CPAP Central || Is CPAP therapy covered by insurance?

Three kinds of CPAP masks:
L to R–Nasal mask, nasal pillow, oronasal mask

Once a person is diagnosed with obstructive sleep apnea, of their main concerns might be affording the equipment and getting insurance reimbursement. Machines can cost in the hundreds of dollars, and they require additional supplies, like masks and tubing. The good news is that most insurance policies cover PAP therapies (including CPAP, BiPAP and other pressure support systems designed to treat sleep-disordered breathing). How much one insurer will pay depends upon whether you have one insurance plan or a secondary plan.

PAP machines fall into the category of Durable Medical Equipment (DME); to find out what your insurance company will reimburse for, you can call them and ask about deductibles and copayments for DME, which are typically paid for separately from doctor’s visits or lab or home sleep studies. Keep in mind that Medicaid will require authorization in order to reimburse for PAP equipment. Most other supplies (masks, tubing, etc.) are covered separately, with reimbursement amounts varying state by state.

Be aware that insurers differ on how many masks and other supplies they will reimburse over the course of a year, and that you may need to replace a mask before your insurance company is willing to reimburse you for it. It is often recommended that masks be replaced every six months, but not every insurance company will reimburse that frequently. You will need to check with your insurer to know for sure what your coverage allows.

About Tamara Kaye Sellman (621 Articles)

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