This may be a little ahead of time for me as I have almost 19 months to go before I turn 65 but does anyone know how medicare handles sleep apnea and its equipment?   When I retire my husband and I will have medicare and a state medicare plan through one or two plans,  "Secure Horizons or Senior Dimensions".   A private supplemental plan is out of the question.  Our insurance rates in this state are too high and the majority of people can't afford it unless they are covered by an employer plan which they were allowed to keep upon retiring.   Just wondering if I am getting into something which I will only be able to have for a year or so.
   Comments anyone?
     Diane
 

I'm over 65 and medicare does cover apnea.

Frank

Diane, your note made me sit up and take notice as I suddenly realized I only have a little over 15 months until 65.

Here's a URL that will give you the information you need:  http://www.medicare.gov/Coverage/Home.asp

It requires that you enter your state so I wasn't able to get your specific information, however, the good news is that there is a specific coverage category for CPAP devices.

Here is what is says for the state of NH:

"Continuous Positive Airway Pressure (CPAP) Device
 
Coverage under Medicare:  Medicare covers a single level CPAP device, for initial coverage, if the patient, during sleep, temporarily stops
breathing (obstructive sleep apnea). This diagnosis must be documented by a facility-based sleep study.
Medicare covers the use of the CPAP for up to 3 months. If a patient requires the CPAP beyond 3 months, no sooner than the 61st day
after beginning use of the CPAP, the supplier must be notified by the doctor or the patient that there will be continued use beyond the
three-month period.

Medicare covers accessories used with the CPAP if the CPAP is covered by Medicare.

An order (prescription) must be on file with the supplier. It must be signed and dated by the treating doctor.

Make sure your supplier is enrolled in Medicare and has a Medicare supplier number. Suppliers have to meet strict standards to qualify for
a Medicare supplier number. Medicare won’t pay your claim if your supplier doesn’t have a number, even if your supplier is a large chain or
department store that sells more than just durable medical equipment (DME).
 
The amount you need to pay:  You pay 20% of Medicare-approved amounts.

CPAPs are in the Capped Rental category of DME; that means you may choose to rent or purchase a CPAP. For more information, you
may call 1-800-MEDICARE (1-800-633-4227).

If a supplier of DME doesn’t accept assignment, there is no limit to what you can be charged. You also may have to pay the entire bill (your
share and Medicare’s share) at the time you get the DME.

Note: Ask if the supplier is a participating supplier in the Medicare program before you get durable medical equipment. If the supplier is a
participating supplier, they must accept assignment. If the supplier is enrolled in Medicare but isn’t “participating,� they have the option to
accept assignment.

If the supplier isn’t enrolled in Medicare, Medicare won't pay your claim.
 
The part of Medicare that pays for this service or supply:  Part B Benefit
 
Medicare Contact for additional information:  State of New Hampshire DMERC -- Durable Medical Equipment Regional Carrier:

1-800-633-4227
  1-800-MEDICARE

Important notes:  You must pay an annual $110 deductible for Part B services and supplies before Medicare begins to pay its share.
Actual amounts you must pay may be higher if a doctor, health care provider, or supplier does not accept assignment.
 
Additional Information:  There are 0 Local Medical Review Policies (LMRPs) and 1 National Coverage Determinations (NCDs) written that
explain when services or supplies are covered, including when they are considered medically necessary. For more information about
LMRPs and NCDs for these services or supplies, please visit the Medicare Coverage Database on www.cms.hhs.gov."

Medicare covers xPAP stuff pretty well, minus the 20% standard co-pay, which sounds like may be covered by your state plan- but you would have to check forsure. Sometimes Medicare will require you to have a more recent sleep study & titration is the existing one is too old, but that is also covered except the 20% copay (and yearly deductable for everything, which is a little over $100 currently). If you need BiPAP or BiPAP ST you have to meet the requirements, which are pretty much  the same for most health insurances since they tend to base theirs on what Medicare does. When it comes to supplies they cover 1 hose per month...which I have yet to figure out why they would need replacing that often...new mask with headgear every 6 months, new mask without headgear every 3 months, new cushions or nasal pillows every month, etc. They even cover heated humidifiers, though you may need a letter of medical necessity to document you need it, I'm not sure since my mom got a CPAP with humidifier built in. CPAP and regular BiPAPs are capped rental items- after about 10 months you get a letter asking if you want to own the item outright or let the DME own it, though the rental continues through 13-15 months. If you opt to own it outright, you are responsible for maintenance though 'medically necessary maintence may be covered' and the DME gets nothing from Medicare after the rental period ends. If you allow the DME to keep ownership they are paid the equavalent of about 2 rental payments per year as long as you need it and are required to cover all maintence 100%. Masks & other supplies are billed the same either way. BiPAP ST fall into a higher maintence category so they are rental forever and ever- at around $500+ per month, so if you don't have a good Medigap policy and have to pay the 20% left over it could be much cheaper to purchase outright on your own if you plan on living for more then a year or so    Masks & supplies are suppose to be included in the BiPAP ST rental price.

Thank you one et al,  I will keep this in mind and be sure to check it out as I get closer to that  all important number 65.   God bless and keep you all!
      Diane