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+--- Thread: Machine replacement by Medicare (/Thread-Machine-replacement-by-Medicare)
Machine replacement by Medicare - Melman - 01-05-2022
My Resmed machine will be 5 years old this month. I understand Medicare will cover replacement after 5 years but am not sure what is required. I have a United Healthcare Advantage plan which follows Medicare guidelines. I phoned their customer service and was told a new machine will be covered but that Medicare requires a new sleep study to verify medical necessity. I pressed the rep a little about the sleep study requirement and it was clear she was unsure. My sleep study was in 2007 but I had no trouble getting my present machine in 2017 with this plan without a new sleep study. I'm wondering if Medicare requirements have changed. Has anyone had recent experience with this?
RE: Machine replacement by Medicare - SarcasticDave94 - 01-05-2022
I've dealt with UnitedHealthCare Community as they were my Medicaid coverage before Disability approval. Regardless, I'd be a bit suspicious of new tests to prove existing medical necessity to get a new machine. Now, when it comes to compliance, they may require that.
RE: Machine replacement by Medicare - Melman - 01-05-2022
Since I've probably missed only 4 or 5 nights in the last 5 years I don't think compliance will be a problem.
RE: Machine replacement by Medicare - SarcasticDave94 - 01-05-2022
Just stating the obvious.
RE: Machine replacement by Medicare - OpalRose - 01-05-2022
If you were changing from an Apap to a Bipap, then Medicare sometimes wants proof of medical necessity for that higher level machine via a Sleep Test.
But if you're replacing with another Apap, there shouldn't be a problem. If you've been seeing a Sleep doctor or even your regular Doctor for your SA and they have documented your use, then the Doctor only has to send a Script to your DME for replacement.
I would be surprised if this was an issue to get a new machine.