Learn more about who needs a CPAP machine, what insurance or Medicare covers when it comes to a CPAP machine, and how to determine what your costs will be should you need a CPAP machine for yourself.
Who Needs a CPAP Machine?
Have you noticed you feel tired after a full night’s sleep, or you’ve been told you snore loudly? You could be suffering from obstructive sleep apnea, a condition that narrows or blocks your airway when you sleep. A CPAP machine can successfully treat obstructive sleep apnea by introducing forced airflow into the airway. The continuous air pressure into the airway helps keep it open while you sleep. While CPAP machines are specifically designed to deliver airflow at constant pressure through a hose that connects to a motor and a mask held in position by straps, there’s also an air filter to purify the air entering the nose. Some machines may have additional features like heated humidifiers.
What Does Insurance Cover for CPAP Machines?
Insurers typically cover a portion of CPAP machines as durable medical equipment (DME), which primarily serves a medical purpose and is not useful in the absence of injury or illness. To qualify for coverage, your attending physician must order a CPAP machine or prescribe it as a medical necessity for use at home. Insurance will typically cover the following costs for CPAP machines:
Repair, adjustment, or replacement of parts and accessories key to the normal and effective functioning of the machineRental charges if you can rent the machine for a cost lower than its purchase pricePurchasing the equipment when the cost would be less than renting it
Unless there’s a federal, state, or contractual coverage mandate, insurance won’t pay for any additional accessories or supplies that are mainly for the convenience or comfort of the patient. Examples of these accessories include air filters and purifiers, air conditioners, humidifiers, and batteries. Under Medicare DME coverage, you’ll pay a portion of the approved coverage amount (usually 20%) after you complete your annual plan deductible. The annual deductible for 2022 is $233.
Does Medicare Cover CPAP Machines?
Medicare covers CPAP machines under its DME (durable medical equipment) coverage. However, coverage is available to those who precisely have Medicare Part B provided the equipment is deemed a medical necessity. Medicare coverage for CPAP machines is available for an initial three-month trial period. When the trial period lapses, a practicing physician must re-evaluate you to establish whether the equipment is still a medical necessity beyond the three months. If the equipment is deemed medically necessary, you can rent it for up to 13 months, after which time you will fully own the machine.
Does Private Insurance Cover CPAP Machines?
Your private insurance may cover some of the costs of your CPAP machine. Many of them follow a process similar to Medicare coverage: The machine must meet the criteria for the medical management of obstructive sleep apnea syndrome and be supported by an order on file from a physician or licensed health care professional. Ask your plan provider or contact your insurance company to check whether your insurance covers CPAP machines. Upon verifying your coverage benefits, your insurer will check the rental or purchase terms to provide an estimate of your financial responsibility.
How Often Can You Replace a CPAP Machine?
You can replace a CPAP machine whether you fully own the equipment or are just renting it. If you fully own the machine, you can get a replacement if it is stolen, lost, damaged beyond repair, or exceeds its practicable useful lifetime, which is typically five years from the date you started using it. If you rent the equipment, your supplier is required to maintain, repair, and keep it in good working condition at all times.
The Bottom Line
Most insurance plans offer partial coverage for CPAP machines after you meet your annual deductible. In the case of Medicare Part B, Medicare covers 80% of the approved amount and you pay the remaining 20%. The rules of how these equipment are covered by either Original Medicare or Medicare Advantage Plans are generally similar, except that costs among Medicare Advantage plans differ.
Disconnect the mask and tubing from the machine.Gently wash with soapy water and then rinse thoroughly.Shake off excess water or wipe with a soft cloth. Allow the mask and tubing to air-dry.
