How to Get a CPAP Machine With Insurance

To get a CPAP machine covered, look closely at your plan’s requirements, including whether you need a sleep study, a prescription, and prior authorization. Knowing the steps ahead of time can help you avoid delays and out-of-pocket surprises.

1. Get Your Diagnosis and Prescription

If you’re wondering, “Do you need a prescription for a CPAP machine?” The answer is yes. To qualify for CPAP coverage under either private insurance or Medicare, you’ll need a sleep apnea diagnosis and a prescription. Medicare requires an apnea-hypopnea index (AHI) of 15 or more events an hour, or an AHI between 4 and 14 with a sleep apnea-related comorbidity (ex. hypertension, obesity, diabetes). 

Private insurance requirements differ between companies, but you’ll generally need to complete an in-person or at-home sleep study. Check with your insurer for exact requirements.

2. Find an In-Network DME Supplier

Since CPAP machines and accessories are considered durable medical equipment, Medicare and private insurance only cover CPAP machines and accessories if they come from a DME supplier.  

You can find out exactly what equipment your provider covers by looking at medical billing codes. Use a reputable DME supplier and look at the codes that correspond with the products you want, then check your plan details to see if that medical code is included. 

The supplier or your doctor will then send your sleep study results, prescription, and prior authorization (if needed) to your insurance provider.

3. Purchase or Rent Your Machine

Some insurers require a rental period before approving full ownership of the CPAP machine. For example, Medicare covers a 13-month CPAP rental. You’ll own the device yourself after 13 months of correct use. Some private insurers use a similar rent-to-own model, while others buy the machine outright with either co-pays or reimbursement methods. 

Keep in mind that there are some advantages to buying a machine out of pocket rather than going through insurance. Buying a device yourself is more expensive up front, but it allows you to buy the exact device you want, avoid follow-up requirements, and keep your data private.

4. Stay Compliant

Most insurers, including Medicare, require you to prove that you’re using the device correctly and for a minimum number of hours (usually four or more hours per night on 70% of nights). This is referred to as compliance. Your device records usage data and either stores it on an SD card or transmits it directly to your provider.