Is A CPAP Machine Covered By Insurance?
Introduction to Continuous Positive Airway Pressure
If you’ve been diagnosed with obstructive sleep apnea (OSA), chances are you’ve heard of CPAP therapy — the most widely recommended treatment for keeping your airway open and helping you sleep through the night. CPAP stands for ‘continuous positive airway pressure’ and is a type of positive airway pressure cpap device used to treat sleep apnea. However, there are alternative options to CPAP, such as oral appliance therapy, that may be suitable for some patients.
But for many people, the biggest question isn’t just “Will it work?” — it’s “Does Insurance Cover CPAP Machines?”
The good news? CPAP machines and supplies are often covered by insurance, including Medicare and many private providers — making it easier and more affordable to start treatment without delay.
In this article, you’ll learn:
How insurance coverage works — and how to access it?
What CPAP therapy is and how it works?
Why it’s so effective to treat sleep apnea?
Types of CPAP Devices
If you’ve been prescribed CPAP therapy, you might assume there’s just one standard machine — but that’s not the case. A CPAP device refers to a machine designed to deliver pressurized air to treat sleep apnea.
In fact, there are several types of CPAP devices, and each one offers different features that can affect your comfort, breathing support, and long-term success with treatment.
Understanding the differences between CPAP, APAP, and BiPAP machines can help you make the best choice for your needs — or speak with your sleep doctor about switching if your current device isn’t working well for you.
- CPAP machines are the most commonly prescribed and use a single, consistent air pressure to keep the airways open.
- APAP machines automatically adjust air pressure within a set range, making them a good option for those who need varying levels of pressure.
- BiPAP machines use two different pressures for inhalation and exhalation, and are often prescribed for chronic breathing conditions.
**Feeling unsure or frustrated with your current CPAP treatment?**You’re not alone — and we can help. Book a virtual appointment with a SLIIIP sleep specialist to review your setup, explore better options, and get personalized support.
Insurance Coverage
CPAP therapy is one of the most effective ways to treat obstructive sleep apnea — but for many patients, the biggest concern isn’t whether it works… It’s how much it costs, and whether insurance will help pay for it. The extent to which your insurance company will assist depends on your specific insurance policy, which outlines what is covered and any requirements you must meet.
CPAP Machine Costs (Without Insurance)
The price of CPAP machines varies depending on the type and features, and can also vary based on the brand, model, and supplier you choose.Sleep Foundation+1Verywell Health+1
- Standard CPAP Machines: Typically range from $500 to $1,000.
- Auto-Adjusting CPAP (APAP) Machines: Approximately $600 to $1,600.
- BiPAP Machines: More advanced, costing between $1,700 and $3,000.
Most CPAP machines fall within the $500 to $1,600 price range, depending on the features and supplier.
These prices generally include the machine itself but not the necessary accessories like masks, tubing, and filters.
The good news? Most insurance providers — including Medicare — offer coverage for CPAP machines and essential supplies as part of their durable medical equipment (DME) benefits.
Insurance plans often cover CPAP machines under Durable Medical Equipment (DME) benefits, but the extent of coverage depends on your specific plan.
- Deductibles: You must pay the full cost of the CPAP machine until your deductible is met. The deductible applies to CPAP purchases, rentals, and replacement components. Deductibles can range from $500 to $2,000 or more. The annual deductible must be met before insurance coverage for CPAP equipment begins.
- Coinsurance: After meeting the deductible, you’re typically responsible for a percentage of the costs (commonly 20%), while insurance covers the remaining percentage. Some insurance plans only offer partial coverage for CPAP equipment, meaning you may still be responsible for a portion of the costs.
- Out-of-Pocket Maximum: Once you’ve reached this limit, insurance should cover 100% of approved medical expenses for the remainder of the year.
For example, if your CPAP machine costs $1,000:
- With a $500 deductible and 20% coinsurance:
- Pay the first $500 (deductible).
- Then, pay 20% of the remaining $500, which is $100.
- Total out-of-pocket: $600.
- With a $1,000 deductible:
- Pay the full $1,000, as the cost doesn’t exceed the deductible.
- Total out-of-pocket: $1,000.
If you have a high deductible health plan, your out-of-pocket costs for CPAP machines and related equipment may be significant, and some people consider purchasing equipment without insurance to save money.
Ongoing Supply Costs
Regular replacement of CPAP supplies and CPAP accessories is essential for effective therapy:
Cleaning Supplies: $80–$200+ per year
Masks and Headgear: $40–$400 per year.
Mask Cushions: $60–$720 per year.
Tubing (Hose): $10–$300 per year.
Air Filters: $12–$60 per year.
Humidifier Chambers: $30–$100 per year.
CPAP Equipment and Supplies
CPAP equipment and supplies, including machines, masks, tubing, and other CPAP supplies, are typically covered by insurance as part of the DME benefit. Insurance coverage for CPAP equipment often depends on meeting specific requirements set by the insurance company. Certain conditions, such as documented sleep apnea and compliance with therapy, must be met for ongoing coverage. Insurance providers may require a review of your medical record to verify eligibility and compliance.
