Does Insurance Cover CPAP? (and How to Save on Your Supplies)

You’ve been diagnosed with sleep apnea and one of the first things on your mind is “How will I pay for the CPAP machine and supplies?” Usually this is followed by “Does my insurance cover CPAP?” and then “Can I get it cheaper online?”

If you’re one of the 22 million Americans who suffer from sleep apnea, these are the kinds of questions that can (literally) keep you up at night.

There’s some good news right off the bat; CPAP equipment is classified as “durable medical equipment.” Skipping over the boring insurance terminology, what this means for you is: most insurance providers (including Medicaid and Medicare) will not only cover your CPAP machine, but also the mask, filters, tubing, and headgear.

But your insurance coverage is subject to deductibles and copay, so buying your CPAP supplies from an online retailer like Amazon is the way to go, right? Hang on! You could be stepping over dollars to save yourself pennies! Read on to find out whether insurance or cash-pay will save you more money in the long run.

Before we get into the cost-saving details, we need to address the elephant in the room: CPAP compliance. Also known as CPAP adherence, compliance is the measurement of how often and how long you use your CPAP machine. If you want your machine covered by insurance (private or government) you’re going to have to demonstrate compliance.

“They want to look at the compliance information to make sure that the patient is using the machine so they will pay for future CPAPs and for future CPAP supplies." <strong>- Megan Roberts, Respiratory Therapist and CPAP Clinician at Aeroflow Healthcare</strong>

The bottom line is that CPAP equipment can get expensive, and insurers want to make certain that you’re actually going to use it before they shell out.

Most private insurance companies– think BlueCross BlueShield or United Healthcare– will cover CPAP machines and supplies. Even better, they’ll likely cover a regular schedule of replacement supplies throughout the year!

With normal use, many of these parts will become worn, cracked, or dirty. If you buy your CPAP supplies without insurance, you’ll be responsible for the full cost of the replacements.

But if your medical costs (including your CPAP machine and supplies) will exceed your deductible for the year, these replacement parts will then be heavily discounted or possibly even free!

Note: Your policy probably won’t cover extras like CPAP sanitizers, removable batteries, or back-up equipment, and buying them probably won’t contribute toward your deductible. For these items, an online CPAP retail store like CPAPSupplies.com may be your best option!

In a moment, we’ll show you how to use your manufacturer’s replacement schedule to calculate whether insurance or cash-pay makes the most sense for you. If you’re not enrolled in Medicare or Medicaid, you can skip directly to the section about buying CPAP without insurance.

Medicare will cover 80% of the costs associated with your CPAP therapy if you meet their requirements, but there’s a catch that surprises many people.

Note: Medicare will require you to purchase your equipment from a Durable Medical Equipment (DME) supplier, and will only cover your machine and supplies if your doctor AND your DME supplier are enrolled in Medicare.

If you have a Medicare supplemental plan, be sure to provide that information when speaking to your Aeroflow Sleep specialist as it could lower your costs even further!

Generally, Medicaid will cover CPAP machines, however the supplies may be another story. Each state manages its own Medicaid plan individually, so CPAP coverage varies from state to state.

You should check your state Medicaid coverage directly for specific benefits and authorization rules.

That said, most Medicaid plans follow Medicare coverage guidelines, so there are a few requirements you can bank on. Most will require prior authorization and a face-to-face appointment with your physician even if you’re already a current CPAP user. A prescription and a compliance period will also be required.

After your doctor has approved your supplies as medically necessary, a request will be sent to your Medicaid insurance provider for review. If this review is required in your state, no supplies can be sent until it is approved.

Your deductible and/or copay may apply. If Medicaid is your secondary insurance, you should inform your Aeroflow Sleep specialist of both your primary and secondary when providing your payment information. Your secondary insurance might cover the additional costs!

Can you find great cash-pay deals on new CPAP machines? Yes!

Will it be cheaper in the end? That depends...

Cons:
On the other hand, you’ll be fully responsible for the cost of any future replacement supplies. Over time your mask will wear down, your headgear will stretch, and bacteria can build up in your filters. Even reusable filters should be replaced every six months. If you bought your machine and supplies through a cash-pay retailer, these purchases won’t contribute toward your deductible.

For the most effective therapy, CPAP manufacturers provide a recommended replacement schedule on certain parts and supplies.
Here’s the trick to getting the best price on those parts: you need to compare your replacement schedule against your deductible and out-of-pocket maximum.

Let’s assume you have a $3,000 deductible. If you were to purchase a new machine in January, then followed Medicare’s CPAP replacement schedule, you’d hit your deductible by July!

And that doesn’t even include any doctor visits, procedures, or the cost of the sleep study itself.

Sleep apnea shouldn’t keep you from a good night’s sleep and neither should paying for CPAP. No matter what payment option you choose, Aeroflow Sleep can assist you at every step.

If you need help understanding your insurance coverage, an Aeroflow Sleep specialist can discuss your CPAP benefits and compliance requirements.

Or, if cash-pay is the smarter choice for you, we’ll discuss the best deals for your money.

Either way, we connect directly with your doctor to handle all the details. When you’re ready to order, we’ll match you with the perfect CPAP machine, while trained clinicians help you adjust your mask fit and machine settings.

Even after you’ve ordered, Aeroflow Sleep patients can schedule a one-hour phone call with a clinician to make sure you get the best rest possible. Additionally, Aeroflow Sleep Coaches are also available as a resource to get you through the compliance period.

Talk to Aeroflow Sleep about the most affordable options today.

Health insurance premium - The monthly rate you pay your insurance company
Deductible - The amount of medical costs you must pay before insurance coverage begins
Copay - A fixed charge paid by you for a specific medical expense (i.e. doctor’s visit, prescriptions, ect.)
Coinsurance - A percentage of a medical cost paid by you after your deductible is met

Information provided on the Aeroflow Healthcare blog is not intended as a substitute to medical advice or care. Aeroflow Healthcare recommends consulting a doctor if you are experiencing medical issues or concerns.