The Tricky Business of CPAP Insurance Coverage

September 23, 2016 | CPAP Payment & Insurance |
The Tricky Business of CPAP Insurance Coverage

It is not hard for anyone to argue that there is chaos in the U.S. insurance industry. Currently, there is a growing percentage of people who have to change coverage or get less coverage than previous years due to cost. Moreover, the price of all types of plans are on the rise with the cost of a historically typical plan becoming increasingly onerous for the average family. As CPAP insurance coverage becomes more and more expensive, more people turn to online options.

In many cases, to keep the cost down for a health care plan, people are now, more than ever, considering the details of their plan and weighing cost versus benefit. Moreover, they are increasing their deductibles to reduce their overall health care spending. While policy deductibles are rising, insurance companies are reducing the reimbursement rate for medical equipment expenses. For example, a $5,000 deductible is now not uncommon for a typical policy. That means that the first $5,000 of medical expenses is an out-of-pocket expense. Even after meeting a deductible, the same policy might only reimburse 50% of a particular piece of home medical equipment.

Given this often played out scenario, people are taking a more active approach to their health care needs. Not only are they more conscious of their medical needs but also what it will cost them. So, if an insurance company is going to charge $1800 for a CPAP machine and the deductible has not been met yet, that cost will be an out of pocket expense. Additionally, if the deductible has been met, you might still be on the hook for $900, or 50%. This is a primary driver behind people doing their own research, price shopping and buying their own medical equipment. Of course, it’s critically important that the equipment supplier need to be reputable, capable of providing information and service and meet a high standard for quality customer care. Given that bar, choosing to purchase outside of your “insurance” or out-of-pocket is a good economic decision for most.
Why the dramatic shift?

The Cost of CPAP Insurance Coverage

In a single word, COST. With insurance costs rising, people climb down the cost ladder for policies. Policies of the same or reduced cost will typically have higher deductibles and lower equipment reimbursement percentages. We are also seeing the rise of the health savings account (HSA). They allow people to purchase using pre-tax funds set aside while covered under a “catastrophic” type policy. This situation forces people to consider all alternatives as funds for medical expenses and equipment are being paid out of personal funds.

The solution for many people with Obstructive Sleep Apnea is to become knowledgeable and engaged in their own treatment options. The most obvious place to begin is online. A significant amount of information on sleep apnea and purchasing equipment is readily available. We at The CPAP Shop do our best to educate people not only on the dangers of sleep apnea but various equipment. There have also been numerous articles about the cost of CPAP equipment in the online marketplace. Many manufacturers restrict online distributors from underselling each other or placing certain equipment like machines on sale unless sanctioned by the manufacturer. Nevertheless, online suppliers remain highly competitive and offer a compelling reason to purchase equipment online.  Online equipment is clearly a viable purchase option for rising CPAP insurance deductibles.

Options When CPAP Insurance Does Not Cover Equipment

Additionally, CPAP supplies usually have a large selection of options and the latest technology available. When shopping online, CPAP users can compare equipment more easily, chat with knowledgeable staff, find coupons, and read reviews on product pages or in online forums. At The CPAP Shop we also have a traditional brick and mortar store. We are located in West Berlin, NJ – very convenient to Philadelphia, NYC, and even Washington DC). We encourage you to stop in! Our salespeople have years of CPAP equipment experience, many use CPAP equipment themselves, and some speak Spanish fluently.

Chris Vasta

Author

Chris Vasta

Over a 10+ year career at PHH Mortgage managing a $100 million portfolio, Chris Vasta learned the ins and outs of the business world. He learned how to establish business relationships, lead a multi-prong team, and implement strategies for long-term growth. In 2007, Vasta used that experience to transition his role into president of The CPAP Shop. Over his tenure, Vasta has been involved in everything from website design to warehouse layout. His hands-on approach with customers has evolved into an in-depth understanding of the challenges of beginning and adhering to sleep therapy. He often provides his insights on product…


3 Comments Leave new

  • Amy

    If Medicare deems that you need a CPAP machine, it is considered “medically necessary” for you, and Medicare picks up the first 80% cost then your Medigap plan F will cover its portion, the remaining 20%. Medicare’s determination is the deciding factor always. Pretty much no matter what the service or equipment or treatment, if Medicare picks up its portion, your Medigap will pick up its portion.

  • N Rodriguez

    I have uhc medigap insurance plan F….would this cover any of the expense of purchasing a CPAP machine and mask???

    • Chris Vasta

      Our advice is to consult your individual insurance company about the specifics of what each will cover for CPAP therapy. We do not work directly with insurance providers and allow you to pay for equipment directly to us, then seek reimbursement from your own insurance company.

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