Three Myths of CPAP Machine Insurance Coverage
When it comes to healthcare, we instinctively believe that our insurance will cover a majority of the cost. While this is true for many conditions, when it comes to PAP therapy to treat sleep apnea, health insurance may not be the best option.
In the ongoing debate between cash pay versus insurance for sleep therapy, there are several factors to consider.
- Insurance only covers a portion of the total cost of PAP therapy equipment and is generally associated with deductibles and copayments.
- In recent years, insurance companies have been consistently reducing the reimbursement rate for medical equipment expenses.
- Deductibles for health insurance continue to rise.
- Even if you go through insurance and receive a PAP machine, it is considered a rental. You must share proof of use or the equipment can be taken away.
Here are some common myths debunked.
Myth: My Insurance Will Cover Most of the Costs of CPAP Therapy
Most people tend to think health insurance will work the same way across all their medical needs. You pay some, and the insurance company pays the rest. But for CPAP supplies, it works differently.
Most insurance companies will require you to enter into an alternative payment structure for your CPAP machine. That usually means agreeing to a rental plan, in which you make payments over an extended period of time and inevitably pay more for your machine then if you bought it outright. Even Medicare requires you to pay at least 20% of the cost and still rent your CPAP machine for up to 13 months.1
However, you do not need to go through insurance to purchase sleep therapy equipment. Direct-to-consumer online stores, like The CPAP Shop, can offer a larger inventory of new-to-market products at a fraction of the cost.
Myth: My Health Insurance Will Get Me the Best CPAP Machine
When (and if) your insurance does kick in, you are limited to work with in-network DME suppliers that sell CPAP machine. Because the supplier is being reimbursed by the insurance company, offering a quality product is not an incentive.
In-network DME suppliers may charge more for low-quality CPAP products because of their guaranteed payout. This arrangement may leave you with below average equipment that still costs you out of pocket.
Paying cash gives you freedom of choice when it comes to selecting the quality of your CPAP equipment. You can compare products and choose the machine that best fits your needs without insurance-mandated restrictions. When traveling, for example, the Philips DreamStation Go Auto or the ResMed AirMini Auto are lightweight, palm-sized machines that deliver all the comforts of in-home PAP therapy on the go. However, travel machines are not covered by insurance or offered through a DME provider.
Keep in mind, independent suppliers are incentivized to be more competitive—and their lower prices reflect that.
Myth: Your CPAP Machine is Yours Once Insurance Pays
Because insurance companies approve machine rental, they also can require that you use your CPAP machine regularly. To comply, insurance companies require access to nightly data collected by your machine.
Insurance companies conduct regular compliance monitoring. If you have not used your CPAP machine as long or as often as the insurance company determines acceptable, they can take back your equipment without reimbursing any money you have already spent.
It’s a double-edged sword: You lose your privacy and potentially lose your money.
On the other hand, when you pay out of pocket for your CPAP machine—it's yours. There’s no compliance monitoring, unless you choose to give access to somebody, and there’s no risk of your machine being taken away!
Paying Cash For CPAP Equipment Can Save You Money
To keep costs down for a health care plan, patients are increasingly doing a cost versus benefit analysis. Find out what you can save by visiting The CPAP Shop or giving our customer service team a call at 866.414.9700. We’re here to help you get a better night’s sleep!
1. Medicare.gov. Continuous Positive Airway Pressure devices, accessories, & therapy. Accessed on September 2019.