A large number of the adult population have sleep apnea and require CPAP assistance. Get the scoop here and find out does Medicare cover CPAP machines.
Did you know that 56% of Americans over the age of 64 are at risk for obstructive sleep apnea (OSA)? The most common treatment for OSA is a continuous positive airway pressure (CPAP) machine.
If you’re diagnosed with sleep apnea, you may wonder, “Does Medicare cover CPAP machines”? Get the information you need here and find out the answer to this question.
Types of Sleep Apnea
OSA describes repeated relaxation of the throat muscles causing a collapse during sleep. With central sleep apnea, the brain sends incorrect signals to the respiratory muscles. Some individuals have a combination of the two, called complex sleep apnea syndrome.
This results in repeated periods where you stop breathing for 10 seconds or longer. Symptoms include loud snoring and feeling tired after a full night’s sleep.
What Are CPAP Machines?
CPAP machines keep positive pressure in your throat to prevent muscle collapse. This decreases snoring and helps you feel more rested.
There are several styles of machines. In general, you have the base machine which holds water to provide humidification. It also has a filter and tube that connects to the mask or headgear that you wear.
The headgear may include a full face mask, mouth/nose mask, or nasal option. The filter keeps dust and other particles out of the machine and tubing.
Overview of Medicare Coverage
Medicare Part A and B are often called “Original Medicare”. Most people over the age of 64 qualify for this Medicare. People under 65 and receiving Social Security disability for 2 years are eligible. This also extends to those diagnosed with ALS or end-stage renal disease.
Part A is free if you paid into Medicare and Social Security for at least 10 years. There is a monthly premium for Part B. This varies based on your income.
After enrolling in Original Medicare, you may buy Medicare Advantage. Medicare Advantage includes Part A, B, and D coverage.
Does Medicare Cover CPAP Machines?
The answer to, “Does Medicare pay for CPAP?” is yes if you have a diagnosis of sleep apnea. You’re eligible for a 3-month CPAP therapy trial under Medicare Part B. If the treatment proves successful, your coverage will be extended.
Medicare may continue coverage if you’ve used CPAP before beginning Medicare. It may cover the cost of machine replacement, rental, and/or accessories.
In general, you’ll pay 20% of Medicare-approved charges for machine rental and supplies. You will need to meet the Part B deductible. Once you’ve rented the machine for 13 months, you own it.
Medicare pays for durable medical equipment (DME), such as CPAPs. A Medicare-approved doctor must order the equipment. You must get the equipment from a Medicare-approved supplier as well.
There’s no limit from Medicare on how much a supplier may charge you. Be prepared to pay the entire bill when you first get the DME.
Looking for the Latest Medicare Information?
You now have the answer to the question, “Does Medicare cover CPAP machines?” It’s important to always ask questions and explore your options. Make sure you check with reputable sources.
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