Does Insurance Cover CPAP Machines?

Most private and government insurance plans provide at least partial coverage for CPAP machines and accessories, as long as the user has a sleep apnea diagnosis and prescription. But it’s important to check your policy to see what’s covered and what’s not.

Here’s how CPAP insurance coverage works—what’s typically covered, what requirements to expect, and how to avoid surprise costs. 

Private Insurance

Private insurance plans are provided by an employer or bought on the marketplace, and their coverage varies, as do out-of-pocket costs for CPAP users. Typically, the insurance company will cover at least part of a CPAP machine and accessories, though it may not be until you meet your deductible. Certain plans pay for the machine up front while others reimburse you after you make the initial purchase.

Because private insurance coverage varies so much, you’ll need to work directly with your insurance company to make sure you choose an approved machine, otherwise the one you choose may not be covered.

Medicare

Medicare is a government insurance plan for people 65 and up as well as those with qualifying illnesses. Medicare covers 80% of a CPAP machine after you meet your Part B deductible. You’re then responsible for the remaining 20%.

During the first 12 weeks, you must use the machine for four or more hours a night, at least 70% of the time to continue to qualify for coverage. If the initial 12 weeks of therapy improve your symptoms, Medicare will continue to cover your machine for a total of 13 months. After 13 months of proper use, you’ll own the machine outright.

What’s Covered

Medicare Part B covers 80% of the cost of durable medical equipment (DME), which includes CPAP machines, as well as related accessories like masks, tubing, and headgear and their regular replacement. Machines qualify for replacement after 5 years, while masks and tubing can be replaced every 3 months. Medicare does not cover accessories like CPAP pillows or cleaning tools.  

Private insurance companies generally cover CPAP machines, accessories, and replacements as well, but you’ll need to check with your provider for details about your individual plan.