Buying Your CPAP Machine Using Cash vs. Insurance

 In CPAP Insurance, Most Popular Posts, Troubleshooting / Tips

When should you pay in cash and when should you use insurance when buying a CPAP machine?

In this blog, we will be covering factors you should consider when deciding how to pay!

Note: It’s typically cheaper to purchase CPAP equipment in cash because cash prices are usually but not always cheaper than insurance prices.

What should you do?

You should sign up with Health Sqyre for free and provide your insurance information to find out exactly what the deal is…

1. Reimbursement by Insurance

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 using insurance is a good option to save money. If not, paying in cash is your only option.

Most CPAP machines are covered by health insurance companies. Most third party payers follow the Medicare reimbursement schedule, which typically covers a machine every 5 years. Check out our blog post on CPAP HCPCS Codes to see the list/schedule of the CPAP HCPCS Codes.

2. High Deductible vs. Low Deductible Plan

Do you have a high deductible plan or a low deductible plan? If you have a high deductible plan, it’s typically better to pay in cash, provided that you have not met or you are not close to meeting your deductible. This is because as noted above, cash prices are usually cheaper than insurance prices, so it’s typically cheaper to purchase CPAP equipment in cash - but this is not always the case. On the other hand, it’s usually better to use your insurance if you have a low deductible plan unless you are not even close to meeting your deductible.

Many Americans now have higher deductibles to meet before they can use their health insurance benefits. Higher deductible typically means lower monthly premiums and that some benefits are covered before you meet your deductible. However, almost all plans require you to meet your entire individual or family deductible before CPAP equipment are covered.

3. Status of Your Insurance Plan

What is the status of your plan? Are you close to meeting your deductible? Have you met your deductible? If you have met your deductible, then take advantage of your insurance to get the cheapest price. If your deductible has not been met, pay out-of-pocket (in cash).

Health Sqyre's Insurance Dashboard
Health Sqyre's Insurance Dashboard

Health Sqyre provides you with a real-time health insurance dashboard that shows your deductible, co-insurance rate, and out-of-pocket maximum information. Sign up free today to see!

Product page for Jane Doe with cash vs. insurance price comparison for her plan

Health Sqyre also provides you with the cheapest cash (out-of-pocket) price and insurance price for your plan, so you can compare them side-by-side.

It makes sense to use your insurance to buy CPAP equipment if you’re close to meeting your deductible. It also depends on the price of the product that you’re buying. If the product costs less than the amount remaining on your deductible, such as a CPAP mask, then you will probably get the best price paying in cash (out-of-pocket). However, if the product costs more than the amount remaining on your deductible, such as a CPAP machine, 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 in cash.

4. Other Cases

If you don’t have health insurance and paying in cash is therefore your only option, but you are experiencing some financial hardship in paying for your CPAP equipment, there is an organization called The Reggie White Foundation that offers low-cost CPAP and supplies. For a CPAP, there is a $25 program fee and proof of financial hardship. For CPAP supplies, there is a $10 program fee and proof of financial hardship. See the Reggie White Foundation CPAP Therapy User Application.

Medicaid is a state and federal program that provides health coverage if you have very low income. It does cover CPAP equipment, but you will need authorization. The amount of coverage varies by state, and supplies are covered separately. Deductibles and co-payments may apply depending on whether or not you have a secondary insurance.

Even if you have insurance, you may want to pay in cash for your CPAP and supplies. Some people may find it easier to pay in cash to avoid dealing with insurance talk, such as EOB, co-insurance, etc. Your insurance company might only authorize specific providers for your CPAP equipment, and you might happen to not be satisfied with the selection (product options, customer service, location, etc.). Then, you can also choose whichever vendor you would like to buy from by paying out-of-pocket.

5. Insurance Companies & Compliance Tracking

Health insurance companies usually cover a CPAP machine with proof from a sleep study. A lot of insurance companies pay for these on a rental basis (term of 2-12 months) than paying it full outright. The patient owns the device after the last rental payment is made.

Less than half of patients prescribed CPAP therapy are actually getting the therapy for more than four hours each night. Insurance companies don’t want to pay for the machine that patients don’t use. Therefore, most insurance companies require that you prove you are compliant in therapy and are tracking data (statistics including hours of use, sleeping time, AHI, and leak rate) for compliance, and sleep apnea patients need to show compliance before purchasing the device or getting resupplies.

The most common ways of obtaining this compliance data is through a smart card, attachable modem, or a wireless-enabled CPAP device. A smart card is the data/memory card inside the device that stores your usage data. It can be removed to be manually sent to your physician or equipment provider for data report. An attachable modem can be bought separately. It uses cellular service to regularly send data. A wireless-enabled CPAP device is common among new models. These wireless-enabled modems use wi-fi, Bluetooth, or cellular service to automatically transfer data. The data is transferred to your equipment provider that is billing your insurance to acquire payment for the equipment, and the insurance company also receives the report.

Most insurance compliance guidelines require that you get CPAP therapy for a minimum of 4 hours per day for at least 22 days out of a consecutive 30 day period within the past 3 months to show compliance. However, the requirements may vary depending on your insurance plan. Many insurance companies, including Medicare, require proof of CPAP compliance to continue paying for the rental or purchase of the equipment. Insurance companies are also requiring yearly proof for authorization of replacement supply payments. Replacement supplies (additional masks, cushions, tubing, filters, etc.) are sent by the equipment provider every 3 months.

Most health insurance companies will require compliance for a machine. If you use your insurance to buy a CPAP machine, you will need to provide documentation, such as prescription, doctor’s notes, and a valid sleep study. Cash, however, only requires a prescription.

This can all sound like a pain in the butt. But worry no more. Health Sqyre conveniently provides a list of specific documentation requirements to make your experience simple and seamless.

These are the factors you should consider when deciding whether to pay out-of-pocket (cash) or use insurance. Choose wisely and save money! If you have any further questions, feel free to chat us or shoot us an email!

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