Getting a CPAP machine is vital
for treating sleep apnea and achieving a better night’s sleep. Whether you are
looking to your first machine or a travel-sized CPAP
machine, you’ll likely want to have your insurance company pay for most or
all of the cost. This begs the question: does insurance cover the cost of CPAP
The Long and Short Answers
The short answer is yes, most insurance providers will
reimburse you for the cost of your CPAP machine. The long answer is maybe, as
it really depends on your insurance carrier.
Most insurance providers cover at least a part of the cost,
and the amount that you can be reimbursed depends on your medical insurance
provider and the plan you have with them. Some providers and plans will cover
the full cost of the machine while others will only pay out a portion of it. It’s
also possible (however rare) that your insurance provider will not reimburse
you for any of the amount paid.
It’s highly recommended that you contact your insurance
provider right after you have received a prescription from your primary care physician
for a CPAP machine (you cannot purchase one without the prescription).
Does Medicaid and Medicare Cover the Cost of a CPAP Machine?
If you are on Medicaid, you still can qualify for a CPAP
machine, but you will need to obtain authorization, and the process and amount
covered will vary by state. It’s best to contact your state benefits provider
for clarification on what they cover and to obtain authorization.
Medicare recipients also qualify for Continuous Positive
Airway Pressure (CPAP) therapy if they have been diagnosed with obstructive
sleep apnea. Medicare usually covers a 3-month trial of CPAP therapy and may
provide longer coverage if your doctor provides information stating that you
met certain conditions.
This information may change as new laws are put in place,
check with medicare.org
for the most recent coverage for CPAP machines.
Can I Pay Using an HSA or FSA?
Yes, you can pay for a CPAP machine using funds contained
within your HSA or FSA accounts. For more information, read
our post about it here.
Get the Treatment You Need
Even if your insurance provider does not cover the cost for
a CPAP machine, it’s still worth it to purchase one and begin getting the
treatment you need. CPAP machines are relatively affordable medical devices,
and there are ways to obtain one without paying 100% up front. In the end, the
benefits of having CPAP therapy wherever, whenever, far outweigh the total cost
of the machine.