If you’ve recently been diagnosed with Obstructive Sleep Apnea (OSA), you’ve probably got a lot of questions on your mind. Not the least of them are “How much does a CPAP machine cost?” and “Should I buy my CPAP out-of-pocket or through my insurance plan?”
Of course, you want to make sure you get the right CPAP at the right price, so it’s important to consider the different payment options and how they affect the overall cost. That’s why we’ve put together answers to the most common questions CPAP users have about CPAP costs and insurance coverage. Read on to help you decide which is the right choice for you!
Table of Contents
- How Much Does a CPAP Cost WITHOUT Insurance?
- How Much Does a CPAP Cost WITH Insurance?
- If My CPAP Supplies Are Covered by Insurance, Why Do I Still Have to Pay Money?
- Does CPAP Count Towards My Deductible?
- Will Insurance Cover a Travel CPAP?
- Will My Insurance Require a Sleep Study or Prior Authorization?
How Much Does a CPAP Machine Cost Without Insurance?
The average cash-pay cost of a basic CPAP machine is typically between $300 to $500; however, depending on the features included and the type of CPAP machine, it could get significantly more expensive. APAP (autoCPAP) and BiPAP machines (bilevel), for example, regularly run from $800 to over $1,500 or more.
That said, the cost of CPAP therapy doesn’t end with the initial cost of a CPAP machine.
To keep your CPAP device running properly, effectively, and hygienically you’ll need to regularly replace certain supplies. With time and normal use these parts will wear down or gunk up and begin to affect the quality of your sleep apnea treatment. This includes filters, CPAP mask cushions, tubing, and other parts that are an important part of CPAP therapy.
If you follow the recommended replacement schedule, you’re looking at around:
- CPAP Cushion - $10 to $75 every 2 to 4 weeks
- CPAP Mask - $40 to $200 every 3 months
- Headgear - $30 to $50 every 6 months
- Tubing - $10 to $35 ($40 to $60 for heated hoses) every 3 months
- Humidifier Water Chamber - $15 to $70 every 6 months
- Disposable Filters - $1 to $10 every 2 to 4 weeks
- Reusable Filters - $5 to $20 every 6 months
These costs can add up quickly and when you purchase your CPAP machine out-of-pocket, these costs fall to you. This is where getting your CPAP through your health insurance may make the most sense.
How much your CPAP will cost through insurance depends on the details of your insurance plan. This includes your deductible and how much of it you’ve met, your coinsurance rates, and whether your CPAP provider is in-network with your insurance company.
If this sounds a little overwhelming, take a deep breath. The important part is this: if you’re going to meet your deductible– whether because of the cost of your CPAP or even unrelated healthcare costs– you could save a lot of money on your CPAP machine and CPAP supplies.
That’s because, once you’ve hit your deductible, most insurance providers (including Medicare) will cover a regular schedule of replacement CPAP supplies! They may even cover a brand new CPAP machine!
Coinsurance: The portion of healthcare costs you owe after your deductible is met
Out-of-Pocket Max: The most you’ll pay for covered healthcare within a given plan year
In-Network: Your insurance company has negotiated a price with your CPAP equipment provider
How Much Does a CPAP Machine Cost Through Health Insurance?
That’s because, once you’ve hit your deductible, most insurance providers (including Medicare) will cover a regular schedule of replacement CPAP supplies! They may even cover a brand new CPAP machine!
As for figuring out the rest of it? Aeroflow Sleep makes that part easy. With Aeroflow Sleep a personal Sleep Specialist will reach out to your insurance provider for you. They’ll confirm your deductible and coinsurance, then help you make the most of your insurance coverage.
Need Fresh CPAP Supplies?
From CPAP machines and masks to tubing and filters, Aeroflow Sleep covers your sleep apnea essentials up to 100% through insurance. Plus, you'll be paired with a dedicated Sleep Specialist, get access to our user-friendly patient portal, and receive world-class resources like our AI mask-fitting technology.
If My CPAP Supplies Are Covered by Insurance, Why Do I Still Have to Pay Money?
After you’ve hit your deductible, you’ll probably encounter something called “coinsurance.” While your insurance company likely covers most of the bill, your coinsurance is the remaining percentage that you owe.
Let’s say you have a policy with 20% coinsurance, and you’ve already hit your deductible. If you purchase a $100 CPAP mask, you would owe $20, while your insurance policy covers the other $80.
Once you’ve hit your out-of-pocket maximum, that same CPAP mask would be covered at no cost to you!
Does CPAP Count Towards My Deductible?
CPAP machines and supplies (like masks, cushions, and tubing) are considered “durable medical equipment (DME)” so if you purchase them through your health insurance they’ll usually count towards your deductible.
CPAP accessories– like soft wraps, cleaning wipes, and removable battery packs– are considered non-essential, so they won’t count towards your deductible.
Will Insurance Cover a Travel CPAP?
Since travel CPAP machines are considered secondary or backup devices, most insurance companies won’t cover them.
If you need to bring your sleep therapy on the road, your Aeroflow Sleep Specialist can help you find the best CPAP machine to balance portability and insurance coverage!
Will My Insurance Require a Sleep Study or Prior Authorization?
Whether you buy your CPAP out-of-pocket or through your health insurance, there are a few requirements to check off:
- A prescription. No matter what, you’ll be required to have a current prescription.
- A sleep study. Getting a prescription usually means you’ll need to have a sleep study, and that’s a good thing! Some online CPAP retailers offer a prescription based only on a survey, but this should be avoided. Your CPAP prescription needs to include an air pressure recommendation calibrated specifically to your health needs in order to properly treat sleep apnea and avoid potential side effects. Remember that a CPAP machine is a medical device meant to treat a dangerous sleep disorder!
Occasionally some insurance providers may also require prior authorization. When this happens, Aeroflow Sleep takes care of it for you! In fact, your personal Sleep Specialist will handle all of the paperwork for you.
From obtaining your prescription to checking your coverage details, we’ll reach out to your doctor and your insurance provider directly. All you have to do is fill out our simple qualify form, then kick back and wait for your CPAP supplies to be shipped directly to your door!
