Patients ask us this question all the time at Health Sqyre. It’s a great question and we have the answer! Unfortunately, the answer is that it depends. We know, we know… no one likes hearing that. Don’t worry though because in this post we will walk you through the three factors that determine whether it’s cheaper to use your insurance for your CPAP supplies or pay for them in cash.
Before we get started there is one thing that you should know…
Did you Know?: CPAP suppliers that work with insurance usually have higher prices than CPAP suppliers that don’t (cash-based suppliers – suppliers that only take cash and do not work with insurance). Insurance suppliers have higher prices because those are the prices that they are charging your insurance company and need to cover their overhead expenses – operating brick and mortar stores, checking insurance coverage, processing claims, etc.
Now that we got that out of the way let’s save you money! Let’s go…
3 Factors in Deciding Insurance vs. Cash
1. Is the CPAP Product Reimbursable by Insurance?
Most machines, masks, humidifiers, tubes, and filters are covered by insurance. However, some supplies like CPAP cleaning supplies (ex: [SoClean]) are not covered by insurance. Health Sqyre has put together a list of each type of CPAP supply along with its HCPCS code so that you can see which CPAP supplies are covered by insurance and how frequently your insurance will cover each CPAP supply.
If you have more questions, please check out Health Sqyre’s Comprehensive List of Insurance Eligible Products. We also have a list detailing CPAP Items Not Covered by Insurance, in case you are more interested in that!
If the CPAP supply is not reimbursable by your insurance company then you will be paying cash (out-of-pocket) for it anyway, so it’s in your best interest to find the cheapest cash price. If it is reimbursable by your insurance then read on to the factor #2…
Answer to Question #1:
Yes – Keep reading, as using your insurance may be a good option to save you money!
No – Pay in cash (it’s your only option!)
2. What Kind of Plan do You Have?
Whether you have a high deductible plan vs. a low deductible plan is another determinant in helping you decide whether to use your insurance or pay without using your insurance (out-of-pocket) to get the cheapest price on your CPAP supplies. A general rule of thumb is that for high deductible plans it’s typically cheapest to pay in cash and for low deductible plans it’s cheapest to use your insurance. This is not always the case though so read on to factor #3…
Answer to Question #2:
High Deductible Plan – Typically best to pay in cash (unless you have met or are close to meeting your deductible)
Low Deductible Plan – Typically best to use your insurance (unless you are not close to meeting your deductible)
To learn more about the way that deductibles work, check out our page on How Deductibles Affect CPAP Prices!
3. Where are You in Your Plan?
Have you met your deductible? If you haven’t, are you close to meeting your deductible? Your health insurance deductible is a key factor in the cash vs. insurance “winner gets the cheapest price” battle.
Answer to Question #3:
Deductible Met – If you have met your deductible then you should use your insurance to get the cheapest price.
Deductible Not Met – If you have not met your deductible then it depends on how close you are to meeting it.
If you’re close to meeting your deductible then most of the time it makes sense to use your insurance. It really depends on the price of the product that you’re buying. If the product costs less than the amount remaining on your deductible, then you will probably get the best price paying in cash (out-of-pocket). On the flip side, if the product costs more than the amount remaining on your deductible, then you will save more money by using your insurance. If you’re not close to meeting your deductible then it’ll be cheapest to pay out-of-pocket in cash.
Real Examples of Patients Choosing Insurance vs. Cash
If you would like to see real world examples of insurance plans with a high deductible, deductible met, or family deductible met and how they change the price of CPAP supplies, please visit our CPAP Patient Case Studies Page!
Let Health Sqyre Help!
Health Sqyre will automatically do all of this insurance math for you and give you an apples-to-apples comparison between paying using insurance vs. paying without insurance. The prices on our site dynamically change based on the vendor (in-network, out-of-network, cash) and your insurance coverage – all in real-time – so you can see what it will cost using your insurance vs. paying in cash so you can choose the cheapest price!