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.

Sleep therapy treatment with CPAP machine

In the ongoing debate between cash pay versus insurance for sleep therapy, there are several factors to consider.

  1. Insurance only covers a portion of the total cost of PAP therapy equipment and is generally associated with deductibles and copayments.
  2. In recent years, insurance companies have been consistently reducing the reimbursement rate for medical equipment expenses.
  3. Deductibles for health insurance continue to rise.
  4. 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!

Reference:

1. Medicare.gov. Continuous Positive Airway Pressure devices, accessories, & therapy. Accessed on September 2019.

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…


26 Comments Leave new

  • GEORGE THOMPSON

    I NEED A AIRSAENSE 11 ON MEDCARE AT KYSER

    • Chris Vasta

      Hi George, if you are in need of a new CPAP machine, our team would be happy to help. Please call us at 866-414-9700. However, please note, we do not work with insurance or Medicare, so you would have to reach out to them independently for potential reimbursement.

  • barry bowen

    I bought an APAP machine myself because the approved suppliers in my area could not supply one. Doctor approved prescription. This was caused by a recent supply chain issue. Will Medicare help pay for my machine after I demonstrate that I used it in accordance with their requirements?

    • Chris Vasta

      Hi Barry, you will have to check with your provider. Providing them with your prescription and a receipt could give you a potential reimbursement. We recommend reaching out to them to see their coverage options.

  • Craig Farquhar

    I’ve had my CPAP for many years. It’s a Phillips dream station. I originally got it from a DME and my insurance paid for it but I assume those payments have stopped because I’ve changed insurance over the years. Now that there was a recall I went on the Phillips website and signed up for the replacement device but they sent it to the DME. Do I own the current device since I’ve had it for so many years or am I’m going to have to give them insurance and payment information again to get the new device because if the recall?

  • tinyurl.com

    Good post. I will be going through many of these issues as
    well..

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    • Chris Vasta

      Hello there, we appreciate your kind words, and we’re glad you are enjoying our content! Should you ever need any assistance with CPAP products, please give us a call at 866-414-9700.

  • Edward Smail

    need help with my cpap

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