|Vol. 14, Issue 17 – August 24, 2015|
Does Medicare cover a CPAP device?
My doctor diagnosed me with obstructive sleep apnea (OSA) and said that I need a continuous positive airway pressure (CPAP) device to help me breathe at night. I have Original Medicare and was wondering whether it will cover the CPAP device.
– Martine (Chesapeake, VA)
Original Medicare will cover an initial three-month trial of your CPAP device if you have been diagnosed with obstructive sleep apnea. At the end of the trial, Medicare will continue to pay for the device if your doctor certifies that you have benefited from the device and used it properly.
Before the three-month trial, your physician and supplier must submit paperwork to Medicare to justify your need for a CPAP device. Although it is their job to know these requirements, familiarizing yourself with them can help to avoid errors and navigate any challenges that arise.
To qualify for coverage of a three-month CPAP trial, Original Medicare requires certain steps:
If these conditions are met, Medicare will cover 80 percent of the rental fees for a CPAP device for 13 months, once the Part B deductible is met. After that you will own the device. Note that these 13 months include the three-month trial. Medicare will also pay 80 percent of the cost of CPAP supplies, such as masks and tubing.
On the other hand, if your symptoms did not improve during the initial three-month trial of CPAP therapy, you can re-qualify for Medicare coverage following a new sleep study in a facility, and a re-examination by your physician.
Good luck with this process! Remember, you can always talk with your doctor to stay informed about your health care services.
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Dear Marci is a biweekly e-newsletter designed to keep you — people with Medicare, social workers, health care providers and other professionals — in the loop about health care benefits, rights and options for older Americans and people with disabilities.
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