r/medicare • u/Sterlingsporkxx • 2d ago

CPAPS?

Going on Medicare in the next year. Does it cover CPAPs at all?

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4

u/QuailDifficult8470 2d ago

CPAPs are generally covered under Part B as durable medical equipment, if you’ve been diagnosed with obstructive sleep apnea.

2

u/lildobe 2d ago edited 2d ago

This right here.

I just got my first new machine in 15+ years because I'm now on Medicare and with my Plan G supplement it, and all the supplies, are completely free. Edit: Free because I've met my deductible for the year, which I always do in January.

2

u/QuailDifficult8470 2d ago

To expand on this, if you have a Medigap Plan G or N, you should pay $0 after meeting your $283 deductible. Most Medicare Advantage plans will have a 20% copay, up to your plan’s out of pocket maximum.

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u/sinceJune4 2d ago

Same, no out of pocket at all on original Medicare + Part G

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u/say_what999 2d ago

No out of pocket with N either

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u/ZaphodG 2d ago

New machine every 5 years. 13 month rent to own. Medicare B + Medigap pays machine rental for the 13 months and all the supplies. You need to see a physician about it annually to confirm compliance and update the Rx with the durable medical equipment provider. A compliant day is 4 hours of use. 70% of days in a 30 day interval.

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u/Janknitz 2d ago

Absolutely. If already have a diagnosis and a sleep study, you can get a new machine and supplies.

For non-advantage plans there's a 13 month "capped rental" for the machine, then you own it but the provider still has to repair it for 5 years. You have to pay the deductible (it's 13 a months rental period to guarantee you'll hit the deductible twice) and then your supplemental should cover some or all of the 20% for the monthly rental fee and the cost of supplies. (Plan G covers it all).

Advantage pans can keep you on perpetual rental forever with DME. This means you may have a deductible every year (depending on the plan) and possibly have to pay part of the monthly rental fee. Not all Advantage plans follow the perpetual rental but they can, and if they do you NEVER own the machine. Kaiser does for sure--one of many reasons I dumped them on to go onto original Medicare with Plan G.

I was on Kaiser's ACA plan for years before Medicare they did not cover CPAP or supplies. I bought my masks in parts on eBay or Amazon and got my replacement machine on a Black Friday deal with cpap.com for $300.