Should you Buy CPAP Supplies Using Insurance or Cash?

You may think that if you have health insurance, the cost of your CPAP machine will be covered. That’s not necessarily true. CPAP equipment insurance coverage is getting increasingly more complicated each year and in the end, going through insurance may end up costing you more than paying out-of-pocket. It all depends on your policy.
We strongly recommend reviewing your coverage before making your CPAP machine purchase. Things to consider include true costs, rental vs. ownership, non-reimbursable supplies, limited supplies, product selection, and long-term customer care.

Insurance-Approved CPAP Suppliers May Charge More

The durable medical equipment (DME) providers that are affiliated with insurance networks may be charging much higher prices for CPAP equipment and supplies. Their relationship with insurance companies creates an opportunity to drive up the cost of product.
Alternatively, cash pay retailers, such as The CPAP Shop, have more incentive to be competitive. Since the market drives business, direct-to-consumer retailers need to keep prices low to appeal to customers and often run promotions or sales. When you calculate the breakdown, you may see that you are in fact saving money by choosing to purchase out-of-pocket.

CPAP Ownership and Privacy

The equipment that you receive from a DME is essentially a rental. You pay monthly payments on the CPAP equipment and must show compliance (i.e., allow an insurance company to access your private data off your machine) in order to keep the equipment. To be considered compliant, you must use your CPAP machine at least 4 hours a night for a minimum of 21 nights during a consecutive 30-day period. If you are non-compliant, your machine can be taken away—and you’d lose the money you paid to date.

When you buy a machine at a cash pay retailer, it is yours. You are not obligated to share your data with anybody.

Some CPAP Products are Not Reimbursable by Insurance

Again, check your health insurance policy. Just because your doctor approves and even prescribes CPAP solutions (i.e., CPAP sanitizers) for your sleep apnea does not mean the equipment is covered. There are several products that your insurance has deemed non-reimbursable, which means you will need to pay out-of-pocket anyway. In these instances, it pays to do research and some online shopping. Check out promotions or sales, sign up for newsletters, and compare the cost at an e-commerce retailer versus a DME provider.

High Deductible Insurance Plans Can Cost You for CPAP Supplies

In particular, high deductible health insurance plans can impact your CPAP supply costs. This is especially true if you are planning a CPAP equipment purchase at the beginning of the year when your deductible restarts. Unless you've met your deductible, you will probably pay for all of your CPAP machine and supplies out-of-pocket.

Limited Coverage on CPAP Supplies

For the sake of hygiene and health, it's critical to replace essential CPAP supplies including CPAP masks, tubing, and filters regularly. However, insurance companies may put a cap on how often you can replenish supplies. This restriction can lead to using your CPAP machine less frequently or possibly not replacing parts when needed.
Many health insurance providers, including Medicare, are not authorizing the replacement of supplies at the same frequency as manufacturer recommendations. For this reason, many people choose to pay for supplies on their own to maintain healthier CPAP therapy.

Cash Purchases Give You the Power of Choice

Lastly, and perhaps most importantly, an insurance-approved CPAP supplier doesn't guarantee the best experience for you. Do not feel forced to compromise with the one or two product selections offered by the DME. At The CPAP Shop, we carry over 900 products including all the latest and most innovative CPAP masks, accessories, travel machines, and more. With a 30-day money back guarantee on our CPAP masks, you can comfortably pick the right mask that fits your needs.

Making Customer Care a Priority

We have repeatedly heard that DME providers are hard to reach after purchase. At The CPAP Shop, we prides ourselves on superior customer care. Our New Jersey-based team is available by phone, email, or chat and can help offer product recommendations, troubleshoot equipment problems, and offer a helping hand as you begin CPAP therapy.

Save on CPAP Machines and Supplies

Visit The CPAP Shop for the latest CPAP equipment and supplies. In business since 2004, we offer a 30-day money back guarantee on all CPAP masks, a price match guarantee on all our products, and a customer-first approach. Our goal is to ease your transition to sleep therapy and set you up for a lifetime of success.

Reference:

^{Levinson D. Replacement Schedules For Medicare Continuous Positive Airway Pressure Supplies. Department of Health and Human Services. 2013 June.}