Between five and 20 percent of the adult population has sleep apnea, though the National Sleep Foundation suggests that the numbers may be underreported. People of all ages can develop sleep apnea, and as you get older, you might need a CPAP machine. But will Medicare Supplement plans pay for your durable medical equipment?
Let’s look at some of the factors that you should take into account when choosing and deciding how to handle your sleep apnea treatment.
WHAT IS SLEEP APNEA?
Obstructive sleep apnea is a condition in which a sleeping person stops breathing briefly and regularly throughout sleep. This disruption can result in lower quality sleep and low blood oxygen levels. A continuous positive airway pressure (CPAP) machine helps regulate breathing during sleep.
Physicians diagnose sleep apnea when the pauses in breathing during sleep exceed 10 seconds. You may attend a sleep clinic so medical professionals can monitor your breathing and make a definitive diagnosis.
If you’re nearing retirement, you might worry about how Medicare will handle your sleep apnea treatment. You may need a CPAP machine to regulate your breathing every night, so you naturally want to know what costs might be associated with that. Original Medicare and Medicare Supplement plans can help cover costs related to your treatment.
WHAT IS DURABLE MEDICAL EQUIPMENT?
A CPAP machine is considered durable medical equipment (DME). It’s covered under Original Medicare Part B. CPAP machines are classified under DME because they’re used in the home to treat an illness and can last three years or longer.
Under Original Medicare Part B, you’re responsible for 20 percent coinsurance on the CPAP machine and any DME-related supplies, such as the tubes that connect to the machine and the mask you wear while you’re asleep. You must also meet the Original Medicare Part B deductible, which is $183 as of 2018.
When you use durable medical equipment, such as a CPAP machine, for 13 consecutive months, and you have Original Medicare Part B, Medicare will pay your monthly rental fee for 13 months. After you’ve rented your CPAP machine for 13 months, you own it outright and no longer have to pay any fees to the supplier.
Keep in mind that you must visit a physician who is enrolled in Medicare. Your supplier must also enroll in Medicare if you want Medicare to cover the DME rental fees.
WHAT ABOUT MEDICARE SUPPLEMENT PLANS?
In some cases, Medicare Supplement plans can help further offset the costs of your CPAP machine and sleep apnea treatment. Medicare supplemental insurance — also called Medigap — helps cover some of the costs that Original Medicare does not.
You can choose from 10 Medicare Supplement plans, each of which offers different coverage levels. Selecting the right Medigap plan for your specific needs can help you budget for medical expenses more accurately.
For instance, Medicare Supplement Plans A, B, C, D, F, G, M, and N all cover 100 percent of your Original Medicare Part B coinsurance. If you have one of those Medicare Supplement plans, you won’t have to pay the 20 percent coinsurance for your CPAP machine rental or purchase or its related parts.
Medicare Supplement Plans C and F also cover your Original Medicare Part B deductible. Under those plans, you wouldn’t have to pay the deductible before Medicare starts to pay.
HOW MUCH WILL MY CPAP MACHINE COST?
Medicare Supplement plans and Original Medicare both help limit the costs of a CPAP machine and other durable medical equipment. However, you may be responsible for part or all of the costs.
If you choose a supplier that isn’t enrolled in Medicare, you may have to buy the CPAP machine and its related equipment in full. Original Medicare may reimburse you for its part of the costs at a later date. When conducting research, make sure you limit your options to suppliers that accept Medicare.
You also need a physician who accepts Medicare patients. Otherwise, your sleep apnea treatment may not be covered.
For Original Medicare to continue to pay for all or part of your durable medical equipment costs, your physician must warrant that it’s necessary for your health. You must also use the CPAP machine continuously for the entire time you have it in your possession. Otherwise, it’s not considered necessary for your health.
According to the American Sleep Association, CPAP devices, including all related equipment, cost anywhere from $500 to $3,000. The average costs around $850.
The variations in cost relate mostly to the type of device and any extra equipment you might need, such as a more comfortable chin strap or a humidifier add-on. Suppliers that aren’t enrolled in Medicare don’t have to abide by Medicare costs, so you may end up paying more for your durable medical equipment.
WHAT TYPES OF INSURANCE COVER CPAP MACHINES?
In most cases, when you’re enrolled in Medicare Parts A and B or a Medigap plan, the cost of sleep apnea treatment, including your CPAP machine, falls under Original Medicare Part B. You’ll visit either your regular physician or a specialist in sleep disorders.
If, however, you are hospitalized for any reason or you need to enter a skilled nursing facility, Original Medicare Part A will be responsible for maintaining your durable medical equipment and treating you for sleep apnea. In those cases, Original Medicare or Medicare Supplement plans will handle payments differently.
WHAT IS A COMPETITIVE BIDDING PROGRAM?
The Medicare Competitive Bidding Program only exists in certain geographical areas. In those areas, durable medical equipment suppliers submit bids for prices on equipment like CPAP machines. Medicare uses those bids to determine how much it should pay for DME.
If you’re subject to the Competitive Bidding Program, your supplier can’t charge you more than your 20 percent coinsurance payment or your Original Medicare Part B deductible for any durable medical equipment.
If you suffer from sleep apnea, it’s natural to worry about the costs of maintaining your CPAP machine and other durable medical equipment after retirement. Medicare Supplement plans can help offset those costs.
Use the Ensurem Medigap Quoter to research Medicare Supplement plans in your area. You can compare premiums from different private insurance companies so you know you’ll get the best deal. Since Medicare Supplement insurance is standardized, you get the same coverage regardless of the plan you choose.