Did you recently turn 65? Medicare is generally available for people 65 or older, and yes; Medicare covers CPAP supplies. In fact, Medicare covers up to 80% of the cost of your CPAP machines and other durable medical equipment after you’ve met the part B deductible, but what exactly does that mean and how do you qualify for Medicare? We’ll go over Medicare guidelines, qualifying for Medicare coverage, replacement supplies, and how Aeroflow Sleep can help with all of the above.
Will Medicare Cover a CPAP Machine?
Medicare is broken down into two categories; part A and B. While Medicare part A covers things like inpatient care, hospice, and nursing, Medicare part B is similar to the health insurance you’re used to, covering well-visits, routine screenings, prescription drugs and treatments. CPAP coverage falls under part B and includes everything from new cpap machines to headgear, full face masks to tubing, and so on– after you’ve met the part B deductible.
A deductible is the amount you pay before Medicare covers the rest. If Medicare covers up to 80% of the cost, you are responsible for the remaining 20%, and the bill must be paid prior to receiving your CPAP supplies. That’s why Aeroflow Sleep pairs you with a dedicated Sleep Specialist when you join our program; we make sense of confusing terms like deductible and coinsurance and keep you on track.
Both your clinician and Durable Medical Equipment supplier (or DME supplier) must be approved by Medicare. Luckily, Aeroflow Sleep is; fancy that! If you are seeking a clinician, we can refer you to Michelle Worley, our Director of Clinical Operations at Aeroflow Sleep and a Registered Nurse. She and other members of the Aeroflow Sleep team are available to assist you.
As your DME supplier, we can also navigate your machine rental. Medicare rents CPAP equipment for 13 months of continuous use to help keep overall costs lower. This also ensures they’re only paying for items that are being used, and it is only when you have successfully met the 90-day compliance requirements and surpassed 13 months of continuous use that we can transfer ownership to you. Don’t worry; we believe in you, and we’ll be with you every step of the way!
Qualifying for CPAP through Medicare
Qualifying for CPAP through Medicare is easy with Aeroflow Sleep! Simply follow these 3 simple steps:
- Determine your eligibility
- Get a sleep test and prescription for CPAP
- Meet Your CPAP Compliance Goals
Who Is Eligible For Medicare?
If you are 65 or older and a U.S. citizen or have been a permanent legal resident of the United States for five consecutive years, you may automatically qualify for Medicare part A and B. An easy way to tell if you qualify is if you already receive Social Security benefits or Railroad Retirement Board (RRB) benefits.
If you do not automatically receive Medicare part A and B, you’ll need to enroll during the initial enrollment period (IEP.) This period begins 3 months before you turn 65 years old and ends 3 months after your 65th birthday. The date when your coverage starts depends on when you sign up during your 7-month IEP.
There are a handful of other reasons you may qualify for Medicare that are not related to your age too. For example, you may have a disability or debilitating condition like End Stage Renal Disease; people with permanent kidney failure who require either dialysis or a transplant. Check with your doctor to see if your condition meets Medicare requirements, if you are not yet 65 years of age.
Get a Sleep Test
Regardless of which method you choose, your sleep test tells us which type of sleep apnea you have and how severe it is. Your Apnea-Hypopnea Index (AHI) determines how many apneas/hypopneas occur in an hour; aka - how often you stop breathing during sleep. If your AHI is above 5, then you have sleep apnea; anything above 30, and you have severe sleep apnea.
The most common form is Obstructive Sleep Apnea (OSA) and it can only be treated with continuous positive airway pressure (CPAP.) This diagnosis, the resulting prescription, and any related medical records are what Medicare needs from an approved clinician in order to have your CPAP therapy covered.
Once it is determined that you are eligible for Medicare, it’s time to prove that CPAP therapy is needed. To be eligible for sleep apnea treatment through Medicare, you need to be diagnosed with sleep apnea. There are two options for sleep apnea tests that have to be prescribed by your doctor to meet Medicare requirements:
You can take an at-home sleep apnea test. The necessary devices are shipped to your home for you to wear for a night. In the morning, simply pack them up and return them in the mail. The results will be saved to your devices and evaluated by a qualified sleep physician.
The other option is to perform a sleep study in the lab overnight. In this case, you will stay at a sleep clinic where the machines are housed. This is a more thorough way of detecting sleep apnea; however, it can be more expensive.
The short answer is yes; Medicare will cover replacement supplies within reason. A recommended replacement schedule has been created by Medicare outlining what they have deemed necessary. For example, humidifier water chambers should be replaced every 6 months according to the determination of the Medicare program while nasal pillows can be replaced twice per month. It just depends on the piece of equipment. We highly recommend that you take advantage of the replacement schedule, as this will help you maintain healthy CPAP therapy.
Meeting CPAP Compliance Guidelines
Your CPAP supplies will then be delivered to you and set up by a healthcare professional. With Aeroflow Sleep, all new setups have some form of a clinical education; whether it be in-home, in-office, or via telehealth. Then, you are in the 90-day compliance period or trial period. Insurance companies, including Medicare, require you to use your CPAP machine daily for at least 4 hours per night, for 21 of 30 consecutive days (or 70% of the time.) They do this so they can definitively say that your CPAP therapy is necessary and should be covered by Medicare.
Compliance data is collected through your CPAP machine; it is sent to your doctor via The Cloud. Between Day 31 and Day 90, you must have a follow-up appointment with your clinician, who will measure your new AHI against your sleep study results and see if you are benefitting from CPAP therapy. Your clinician will also check and see how long your CPAP device was used to determine if compliance was met.
That’s all it takes! Medicare will cover up to 80% of CPAP supplies ordered from an approved DME supplier; like Aeroflow Sleep. If you fail to meet compliance, you can start the process over. This will also need to be done if you are switching insurance plans; from private or Medicaid to Medicare.
Will Medicare Cover Replacement Supplies?
Aeroflow Sleep is Here to Help
You deserve peace of mind when it comes to your insurance, so let Aeroflow Sleep take care of it for you! As your Medicare-approved Durable Medical Equipment supplier, we will never leave you wondering if your CPAP therapy is covered. Treatment options may be available at little to no cost to you, and we promise to find them. Start sleeping well and living better and call (800) 480-5491 to speak with your personal Sleep Specialist.
