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Medicaid and Medicare partially cover CPAP machines for all three AHI indexes, provided you meet certain conditions. Other insurance providers may have different standards. Be sure to check your insurance policy to determine your specific requirements.
CPAP supplies are covered by insurance because they fall under the Durable Medical Equipment (DME) category. While CPAP insurance coverage is helpful, there is a flip side—limited device options. Insurance companies require you to purchase a CPAP machine through in-network DME suppliers.
Most insurance companies, including Medicare, cover the cost of some CPAP machines and supplies. The out-of-pocket costs you’ll be responsible for paying will vary based on your insurance provider, your plan, and whether you choose an enrolled doctor and supplier.
Sleep apnea insurance coverage for CPAP therapy. Since CPAP is the most common form of sleep apnea therapy, it’s generally covered by most insurance policies. CPAP is “considered to be durable medical equipment,” writes Dr. Helene A. Emsellem, director of the Center for Sleep and Wake Disorders.
CPAP devices and certain supplies (such as masks, tubing, filters, and humidifiers) are generally covered by most health insurance plans, including Medicare and Medicaid. Here’s what you need to know to make the most of your insurance coverage.
If you have a diagnosis of sleep apnea, your insurance company will probably cover the cost of your CPAP or bi-level PAP device; however, coverage varies from plan to plan and so do authorization requirements. Read more about insurance coverage below.
Does Private Insurance Cover CPAP? Private insurance companies—think Blue Cross & Blue Shield or United Healthcare—will typically cover CPAP machines and supplies. Even better, they’ll likely cover a regular schedule of replacement supplies throughout the year!
CPAP machines are often at least partially covered by private insurance, as well as by government plans such as Medicare. In fact, from 2014 to 2017, insurance claims featuring an obstructive sleep apnea diagnosis increased by 850%. CPAP machines are covered as durable medical equipment (DME).
Does Original Medicare cover CPAP supplies? Yes. Original Medicare helps pay 80% of the cost of the following equipment after you’ve met your Part B deductible: 6. Original Medicare has certain rules for replacing CPAP machine supplies. Contact your doctor or device supplier for more information.
In this article, we’ll go over what CPAP equipment insurance companies typically cover, whether or not Medicare and Medicaid cover CPAP therapy, when to replace your CPAP parts, the requirements you’ll need for CPAP coverage, and how to buy CPAP equipment if you don’t have insurance.