Question for those of you who have to pay a Co-Pay.

[DougVK]

I noticed many of you have said you are paying 20 to 50% Co-Pay a month or so for your xPAP and supplies. Do you all have a PPO plan or medicare. I find it very unusual for an HMO to have any type of Co-Pay for medical equipment. Just wondering if most on here have some kind of PPO or Medicare instead of an HMO plan.

[GTOJim]

I noticed many of you have said you are paying 20 to 50% Co-Pay a month or so for your xPAP and supplies. Do you all have a PPO plan or medicare. I find it very unusual for an HMO to have any type of Co-Pay for medical equipment. Just wondering if most on here have some kind of PPO or Medicare instead of an HMO plan.

I"m not yet on medicare and have a 50% co-pay. Seems with rising cost of medical care the insurance companies are covering less of DME expenses. My wife and I pay a bit over $1,700 a month out of pocket over and above what her employer puts in for our health insurance. We have HMO insurance, not many years ago we had 100% DME coverage.

[DougVK]

I noticed many of you have said you are paying 20 to 50% Co-Pay a month or so for your xPAP and supplies. Do you all have a PPO plan or medicare. I find it very unusual for an HMO to have any type of Co-Pay for medical equipment. Just wondering if most on here have some kind of PPO or Medicare instead of an HMO plan.

I"m not yet on medicare and have a 50% co-pay. Seems with rising cost of medical care the insurance companies are covering less of DME expenses. My wife and I pay a bit over $1,700 a month out of pocket over and above what her employer puts in for our health insurance. We have HMO insurance, not many years ago we had 100% DME coverage.

My, 1700 a month and you still have a 50% co-Pay. My employer pays $400 month, and I pay another $150 with 0 copay.

[pitrow]

I have a PPO and I had to pay my 30% copay on the rental of the machine itself, which luckily is over now. Any supplies however, I have to pay for out-of-pocket until my yearly deductible of $2000 is met So I pretty much just buy all my supplies by myself, since I can get much better rates online than going through the one and only DME my insurance will authorize. But if I ever did hit my deductible, then it would be the 30% copay for the supplies too.

[Janknitz]

It all depends on your plan--there are as many plans around as there are employers and private parties--each employer negotiates its own plan with insurers.

That's why posts like "what does BCBS of the state of Confusion pay for such and such" drive me nuts. There are thousands of plans that insurer can have, depending on who purchases the insurance. No consistency. It's part of the confusing state of the US system, and a reason why we really CAN'T often be savvy healthcare consumers--because there's no consistency in how insurance works and costs from one person to the next.

[robysue]

Mine's a PPO with a 50% co-pay and a rather lousy, stretched out replacement schedule to boot.

[TooGroggy]

Unless you get your health coverage through an employer with 250+ participants or through Medicare, things get very ugly out there. My small group policy is $1,850 a month (two adults + one child) with 100% copay for the first $5,000 of durable medical equipment.

[xenablue]

I had an initial co-pay of $50 for my CPAP machine and supplies. Each month I go to the DME storefront and pick up my replacement supplies according to the replacement schedule and pay nothing more - it's all covered under the initial co-pay.

Cheers,
xena

[LinkC]

Any co-pay is not dependent on DME...it's part of your health ins policy. Mine is approximately 15-20% for covered equipment/supplies.

However, there are some DMEs who waive the copay, accepting whatever the Ins covers as payment in full. And mine even ships Priority 3-day! (I live close enough they usually arrive the second day.) That's the best deal I've found.

[louspeachy]

My co-pay is 20% (could change when new policy takes effect 7/1). I got my new CPAP, Mask, etc for $0 this time since I had a lot of other medical expences this year and had already met my out of pocket.


If it stays at 20%, I won't complain. Getting a $180 mask for $36 is OK with me.

Louise

[Slinky]

Medicare is my primary and I have a copay of 20% which my secondary group health insurance picks up for me. We've been truly blessed w/good insurance all our lives making the future look scarier and scarier since we counted on continuing w/that until we croak.

[chunkyfrog]

Co-pay, deductible, co-insurance, 'out-of-pocket' whatever; it all means they pay less/we pay more.
At least lifetime maximums are going away--at least until the congressional insurance lackeys figure out how to undo that.

[ozze_dollar]

I live in Sydney,Australia and we have a two tiered system of medicare and private cover. I get a small payment of $600 when I buy my machine and thats it. Any further purchases I pay all of it.We also pay much more for our machines here. I just paid in excess of $4000 dollars for the new S9 VPAP.

[Slinky]

Whew, ozze!!! That enough to make us feel a bit ashamed of our whining and crying about prices for PAPs and equipment here in the USA!!!

[idamtnboy]

If you are paying medical costs out of pocket for DME and supplies, you really need to take advantage of a Flexible Spending Account if one is available to you. That way you use before tax dollars instead of after tax dollars.

The only downsides are any money not spent at the end of the year, or the grace period after, goes to the plan administrator, and once you start the contributions at the beginning of the year you cannot stop them except by losing your job.

The upsides are: you don't pay income tax on the money that goes into the FSA; the entire amount of the annual commitment is available at the start of the year; and if you lose your job during the year and have been reimbursed more than you have contributed you don't have to pay it back.

If you have a reasonably predictable medical outlay during the year, and an FSA plan is available to you, you have no good excuse to not take advantage of it. If you are mortally opposed to the idea you may lose some money at the end of the year, then set up your FSA to cover something like 80% to 90% of the expected expenses. Paying 80% of your medical costs with pre-tax dollars is a lot smarter than paying 100% with post-tax dollars.