Does Insurance Cover CPAP Machines?

Health insurance documents.

Just the thought of having a discussion on the subject of health care can lead to a migraine. Unless you have been living in a cave, it has been at the forefront of the national debate for months. If you agree with it or not, health care and the way Americans approach health care decisions have changed. Health care obviously impacts every citizen from cradle to grave. Let’s look at some of the potential changes for the sleep therapy device market.

Are CPAP Machines Covered By Insurance?

Currently, if a person struggles with sleep apnea after undergoing a sleep study, the patient will receive a script by their doctor for a CPAP machine and accessories. Generally, insurance will pay some portion of your CPAP machine cost once a deductible is met. Patients then tend to purchase a CPAP machine and supplies from a medical equipment supplier their doctor recommends. Traditional home medical equipment providers typically charge well over $1000 for a basic CPAP machine. CPAP masks, filters, tubing, CPAP mask headgear are all charged separately.

Conversely, Medicare requires sleep apnea sufferers to rent a CPAP machine for 13 months. This is so they can determine order to determine if apnea treatment is necessary and compliance is continuing. Of course, sleep apnea does not go away unless lifestyle changes are made and continued. So compliance data will need to be accessible by the CPAP machine provider in order for the patient to continue its use.

If all this seems complicated, it will probably not change much under the new health care initiative. A sleep study will continue to be required by private insurance or Medicare in order to be covered for a CPAP machine and supplies. Medicare will still require strict compliance monitoring for it to continue paying for a CPAP machine, mask and supplies. One change which most likely will occur is private insurance’s willingness to pay for CPAP equipment. Given the significant increase in patients who are diagnosed with sleep apnea, private insurance will possibly increase deductibles or reduce coverage altogether. They will also follow Medicare’s lead by strictly following guidelines on compliance.

Depending on one’s point of view, it might not be all bad. If insurance companies are required to provide preventive medicine including advice on well being, the need for CPAP machines might decrease which ultimately can reduce premiums. Bringing understanding and awareness to people suffering from sleep apnea will also help to fight its causes primarily obesity. Nevertheless, people with sleep apnea have a choice on where they can purchase their sleep therapy equipment. When it comes to sleep apnea and CPAP machines and supplies, patients should evaluate the most valued solution relative to their situation. There are many CPAP machine choices with varying levels of technology. There is also a plethora of CPAP mask choices to satisfy even the most fickle sleep apnea suffer. Some CPAP equipment providers offer few choices and some offer everything.

How Much Does a CPAP Machine Cost With Insurance?

When it is time to make a purchase, sleep apnea patients should evaluate all their options. This includes what it will cost with and without insurance. Choice allows for flexibility when it comes to purchasing CPAP equipment. With deductibles increasing and compliance critical, buying CPAP equipment out of pocket might be less expensive than going through an insurance company. Purchasing a CPAP machine and mask outside of insurance can cost anywhere from $500 – $1200. With an insurance deductible of $1000, the sophisticated consumer could make a case that it makes more sense to buy the CPAP equipment outright. However, some level of responsibility will rest on the apnea patient to choose their CPAP equipment provider wisely. Overall, the long term benefits could outweigh any potential risks.

Bio: Chris Vasta operates TheCPAPShop.com, a leading retailer of CPAP equipment, located in New Jersey. He understands the importance of education about CPAP equipment so that sleep apnea sufferers will continue to use CPAP machines, CPAP masks, and CPAP supplies and increase their quality of life.

Chris Vasta

Author

Chris Vasta

Over a 10+ year career at PHH Mortgage managing a $100 million portfolio, Chris Vasta learned the ins and outs of the business world. He learned how to establish business relationships, lead a multi-prong team, and implement strategies for long-term growth. In 2007, Vasta used that experience to transition his role into president of The CPAP Shop. Over his tenure, Vasta has been involved in everything from website design to warehouse layout. His hands-on approach with customers has evolved into an in-depth understanding of the challenges of beginning and adhering to sleep therapy. He often provides his insights on product…


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