicare will require a new compliance period. I am doing that now. It's not a problem for me since I have not missed a night of therapy in over 7 years.

You also may want to do a little research on your supplement, there are major differences in having an Advantage plan, vs. conventional Medicare with a supplement, like Plan G, for example.

Advantage plans usually have lower premiums, but often have much higher copays and deductables. They can be substantial if you ever have any serious health issues. Conventional Medicare like a Plan G, generally has higher premiums, but the deductable is $257 for this year, and any services covered by Medicare are fully covered after that. You would also need a drug plan; Plan D.
I originally was enticed by the extra benefits of the Advantage plans, but... you are locked into specific providers, and for me some of my therapy was not covered.  With Plan G, any provider who accepts Medicare must accept that plan for all covered services.

There are some more nuances, but if you have not already locked into a plan, you may want to do some additional research to make sure that you have a plan that is best for your specific needs.

[Sleeprider]

The change in coverage can be confusing, and I would be inclined to take these questions to a Medicare ombudsman. You don't have any conflicts in the coverage and just need guidance to keep it that way. By calling, you get first-hand information and can take better control of the transition process. My understanding is that Medicare should pick up seamlessly for a patient that is already using CPAP or BPAP therapy prior to receiving Medicare coverage. They will require a current prescription be on file, but not necessarily an new prescription. Your diagnostic test and review of OSA diagnosis also needs to meet their requirements, but a new test is not required. When I was provided a new Vauto under Medicare, I did not have a compliance period because I had already established compliance. The DME tried to actually charge me for monitoring and compliance reporting, but since it was not required or covered, the Medicare representative called Rotech and compelled them to cancel the extra charges for non-essential services. Anyway, I have had good luck going straight to the source.

[NewlyDiagnosed]

Thank you, jsmit86! A week ago I did not know the difference, and assumed that I'd sign up with one of the retiree medical plans my employer (large hospital system) offers. Then I learned that they are all Advantage plans, and learned the difference between that and Medicare + supplement + Part D. I'm definitely going for a supplement + D.

Another factor for me is that the employer plans are local, covering 7 counties in my state (hospital system self-insures, they are the network). I can't be sure that I will live here forever.

[NewlyDiagnosed]

Thank you for the suggestion, SleepRider! I had not been aware that there were ombudsmen. I will definitely call one to get definitive answers to my questions.