Got $800 to spare? If you’re in the market for CPAP machine therapy supplies, the machine by itself may cost you that much—not to mention the rest of the accessories you need to get the best treatment possible. So, naturally, you may be wondering if your insurance provider covers the price you have to pay to get restful sleep. Fortunately, we here at Apria have some answers to those questions.
Note: We’re speaking generally when we talk about “insurance providers,” so you’ll need to contact your provider for specifics on your plans before you make any decisions with your doctor regarding your therapy.
We’ll talk about how insurance can cover your CPAP machine and the accessories you’ll need.
1. The Machine Is Likely Covered
Right away, you should know most insurance providers cover CPAP therapy. Each provider is different, but most classify a CPAP machine as “durable medical equipment,” or DME, which falls under most coverage categories. But what are the steps to getting that coverage?
Basically, you should treat CPAP therapy like prescription medication. You’ll need to prove you have sleep apnea via an accredited sleep study, and then you’ll need authorization from your insurance provider to give to your device supplier. If and when you need to replace your machine, know that most providers will cover total device replacement every three to five years. Some companies will require re-authorization before covering replacement, which means another sleep study to verify you still have sleep apnea.
2. The Accessories Likely Are, Too
This one’s simple. Most CPAP therapy plans come with accessories—mask, tubes, filters, and cushions—included, and most insurance providers cover machines and accessories together. And even better, most providers cover accessory replacements after set periods of time, just like ongoing prescription refills. You could probably even set these up to renew automatically. This is especially useful if your therapy goes on longer than a few months, which is normal.
Rental vs. Purchase
Different patients require different treatments, and not all sleep apnea is severe enough to warrant an outright purchase of a CPAP machine. You may want to consider renting a CPAP machine instead of buying one. Naturally, your insurance provider has the final say, but most companies offer plans in this case as well.
You’ll typically face the bulk of your expenses at the front of your rental term since you’ll be paying for both the machine and the accessories that come with it. Keep in mind, your total cost is generally the purchase price of the device divided by how long (usually in months) your rental term will be.
Cover Yourself
Again, we speak in general terms when we talk about insurance companies, but since sleep apnea and CPAP therapy is so common, most will cover at least part of your costs.
Speak with your insurance provider for the details to ensure you don’t have to shell out $800 right off the bat just to get a good night’s rest.
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