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Does Insurance Cover CPAP Therapy: What You Need to Know

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Does Insurance Cover CPAP?

💡 Key Takeaways

  • Insurance Does Cover: Most insurance plans do cover CPAP machines, masks, tubing, headgear, and filters. However, cleaning supplies and travel CPAP machines are usually not covered.
  • Requirements and Compliance: Obtaining a CPAP machine through insurance requires a prescription, a valid sleep study, and an initial compliance period. Usage proof is also needed for replacement supplies.
  • High Deductibles Matter: If you’re on a high-deductible plan, buying a CPAP machine through insurance might not be cost-effective. Prices are often higher than purchasing online.
  • Replacement Schedule: Insurance companies have a set schedule for replacing CPAP parts. Machines are generally replaced once every five years, while other parts have shorter replacement cycles.
  • Direct Purchase Option: You can buy CPAP supplies directly online without insurance, often at lower prices. A prescription is the only requirement for this route.

If you are one of the 30 million Americans living with sleep apnea, you’re tired (literally) of the inability to enjoy one of the body’s most natural functions—sleep. For many, CPAP therapy is the key to getting some much-needed rest.

As with any medical treatment, there is a financial obligation involved. This leaves many people contemplating the best option for purchasing supplies without breaking the bank.

There’s usually one question that comes to mind first: does insurance cover CPAP equipment?

They do. However, depending on your situation, there may be some hoops to jump through. If you’re trying to decide whether or not to purchase a CPAP machine through your insurance, here’s what you need to know:

Does Insurance Cover CPAP Therapy?

In short, yes; however, the process can be a bit complicated. Here are a few important factors to keep in mind when deciding whether or not to purchase your CPAP machine through insurance.

CPAP Supplies Covered By Insurance

Does insurance cover CPAP masks? What about cleaning supplies? Besides the CPAP machine, you might be wondering what other items your insurance covers.

Most plans include the CPAP machine, masks, tubing, headgear, and filters. They do not include cleaning supplies, CPAP Batteries, or travel CPAP machines (mini CPAPs). Items such as sanitizers, mask wipes, and back-up supplies will need to be purchased separately as well and probably won’t go toward your deductible.

Insurance Requirements for CPAP Therapy

Obtaining a CPAP machine through your insurance company requires a lot more than a simple request. Most insurers require a prescription, a valid sleep study, and an initial compliance period (more on that later). You will also need to provide usage proof to receive replacement supplies.

On the other hand, when you buy CPAP equipment online yourself, the only requirement is a prescription.

Your Deductible Affects the Cost

Here’s the kicker—if you are on a high-deductible plan, buying a CPAP machine through insurance might not be the best route.

Let’s say your deductible is $2,000, and you’re not even close to meeting it. Not only would the CPAP supplies be an out-of-pocket cost, but the insurance price is usually more expensive than purchasing them online yourself.

How Often Will Insurance Pay for a New CPAP Machine?

To maintain proper hygiene standards, CPAP parts need replacing every so often. Doing so is necessary to stay healthy and keep your equipment running smoothly.

Insurance companies use a replacement schedule for resupplying parts. Generally, tubes, masks, headgear, and filters are replaced every few months, and the CPAP machine is replaced once every five years. If you need new supplies before the given timeframes, it can be frustrating—which is a big reason many people choose to buy the machine and parts themselves.

Can I File a Claim for CPAP Supplies?

In short, it depends on your insurance. That said, CPAP.com (considered out-of-network) offers a Self-Filling Insurance Tool to help out. Using this tool will help you access the correct forms and ensure you receive your reimbursement, which of course depends on your insurance plan.

Related reading: Looking for the best CPAP machine? We’ve got you covered! Read our review of the latest CPAP machines to find your perfect match!

CPAP Device Monitoring Through Insurance

If you decide to go through insurance for your CPAP supplies, the process isn’t as simple as a quick transaction. Insurance companies need to know that you will use the device before they shell out money for it.

During the first few months, your insurer will require CPAP adherence (or compliance) to ensure you are using the machine frequently. Most devices contain SD-cards that store the amount of time it’s used, giving insurance companies a way to keep tabs. They require you to use your CPAP machine for a certain number of hours per night (at least four) and a set number of days per month before they cover the cost.

During the initial “lease” period, you are also required to pay a monthly rental fee. Most times, the total amount of rental fees you pay over the first few months ends up being more than the machine’s actual cost. What’s more, if the insurance company deems you are not using the device enough, they can take it back without refunding any rental fees you paid.

CPAP Machine Options

CPAP supplies are covered by insurance because they fall under the Durable Medical Equipment (DME) category.

While CPAP insurance coverage is helpful, there is a flip side—limited device options. Insurance companies require you to purchase a CPAP machine through in-network DME suppliers. This doesn’t mean all options are low-quality, but your choice may not be best suited for you.

When you purchase CPAP supplies through a direct seller like CPAP.com, you have free range to choose the best option for your lifestyle, meaning there’s no obligation to settle!

Can You Buy CPAP Supplies Without Insurance?

Does insurance cover CPAP supplies? Yes. But it’s not the only option.

As long as you have a prescription, you can purchase CPAP supplies directly online. Unlike insurance, you do not need an initial trial period.

When you go through a direct seller like CPAP.com, the prices are actually lower. Why? Since we don’t bill or work with insurance companies, we can provide CPAP supplies at the most reasonable prices.

At CPAP.com, your unlimited options of CPAP machines ensure you receive the best CPAP therapy to fit your CPAP needs. Since we do not require a compliance period or yearly check-ins, you have the freedom to decide which equipment suits you and how often it’s used.

Your lack of sleep might be stressful, but your solution doesn’t have to be. Our CPAP products will ensure each night’s sleep is what it’s meant to be—peaceful.

  • Taylor Whitten

    Taylor has seen sleep apnea treatment first-hand and has learned the ins and outs through formal training in CPAP machines, masks, and equipment. She strives to make learning about sleep apnea and sleep apnea therapies a breeze. Interested in sharing your story or have a topic you’d like CPAP.com to investigate? Contact us!

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