CPAP machines are the most common and effective treatment for obstructive sleep apnea. Their use has improved the quality of life and decreased the risk of heart disease of millions of people who have this common sleep disorder.
Continue reading to learn more about whether your insurance will cover your CPAP therapy expenses, and what are the most common requirements you’ll need to start your CPAP journey.
Will My Health Insurance Cover My CPAP Equipment?
Most insurance providers may cover continuous positive airway pressure (CPAP) machines, since they are considered Durable Medical Equipment (DME). Some insurance plans only cover CPAP machine rental, and not purchases.
Most health insurance plans will cover at least a portion of the cost of your CPAP device. However, this may vary, so it’s important to verify the insurance coverage within your policy with the assistance of your insurance provider.
Even if your insurance plan offers CPAP coverage or reimbursements over the purchase of new CPAP machines, it is recommended to evaluate the financial practicality of using insurance coverage, as the insured may have out-of-pocket costs like high deductibles, copayments, and other expenses.
It’s also important to consider that some insurance providers don’t cover some types of CPAP machines, such as auto-adjusting CPAP machines and BiPAP machines, or they may not cover CPAP devices that include humidifiers. In some cases, buying the equipment for your CPAP therapy without going through your insurance provider could be more convenient.
Are CPAP Supplies Also Covered by Insurance?
Whether your insurance pays for CPAP supplies or not is going to depend on your specific plan. CPAP masks and tubing are usually covered by insurance plans, since they are considered DME, but other CPAP supplies, such as filters, headgear and chin straps, are considered disposable supplies, so they may not be covered by your insurance.
Some insurance providers have replacement schedules, which tell you how often your insurance plan will cover replacement supplies. If one of these supplies needs to be replaced before the timeframe established by the insurance provider, you’ll have to pay for it out-of-pocket.
If you aren’t sure if your health insurance provider covers the CPAP supplies you need, you can fill our Rx Form, and we can check if you are eligible for coverage!
Most of the essential supplies for your CPAP devices are going to be covered at some capacity by your insurance provider. However, CPAP sanitizing products and supplies aren’t usually included in that coverage.
What Are the Requirements for Insurance Companies to Cover CPAP Machines?
The requirements to get coverage on your CPAP machine may vary depending on your insurance provider’s specific policies. These are some common steps that you usually need to follow in order to get your insurance to cover this equipment:
- A prescription from a licensed healthcare provider: Most insurances may require you to get this prescription from an in-network physician.
- A sleep study: This study can be conducted in-lab or at home, and the results have to be analyzed by a specialist in sleep medicine. The results of this test are not only used to confirm the diagnosis of obstructive sleep apnea, but also to verify the kind of sleep apnea treatment you need.
- Documentation of therapy compliance: Insurance providers usually require a compliance period, in which the CPAP user has to use the device regularly for a certain amount of time before they pay for it.
In some cases, even if you fulfill all the above mentioned requirements, the insurance company may require you to meet certain criteria to get the coverage, such as having a chronic condition that may be affected by your sleep apnea (e.g., hypertension) and an apnea-hypopnea index (AHI) of 5-14, or an AHI of 15 or greater, which is a parameter measured in sleep tests.
Can Medicare Cover CPAP Treatment?
Medicare is a federal health insurance program that covers various medical services and supplies for eligible individuals. One of the services covered by this program is CPAP therapy as a part of sleep apnea treatment.
Medicare coverage only applies if your healthcare provider and DME supplier are enrolled in Medicare, and you must have paid your Part B deductible to get its full benefits.
The Part B deductible is the amount of money you need to pay out of pocket before Medicare covers 80% of the approved amount for your CPAP equipment and supplies. You are responsible for the remaining 20% of the cost, unless you have supplemental private insurance that covers it.
Medicare requires a face-to-face appointment with your physician, in which you have to be diagnosed with sleep apnea. Upon being diagnosed with OSA, Medicare may cover a 3-month trial, in which you have to regularly use your CPAP machine and prove, through your medical records, that the therapy is effective.
For the first 13 months of your CPAP therapy, Medicare will only pay the supplier for a machine rental, and you will own the machine after this period.
Is Medicaid Coverage Available for CPAP Machines and Treatment?
Medicaid is a public health insurance program that helps low-income people pay for medical services. This program covers the costs associated with CPAP therapy, but with some conditions.
To qualify for CPAP coverage under Medicaid, you must have a sleep test that confirms you have OSA. You will also need a prescription from your sleep medicine doctor that specifies the settings and accessories needed for your CPAP treatment.
However, keep in mind that Medicaid is a joint program between the federal government and the states. This means that each state may have different rules and requirements for CPAP coverage. You should check with your local Medicaid office or provider to find out the specific guidelines for your state.
What Is the Average Cost of CPAP Machines?
The price of a CPAP machine depends on several factors, such as the brand, the type machine, and its model. There are some CPAP machines that have more advanced features, such as auto-adjusting pressure, humidifiers and touch screen controls, which can increase the price. The cost of a modern CPAP machine can be anywhere from $600 to $2,000.
In addition to the cost of the machine itself, there are other costs associated with CPAP therapy, such as masks, filters and cleaning supplies. They can add up to hundreds of dollars per year if you don’t buy appropriate or high-quality CPAP supplies.
Can I Buy a CPAP Machine Online?
Yes, you can buy a CPAP machine online from the comfort of your home! Sleeplay is a certified provider of several reputable CPAP machine brands, such as ResMed and 3B Medical. At Sleeplay.com, you can also find all the essentials for your CPAP therapy, including CPAP masks, tubing, filters, and cleaning supplies.
Some of the benefits you can enjoy when buying from us are:
- A wide selection of the best CPAP machines on the market.
- Free shipping on CPAP machines.
- A 30-day free mask exchange program.
- Free shipping on orders over $99.
- Deals and special discounts that you won’t find anywhere else!
If you need to test for sleep apnea, a Home Sleep Test is the easiest and most convenient way to get a diagnosis. It consists of a small device with three minimal touchpoints that record your oxygen levels, heart rate, and breathing patterns while you sleep.
Once the test is completed, we’ll email you the sleep test results. If sleep apnea is detected, your diagnosis makes you eligible for a CPAP prescription. You may follow up with one of our CPAP experts, who can guide you in finding the best treatment for you.
Additionally, you may choose to participate in the WatchPAT Green Program to recycle your device. Just send the device back in its original packing with the pre-paid label device, and that's it!
Most insurance plans, including Medicare and Medicaid, will cover at least a part of the cost of a CPAP device if you meet certain criteria. However, as we’ve mentioned, there may be some out-of-pocket expenses, as well as restrictions on what type of machine and supplies you can get.
Dealing with insurance companies can be cumbersome and can delay the start of your sleep apnea treatment. You should always explore every option available to you when buying a CPAP machine, to maximize your benefits and minimize the cost of your CPAP therapy.
At Sleeplay, we're committed to offering the latest in CPAP machine technology to help you achieve a better, more restful sleep. If you suffer from sleep apnea and struggle to sleep soundly, just reach out!
Medically reviewed: Gabriela Alvarado
Medical Doctor from the Central University of Venezuela. She holds certifications in Public Health Practice from institutions such as Johns Hopkins University (USA) and Imperial College London (UK).
