Written by Natalie Grigson, Writer
When someone is diagnosed with sleep apnea, their healthcare provider may recommend continuous positive airway pressure (CPAP) therapy. While CPAP therapy is important for those who need it, many people may understandably be concerned about whether they can afford it.
The good news is that if you have health insurance, most carriers do cover at least some of the costs of CPAP therapy. 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.
Does Insurance Cover CPAP Therapy?
Most insurances help cover CPAP therapy1 for those who have been diagnosed with sleep apnea by their doctor, likely after doing a sleep study. Additionally, insurance carriers may require proof that you’re consistently using your CPAP machine.
The money that you’ll have to pay out of pocket will vary based on your insurance plan, but most should at least cover the CPAP machine and its most basic accessories.
What CPAP Equipment Does Insurance Cover?
CPAP Machines
A CPAP machine delivers continuous positive air pressure through a mask. This helps to keep the airway from collapsing during sleep so that those with sleep apnea don’t experience gaps in breathing at night.
Insurance typically covers CPAP machines. In some cases, the CPAP machine (and its basic components) are rented for a certain amount of months, during which you’ll have to provide proof that you’re consistently using it, and after this rental period, you own the machine.1
Explore our picks for the Best CPAP Machines
CPAP Machine Parts
The following CPAP parts should be at least partially covered through insurance, though this depends on your plan and whether you consistently use your CPAP device.1
- Mask and Headgear – The CPAP mask fits over your nose or nose and mouth, and the headgear is what keeps the mask in place.
- Mask Cushion – The mask cushion attaches to the mask, and allows it to sit comfortably and snugly against your face.
- Tubing – The tubing is what connects the mask to the CPAP machine.
- Filter – CPAPs include filters to keep unwanted particles from entering the air that flows through the mask.
- Humidifier – Humidifiers are now a normal part of most CPAP machines to keep the airway from drying up and increase the user’s comfort.
CPAP Accessories
The following are optional accessories, so they are less likely to be covered through insurance, but again, this will depend on your carrier and plan.
- CPAP Pillow – A CPAP pillow is a type of pillow that is designed to better accommodate your CPAP mask so that you can comfortably lie either on your back or side.
- CPAP Cleaner – CPAP cleaning wipes or detergents are used to keep your machine clean.
- Hose Holder – A hose holder is a device that often looks like a stand or a hook and is used to hold your CPAP hose in a certain position. This can make sleeping more comfortable and unencumbered.
- CPAP Batteries – CPAP batteries allow you to use your CPAP without a wall outlet. This can be convenient for those who are traveling or in case of an emergency power outage.
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Does Medicare Cover CPAP Machines?
Yes, Medicare should cover at least some of the costs of your CPAP machine and its most basic components like the mask, headgear, cushion, tubing, filter, and humidifier. That said, the amount you’ll pay out of pocket2 depends on the type of Medicare coverage you have and whether or not you’ve met your deductible.
The specific type of Medicare that covers CPAP therapy is called “Original Medicare Part B.” They’ll only cover this therapy after you’ve completed a diagnostic sleep study and if your prescribing doctor and the CPAP equipment supplier are enrolled in Medicare.2
Once you’ve confirmed that your doctor and supplier are enrolled in Medicare and you have paid your deductible, you’ll get a three-month trial of CPAP therapy, including the machine and its key components. After this, Medicare will pay 80 percent of the Medicare-approved amount to rent the machine for 13 months, and you’ll pay the remaining 20 percent.2
It’s important to note, though, that to continue receiving Medicare’s assistance, you’ll have to use the machine consistently throughout these 13 months. If you stop using it regularly, Medicare can stop paying for the rental and you’ll have to return it and pay the balance in full. After these 13 months, you’ll own the machine.2
For those with Medicare Advantage, coverage of CPAP equipment varies depending on your specific plan.2
Reach out to your plan to find out more before ordering CPAP supplies.
Does Medicaid Cover CPAP Machines?
Unlike Medicare, which is federal health insurance for people over 65 and some people under 65 with certain conditions or disabilities, Medicaid is a joint federal-state program3 that provides healthcare for people with limited income.
Whether or not Medicaid covers CPAP therapy and how much it will cover will depend on what state you’re in. You should contact your state’s benefits provider to find out what they cover and learn how to get authorized for CPAP therapy.
Replacing CPAP Equipment
Since CPAP therapy can be vital for the health of those who need it, you should make sure each component is working perfectly. Over time, equipment will deteriorate and naturally stop working, so you’ll need to replace those items.
