Medicare in the U.S. Question about masks

[CZOscar]

I’m a newbie with almost two weeks using CPAP and am still making adjustments based on great advice from members of this board/forum.  Thank you.

My question is specific to Medicare in the U.S. as it relates to masks.

I was originally fitted with ResMed P10 and liked it but had issues with mouth leaks and returned to my assigned DME and was fitted for AirFit F20.  

I kept the P10 despite DME asking me to return it next time I came by.

I’m alternating and still trying to decide which is best for me.

My questions (Medicare) are:

1),  Did Medicare buy the masks!  If so then they are both mine - right?

If true, then 

2).  How many masks will Medicare buy at the beginning to ensure good long term fit?

3).  Will Medicare pay for AirTouch foam cushions for F20 or just the AiFit?

I know Medicare will continue to provide Mask, cushions, at a set rate - but my question relates to how many times, or how many different masks, will Medicare pay for initially?

My DME said something to the effect that each additional “fitting” is costing the DME $$ and I’m not sure that is accurate.

As always thank you.

PS:  getting my APAP tuned in and AHI’s are improving along with OA’s & CA’s.  Will look for further refinements after a few more days of trial.  Thank you.

[OpalRose]

All DME’s operate differently, but the normal is that for the first 30 days, they should allow you to try a couple masks to see what works best.  Some DME’s may ask for the first mask to be returned, but some will allow you to keep it.  I’m sure they have a limit as to how many masks they let you try.

The answer to your first question is: No.
To answer your second question, Medicare will pay for “one” mask initially.  
To answer your third question: Medicare will pay for a complete mask (regardless which you choose) plus one extra cushion. DME’s bill all the parts of a mask separately.

You can wait for the 3 month replacement schedule to kick in to try something different or use an online supplier (at your own cost) that offers a 30 day return policy.

[CZOscar]

All DME’s operate differently, but the normal is that for the first 30 days, they should allow you to try a couple masks to see what works best.  Some DME’s may ask for the first mask to be returned, but some will allow you to keep it.  I’m sure they have a limit as to how many masks they let you try.

The answer to your first question is: No.
To answer your second question, Medicare will pay for “one” mask initially.  
To answer your third question:  Medicare will pay for a complete mask (regardless which you choose) plus one extra cushion.  DME’s bill all the parts of a mask separately.

You can wait for the 3 month replacement schedule to kick in to try something different or use an online supplier (at your own cost) that offers a 30 day return policy.

Thanks - good to be knowledgable for what I’m entitled to and what I’m not.

Appreciate your response

[Gideon]

http://www.apneaboard.com/wiki/index.php...care_Links

contains a Medicare replacement schedule.

[CZOscar]

http://www.apneaboard.com/wiki/index.php...care_Links

contains a Medicare replacement schedule.

Great - helpful & thank you

[Mosquitobait]

Just so it's clear, if you kept both masks, the DME is going to charge you for one. They will only pay for cushions/pillows for a single mask each month. However, you can alternate if you bought the other mask from the DME. I currently alternate between 2 masks - I get cushions for the Dreamwear through Medicare and bought nasal pillows for the Swift out of pocket because I could get them for the same or less than my 20% copay.

[CZOscar]

Just so it's clear, if you kept both masks, the DME is going to charge you for one.  They will only pay for cushions/pillows for a single mask each month.  However, you can alternate if you bought the other mask from the DME.  I currently alternate between 2 masks - I get cushions for the Dreamwear through Medicare and bought nasal pillows for the Swift out of pocket because I could get them for the same or less than my 20% copay.

Thank you.  Keeps me from making a mistake in my discussions with DME.