A medical equipment supplier plays a key role in providing CPAP machines and supplies. Patients should ask their insurance provider for a list of recommended suppliers to ensure a smooth process. You also have the option to obtain a CPAP machine from a medical equipment supplier directly, which may offer a wider selection but could affect your insurance coverage. Using in network providers is important to ensure your insurance will cover the costs.
Make sure you have up to date information on your insurance policies and coverage requirements to avoid claim denials. A sleep study is typically required to diagnose sleep apnea and qualify for insurance coverage. A CPAP prescription from a doctor is necessary to obtain a CPAP machine through insurance. Doctors are essential in diagnosing sleep apnea, prescribing CPAP therapy, and documenting compliance for insurance purposes.
Medicare covers replacement supplies on a regular schedule, depending on the item’s usage and maintenance needs.
Patients may need to pay a copayment or coinsurance for CPAP equipment and supplies, but insurance coverage can help reduce the out-of-pocket cost.
It’s essential to check with your insurance provider to determine the specific coverage and requirements for CPAP equipment and supplies.
What Are CPAP Alternatives?
While CPAP therapy is the most common treatment for sleep apnea, it’s not the only option. For individuals who find CPAP uncomfortable or ineffective, there are alternative treatments worth exploring—some of which may also be covered by insurance.
Alternative treatment options include oral appliances and implantable devices, these can be covered by insurance as part of a separate benefit. Coverage for these alternatives may be available through a Medicare Advantage plan or under Medicare coverage, depending on your eligibility and plan details.
These options may be more suitable for patients who cannot tolerate CPAP therapy or prefer alternative treatments.
Patients should consult with their healthcare provider to determine the best treatment option for their specific needs and insurance coverage.
Insurance coverage for alternative treatment options can vary, so it’s essential to check with your insurance provider. For eligible patients, both Medicare and Medicaid can work together to help cover the costs of alternative treatments, coordinating benefits to reduce out-of-pocket expenses.
Here’s what you can do to take control of your weight and your sleep health:
Questions to Ask Your Insurance Provider
Before starting CPAP therapy, it’s important to understand what your insurance will cover and what your financial responsibilities may be. Insurance policies can vary widely, so asking the right questions can help you avoid unexpected costs and ensure you’re making informed decisions about your treatment.
Here is a list of questions you should ask your insurance provider:
- Is CPAP therapy considered a covered benefit under my plan?– Confirm that CPAP machines and supplies are covered under your durable medical equipment (DME) benefits.
- What types of CPAP machines are covered (CPAP, APAP, BiPAP)?
- Do I need a diagnosis or prescription from a sleep specialist to qualify for coverage?
- Is prior authorization required before obtaining the machine or supplies?
- Do I need to purchase the CPAP machine through an in-network supplier?– Ask for a list of approved providers.
- What is my deductible, and has it been met for the year?
- After the deductible, what percentage of the cost will I be responsible for (coinsurance)?
- What is my out-of-pocket maximum, and how close am I to reaching it?
- Are replacement supplies (mask, tubing, filters, humidifier, etc.) covered?– Ask about the replacement schedule and limits.
- How often can I replace each supply item under my coverage?
- Will alternative treatments like oral appliances or implantable devices be covered if I can’t tolerate CPAP?
- What documentation or follow-up is required to maintain ongoing coverage?– Some plans require proof of usage via compliance tracking.
- Are there any brands or models that are excluded from coverage?
- Are there any copays or hidden fees I should be aware of?
- What is the rental period for a CPAP machine, and how long will insurance cover machine rental?– Ask how many rental months are included and if the plan covers machine rental or purchase.
- Are the CPAP machine and supplies Medicare approved, and what is the Medicare approved amount?– Confirm if your equipment is eligible for reimbursement and how the Medicare-approved amount affects your costs.
- What does Medicare require for ongoing coverage, such as compliance and documentation?– Ask about usage requirements and necessary paperwork for continued coverage.
- How does Medicare pay for CPAP equipment and supplies, including under Medicare Part B?– Clarify what Medicare Part B covers, how much Medicare pays, and what your coinsurance will be.
- What is included under Medicare cover for CPAP therapy?– Find out if both the device and replacement supplies are covered.
- If I use an out-of-network supplier, will I be responsible for the entire bill?– Understand if you may have to pay the full cost out-of-pocket if the supplier is not enrolled in Medicare.
- How are claims paid and what documentation is needed to ensure timely payment?– Ask what is required to have your claims paid promptly and avoid delays.
We are happy to help navigate CPAP treatment with your insurance. Our goal is to help you sleep better. We are here to help.
Dr. Avinesh Bhar
Final Thoughts
Navigating CPAP therapy and insurance coverage doesn’t have to be overwhelming. By understanding the types of machines available, the potential out-of-pocket costs, and what questions to ask your insurance provider, you can take control of your sleep apnea treatment with confidence.
Whether you’re just getting started or looking to improve your current setup, knowing your coverage details can make a major difference in both comfort and cost. And if CPAP isn’t the right fit for you, remember—there are alternative therapies that may also be covered by your insurance.
At SLIIIP, we’re here to help you every step of the way. From diagnosis to device selection and beyond, our sleep specialists can guide you through the process and ensure you’re getting the treatment—and insurance support—you deserve.
Need personalized help navigating your CPAP treatment or insurance plan?
Book a virtual appointment with a SLIIIP sleep doctor and get expert support tailored to your needs.
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