Insurance should cover these replacement parts, but this is usually on a certain schedule. Many insurance companies base this schedule on Medicare’s guidelines4 for replacing CPAP equipment, which we’ve included below.
| CPAP Item | Frequency |
|---|---|
| CPAP Tubing With Heating Element | 1 per 3 months |
| Combination Oral/Nasal CPAP Mask | 1 per 3 months |
| Replacement Oral Cushion for Oral/Nasal Mask | 2 per 1 month |
| Replacement Nasal Pillows for Oral/Nasal Mask | 2 per 1 month |
| Full Face Mask | 1 per 3 months |
| Full Face Mask Interface | 1 per 1 month |
| Cushion for Nasal Mask Interface | 2 per 1 month |
| Nasal Pillows | 2 per 1 month |
| Nasal Interface | 1 per 3 months |
| Headgear | 1 per 6 months |
| CPAP Chinstrap | 1 per 6 months |
| Tubing | 1 per 3 months |
| Disposable Filter | 2 per 1 month |
| Non-Disposable Filter | 1 per 6 months |
| Humidifier Water Chamber | 1 per 6 months |
While many insurance companies base their replacement schedule on the table above, it’s important to note that each provider has their own replacement guidelines, and some providers may allow for fewer replacements. Therefore, be sure to ask your carrier how often they cover the cost of CPAP replacement parts.
Requirements for CPAP Insurance Coverage
Before you receive insurance coverage for CPAP therapy, you must first receive a formal sleep apnea diagnosis and prescription for CPAP from a doctor.
You’ll start this process by visiting your doctor to discuss your symptoms. If your doctor believes you may have sleep apnea, they will likely recommend you do an overnight sleep study. After your sleep study, your doctor will review the information to determine whether or not you have sleep apnea and should receive CPAP therapy.
More Info: How to Prepare for a Sleep Study
Depending on the insurance company, they may ask you to receive training on how to properly use CPAP equipment from either your doctor or the CPAP suppliers. That said, if you’re new to CPAP therapy, you’ll likely need this training anyway to understand how to use the device. To maintain coverage, some insurance providers may require proof of compliance, which means evidence that you’re consistently using your CPAPs.
Remember, these are general requirements for CPAP coverage. Your particular insurer might have some different rules, so be sure to ask them what their specific requirements are so you won’t lose coverage.
Can You Buy CPAP Equipment Without Insurance?
You can purchase CPAP equipment without insurance, but you’ll still need a prescription from your doctor to do so. Sometimes, it can. actually be more economical to buy CPAP equipment without insurance, depending on how high your plan’s deductible is.
While you wouldn’t have to worry about providing data about your CPAP use to an insurer, it’s still important to regularly use your CPAP to ensure you receive the health benefits of it. Also, purchasing your CPAP out of pocket means you have more CPAP suppliers and products to choose from since you don’t have to go with whatever brand is covered by an insurance company. If you’re unsure about a particular CPAP device, though, we recommend running it by your doctor first to make sure it’s a good fit.
Frequently Asked Questions
How often does insurance pay for a CPAP machine?
Insurance typically covers CPAP machines that are replaced once every five years.5 Other components, like masks, tubing, filters, etc. are replaced more often – anywhere from twice a month to once every six months.4
Is a CPAP machine considered medically necessary?
Yes, for those living with sleep apnea, a CPAP machine is considered medically necessary. Sleeping without a CPAP can lead to several health complications including an increased risk of complications6 like vehicular accidents, high blood pressure, heart disease, diabetes, liver problems, and more.
How do you qualify for a CPAP machine?
To get a CPAP machine, your doctor will have to diagnose you with sleep apnea and write you a prescription. This means they will discuss your symptoms with you, and then refer you to an overnight sleep study. Once they’ve received the results from the study, your doctor may or may not diagnose you with sleep apnea.
If you are diagnosed with sleep apnea, your doctor can then write you a prescription for a CPAP machine, which you can either buy or rent yourself or go through insurance.
Natalie Grigson
Writer
About Author
Natalie is a content writer for Sleep Advisor with a deep passion for all things health and a fascination with the mysterious activity that is sleep. Outside of writing about sleep, she is a bestselling author, improviser, and creative writing teacher based out of Austin.
Combination Sleeper
- 1. “Positive Airway Pressure and Your Insurance: What You Should Know”. American Academy of Sleep Medicine. Webpage accessed December 28, 2024. –
- 2. Riva, Miranda M. “A Guide to Medicare Coverage of CPAP Machines and Supplies in 2024”. National Council on Aging. 2024. –
- 3. “Category: Medicare and Medicaid”. U.S. Department of Health and Human Services. Webpage accessed November 8, 2024. –
- 4. “REPLACEMENT SCHEDULES FOR MEDICARE CONTINUOUS POSITIVE AIRWAY PRESSURE SUPPLIES”. Department of Health and Human Services. 2013. –
- 5. “Time for a new CPAP machine?”. ResMed. Webpage accessed December 28, 2024. –
- 6. “Sleep Apnea”. Mayo Clinic. Last modified April 6, 2024. –