Does Insurance Cover CPAP Machines?

Most health insurance plans cover CPAP machines, as well as related items such as masks and tubing if they are prescribed for treating sleep apnea. For CPAP machines to be covered by insurance, you may be required to undergo a sleep study and receive an official diagnosis that you have obstructive sleep apnea.

Learn about the steps for filing a claim so you can get the CPAP you need.

On This Page

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  What CPAP Equipment Does Insurance Cover?

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  What Are the Requirements for CPAP Coverage?

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  Will Insurance Replace My Old CPAP Machine?

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  Can I File an Insurance Claim for CPAP Supplies?

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  Do I Need Insurance in Order To Get CPAP Therapy?

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  FAQs

What CPAP Equipment Does Insurance Cover?

Health insurance can partially or fully cover a continuous positive airway pressure (CPAP) machine, masks and tubing, as they are considered essential equipment for treating obstructive sleep apnea (OSA). The exact items and frequency of replacement may vary based on the insurance policy and specific medical necessity documentation. Remember, you may be required to meet your plan’s deductible before your policy will cover CPAP therapy.

CPAP Machines

Some insurance plans pay for the CPAP machine upfront, while others have a rent-to-own system where you share the monthly costs with your insurer until you fully own the CPAP machine. In a rent-to-own arrangement, the machine's cost is split into monthly payments. How much you pay depends on your policy.

If you don't use the machine enough, the insurer might deny coverage and stop their part of the payment. You'd then have to decide if you'll fully cover the rent payments yourself, buy the machine and equipment for between $500 to $1,500 depending on how sophisticated the equipment is, or stop the treatment.^[1] The cost can be even higher if you require a BiPAP (bilevel positive airway pressure), which delivers higher air pressure than a CPAP when breathing in.

CPAP Machine Parts and Accessories

Insurance coverage for CPAP machines often includes essential supplies, such as the mask, cushion and the headgear that delivers the pressurized air. The tubing that connects the machine to the mask, as well as the filters used to purify the air and water tanks in the humidifiers for moisture may be covered as well.

Insurance may also cover periodic replacements when essential CPAP parts wear out, so long as you’re using the CPAP as prescribed.

However, additional replacements beyond what your insurance will cover will likely be paid out of pocket. We’ve provided a simple table breaking down the cost of the individual parts for your CPAP without coverage.

^{*Pricing is based on data collected from multiple vendors and is meant as a starting point for potential buyers.}

Prices billed by suppliers can differ from online prices and costs can vary based on your CPAP model. While core components are often insured, optional accessories like cleaning wipes, specialized pillows, mask liners and travel bags might not be.

What Are the Requirements for CPAP Coverage?

Insurance companies usually demand proof of medical necessity for CPAP therapy coverage and often require the use of in-network providers. The typical steps for obtaining coverage from your provider include:

1. Initial doctor visit: Discuss sleep apnea symptoms, potentially in person.
2. Sleep study: Obtain a doctor-prescribed overnight examination, either at a lab or at home, to monitor breathing and health data. Studies are typically covered partially or fully by your insurance.
3. Diagnosis: Receive a diagnosis of OSA based on the sleep study results. You will also need a prescription from your doctor authorizing the purchase and usage of a CPAP machine.
4. CPAP education: Learn about CPAP machine operation and maintenance.

Initial coverage lasts a few months, after which further criteria must be fulfilled for your carrier to cover a CPAP machine:

1. Follow-up visit: Assess the effectiveness of the CPAP therapy.
2. Symptom improvement: Receive documentation from your doctor indicating benefits from CPAP.
3. Proof of use: Show data from the machine showing regular and consistent use. For example, Medicare defines this as using the device for at least four hours on 70% of nights over a continuous 30-day span depending on your insurance.^[8]

Keep in mind that even if your insurance covers CPAP equipment, you might still face out-of-pocket expenses due to deductibles, copays and coinsurance.

Will Insurance Replace My Old CPAP Machine?

Your health insurance company should replace your CPAP machine when it's time to trade it in, typically after five years.^[9] Keep in mind that the timeframe for when a health insurance provider will replace a piece of equipment will vary depending on who your healthcare is through.

Can I File an Insurance Claim for CPAP Supplies?

You can file a claim for CPAP supplies by getting in touch with the member services department of your insurance company. During this conversation, inquire about the type of form they require for claims. Many insurance providers accept a standard health insurance claim form which is readily available online.

Once you have the right form, make sure to fill it out completely, including any necessary details like HCPCS (healthcare common procedure coding system) codes, diagnosis codes and tax ID numbers.

Next, attach a copy of your invoice to the form. After preparing your documents, submit them using your insurance company's preferred method, which can be through mail, fax, email or mobile app.

Do I Need Insurance in Order To Get CPAP Therapy?

You can purchase CPAP equipment without insurance but federal law will require that you show a prescription issued by a licensed doctor to the vendor for the transaction to be legal.^[10] While insurance typically reduces your costs, some suppliers charge insurers more, which might lead to greater costs if you have high deductibles. In this instance, purchasing CPAP equipment out of pocket can still be relatively affordable.

Without insurance, you also don't need to share usage data. But if you buy on your own, make sure the supplier can coordinate with your doctor about any device issues.