Often, health insurance plans will have a deductible that you must attain before your co-insurance rate starts splitting the cost with your insurance provider. To start off, Health Sqyre is here to explain what a co-insurance rate is, as well as how it will affect your CPAP purchases. First, let us discuss what exactly a co-insurance rate is…
What is a Co-Insurance Rate?
Co-Insurance – the percentage of a medical expense (CPAP supplies in this case!) that you are required to pay after you have met your deductible.
What are Common Co-Insurance Rates?
Co-insurance cost sharing rates range from 100/0 to 50/50, where the insurance pays 100% of the cost and you pay 0% of the cost to where the cost is split equally by both you and your insurance company. However, more common co-insurance rates range from 10%-40%, meaning you, the patient, will be responsible for paying 10%-40%. This percentage often depends on whether the Durable Medical Equipment (DME) / CPAP provider is in-network or out-of-network with your insurance company.
|Common Co-Insurance Rates|
|Percentage You Pay||20%||40%|
|Percentage Your Insurance Company Pays||80%||60%|
Pro Tip: A plan with a higher deductible, often referred to as “Catastrophic Plans” usually have lower monthly premiums but higher co-insurance rates (20% – 50%), whereas low deductible plans will have higher monthly premiums and lower co-insurance rates (0% – 20%).
Did you know?: Most health insurance plans reset the amount of the deductible that has been met to $0 on January 1st of each year.
This means that it if you have met your deductible or are close to meeting your deductible near the end of the year, say around October, November, or December that you should be buying your CPAP supplies… Why? Because you’ll only have to pay your co-insurance rate instead of the full amount!
How Does My Co-Insurance Rate Affect My CPAP Supplies’ Cost?
With most healthcare policies, you must meet 100% of your deductible, or, in other words, have a balance of $0 deducible remaining for your co-insurance rate to affect the price of medical expenses (CPAP supplies). Once you have met your deductible, your insurance company will begin covering a large percentage [common amounts stated above] of your medical expenses… YAY!
Is the CPAP Product You Are Buying Covered by Insurance?
Most machines, masks, humidifiers, tubes, and filters are covered by insurance – yay!!! 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!
Co-Insurance Rates Are Only Used After Your Deductible Has Been Met… Has Yours?
The amount of your health plan’s deductible that you have met (have already spent out-of-pocket on medical supplies) will be somewhere in the following three categories: Zero Deductible Met, Deductible Partially Met, or Deductible Met. If your deductible has been met, well then congratulations your insurance company is going to start paying for your CPAP supplies and you only owe your co-insurance rate!
Real Examples of How Co-Insurance Works
If you would like to see real world examples of insurance plans with a high deductible, deductible met, or family deductible met, please visits our Patient Case Studies Page!
What About My Out-of-Pocket Maximum? Does That Affect When I Pay My Co-Insurance Rate?
Yes. It absolutely does. It’s simple… If you have met your out-of-pocket maximum then you no longer owe anything. Once you reach your out-of-pocket maximum, your co-insurance rate goes to 0% and 0% of anything is $0.00… you owe nothing. This means your health insurance plan will pay for 100% of your medical equipment!
Health Sqyre does the math for you while you are shopping for CPAP supplies! Sign up for free to see how much you can save!
Pro Tip: If you have met your out-of-pocket maximum you should try to buy as many CPAP supplies as you can / need / allowed by the reimbursement schedule using your insurance. Why? Because you pay nothing… zip. Zilch!
Did you know?: On January 1st of each year, most health insurance plans reset the amount of the out-of-pocket maximum met to $0. Meaning, if you meet your out-of-pocket maximum, you need to get your CPAP supplies ASAP when they are zero cost to you!