Going on Medicare...

[Shamus54]

Went on Medicare this month and my sleep doctor told me I had to have a new sleep study performed to continue receiving supplies. I also probably will need to upgrade from my S9 to another cpap machine with a modem installed. Hopefully everything will be covered by Medicare and Tricare for Life secondary insurance? Does all this seem about right to others in my situation, or are there other options? Thoughts anyone?  Thanks! 

[OpalRose]

You should probably double check with them, but Medicare usually pays the DME rental for 13 months.
After that time, you then own the machine.

Yeah, Medicare has their own rules, and it seems likely they would want a sleep study. Again, double check with your insurance to see what is covered and what you may have to pay. Keep your S9 as a backup.

[SideSleeper]

You are in luck! I have the same coverage--Medicare and Tricare4Life. We don't pay a penny. I got good equipment right from the start--fully data capable Respironics machine and heated hose. All supplies are paid for if within the Medicare time guidelines which are very generous. Medicare covers 80% and Tricare the 20% of the Medicare-approved amount. Medicare pays the "rent" for 13 months then it is yours. Tricare is great as a secondary insurance for all care--except dental and vision--superior for prescriptions. You may know this already.

[jaswilliams]

Try and get a Prescription from your dr for a Resmed Autoset 10 or the for her version as it has an extra mode that may be useful as these are the replacement machines for your S9 and it always. Better to stick with the brand you are used to.

[Shamus54]

You are in luck!  I have the same coverage--Medicare and Tricare4Life.  We don't pay a penny.  I got good equipment right from the start--fully data capable Respironics machine and heated hose.  All supplies are paid for if within the Medicare time guidelines which are very generous.  Medicare covers 80% and Tricare the 20% of the Medicare-approved amount.  Medicare pays the "rent" for 13 months then it is yours.  Tricare is great as a secondary insurance for all care--except dental and vision--superior for prescriptions.  You may know this already.

Glad to hear the good report on benefits! Are you saying no deductibles or copays for either insurance? 

[Shamus54]

Probably a good thing to get another study done anyway after nearly ten years... I bought a used respironics machine several years back that I use for travel and day knapping, (and squirreled away some extra supplies for unexpected contingencies), so I'm in pretty good shape for a poor old guy I guess? lol

[michael9346]

Just make sure your DME (durable medical equipment) fills prescription as prescribed. Make sure you check machine blower hours so you know you have a new machine. I'm not sure if you already used a DME or bought supplies online but ask Medicare and get the list of DME's in your area. (not all DME's accept Medicare.)

[Sleeprider]

If you have a copy of your original diagnostic study, it is usually accepted as proof of medical need without a new test. The fact you have continuously under care for sleep apnea and are using CPAP equipment and supplies further supports the case. Do not just accept you need another test! Any test you have will be diagnostic or perhaps a split-night diagnostic and titration. You really don't need it, and Medicare does not need to pay for it if you have the required documentation. There is nothing new that is going to be learned from having you sleep with testing equipment hooked up, other than the loss of a perfectly good night's sleep and a lot of extra expense.

Individuals that did not keep their documentation and test results will be required to obtain a test proving diagnosis of a covered condition before coverage is provided...that is not you. Be sure your DME is provided copies of all required prescriptions and evidence of testing and ask for that to be submitted for a Medicare coverage determination, before you submit to new testing.

[Homerec130]

Back in October I shifted over to the Medicare/TFL and had to get a new study done to keep my machine supplied. I talked to the DME and my doc and the reason for this was my sleep study was more than 5 years old. I was also able to keep the same DME. Got a new sleep study (which was a joke) and then a new machine - the one I wanted - without any problems. I had my first follow up with my sleep doc yesterday and told him about the study and he told me I wasn't the first person that told him that. Plan is to watch the numbers from this machine, and combined with my comments and feelings, wait about 6 months before possibly doing another study. 

BTW, I ended up going with Delta for my dental and VSP for vision under the new plans for us mil retirees.

Homer

[greatunclebill]

i switched to tfl and medicare 5 years ago and haven't paid one penny for anything medical or dme for me or my wife. tfl also pays your medicare deductible. we do have co-pays in drugs. you don't need referrals for anything except if the specialist requires one from your primary. make sure you get new id's when you turn 65. i was really scared prior to switching but found out real quick everything is seamless and easy.