After getting diagnosed with obstructive sleep apnea, your doctor will typically prescribe a CPAP machine to help you manage your condition. For those who have Medicare or other insurance coverage, it’s only natural that you would hope for your insurance policy to cover the costs of this equipment.
Unfortunately, insurance coverage for CPAP can be a bit trickier than other medical needs. While some form of coverage is typically available, it may not be as financially beneficial as you would hope.
Common Health Insurance Issues
While most health coverage policies now provide some level of coverage for CPAP devices and other medical equipment, this coverage tends to be much less expansive than the average person would like.
For starters, most insurance policies actually require that you enter a rental agreement for your CPAP machine. You can’t just buy the equipment outright. Instead, you have to rent it over a period of several months before it is considered “yours” — and quite often, the insurance company only covers a portion of these rental expenses.
It is also worth noting that under many insurance policies, you won’t receive any coverage for a CPAP machine until you’ve hit your deductible. With insurance plans seemingly increasing their deductibles more and more each year, this could make it difficult to obtain any financial help.
Just like how your medical expenses are only covered when you visit an in-network provider, insurance coverage also typically only allows you to work with an in-network supplier of CPAP equipment. This means that you are limited in the type of CPAP equipment you can get. Your preferred brand — or specialty options like a travel CPAP device — may not even be available from your in-network supplier.
As a result, you could get stuck with sub-par CPAP equipment that doesn’t fully meet your needs.
What About Medicare?
While Medicare coverage for CPAP equipment is a step up from standard health insurance, it still shares many of the same drawbacks. As with other insurance coverage, CPAP users must rent their equipment for 13 months before they “own” it.
In addition, Medicare patients are still required to pay 20 percent of the cost of their monthly rental, as well as the cost of replacement parts like tubing and mask components. If you work with a doctor or supplier who isn’t enrolled in Medicare, you won’t receive any coverage. Even when your doctor is covered by Medicare, you may need to pay the entire cost upfront, and then wait for Medicare to reimburse you for their share of the expenses later.
Equipment replacement schedules are also relatively limited under Medicare and other health insurance coverage. For example, you can replace the tubing and mask interface once every three months. The humidifier water chamber and chinstrap can be replaced every six months. Disposable filters and nasal mask cushions can be replaced as frequently as every two weeks.
While this is a good timeline in theory, it doesn’t give you much leeway for the unexpected. What happens if your dog gets ahold of your tubing? What if your CPAP machine falls off the nightstand and cracks the water chamber? In such circumstances, the replacement would not be covered by your insurance.
Go the Direct Route
Because of the ongoing deficiencies with health insurance coverage for CPAP supplies, many people find that it is actually less expensive (and certainly less stressful) to buy their CPAP supplies with cash.
When you don’t have the insurance company involved, you can choose where to buy your equipment. More importantly, you can choose the CPAP or BiPAP machine you want based on your personal preferences. This decision won’t be dictated to you by the insurance company. You also get to choose whether you rent, purchase, or finance your equipment.
Of course, before making any purchasing decision, it is best to check your insurance provider’s list of benefits to determine just what they do and don’t cover. Not all insurance policies are created equal, and as a result, your policy may not have all the issues that have been discussed in this article.
Ultimately, because CPAP equipment is a significant financial investment, it is worth doing your research before making a final decision. Evaluating the pros and cons of working with your insurance will help you save money and avoid unnecessary hassles. Most importantly, it will put you on track for getting the sleep apnea therapy that you so desperately need.
Choose No Insurance Medical Supplies For Your CPAP Needs
When you don’t have health insurance or your health insurance does not provide quality CPAP coverage, getting a quality CPAP machine to manage your sleep apnea can become a bit stressful. The good news is that this doesn’t have to become an overwhelming problem.
Here at No Insurance Medical Supplies, we offer CPAP and BiPAP machines from leading brands like ResMed, Fisher and Paykel, and Philips Respironics, with many of these devices at prices significantly discounted off MSRP.
In addition to our low prices on CPAP equipment, many buyers are able to qualify for financing on purchases over $500. Breaking your purchase up into affordable monthly payments could even be less than what you would pay each month doing a rental through your health insurance.
Remember, you have more options for obtaining a CPAP machine than going through your potentially limited insurance coverage. With No Insurance Medical Supplies, you can get quality equipment at a price you can afford so you can sleep better than ever.