Are CPAP Machines Covered By Insurance?
If you have been recently diagnosed with sleep apnea, a continuous positive airway pressure or CPAP machine may be an important way to help you breathe freely, sleep better and get on the road to wellness. This is good news for those with sleep disorders, because research is increasingly showing that a good night's rest is just as important to health as good nutrition and regular exercise.
CPAP machines have improved the lives of many users by opening their airways and helping them to sleep better. These miraculous machines can be expensive, however. They typically cost hundreds of dollars. You may be wondering if you can afford one, even if it is the only viable alternative for you to sleep better. Paying for one of these machines can put a dent in the budget of most people and can be beyond the reach of some.
There is good news for those who suffer from sleeplessness. Generally, if you have just been diagnosed by your doctor with sleep apnea and your doctor has prescribed treatment with a CPAP machine, you can be reimbursed for your costs of using one of these machines. As with all health insurance policies, however, these benefits are subject to deductibles and copayment. These payments may differ from those you make for office visits and prescriptions. A CPAP machine comes under the category of durable medical equipment and will be handled by an insurer according to its rules for such equipment.
Check with your insurer first
Before you buy a CPAP machine, you should check to see if your private health insurer will cover the cost. Find out about your insurance company's requirements. For instance, a doctor's prescription will be needed.
Also, ask your insurer about its policy regarding deductibles and copayment and how they will apply to your purchase of a CPAP machine. You should also ask about replacement and maintenance parts for your machine and whether they are covered. For instance, CPAP machines need routine changes of their tubing, filters and water chambers to ensure maximum efficiency for the machine and effectiveness and good health for the user.
Medicare and Medicaid
If you are covered by government health insurance such as Medicare or Medicaid, there is also good news.
CPAP machines and equipment are generally covered by Medicaid, but you should make sure to get authorization first. Supplies are covered but come under a different category than purchase or rental of a machine, so you should also check the rules covering supplies and parts. Every state has different rules and regulations for Medicaid coverage of CPAP machines and supplies. Check with your appropriate state agency for specifics.
Medicare also usually covers the purchase of CPAP machines. If you are diagnosed with sleep apnea, you will be permitted a three-month trial of CPAP therapy. After that, if your doctor documents that CPAP is helping you, you will probably qualify for longer-term coverage of your CPAP costs. Typically this involves renting a CPAP machine for 13 months. At the end of that period, you will own it.
Bear in mind that government health insurance typically requires copayment. If you are covered by a Medicare Part B plan, for instance, your copayment will be 20 percent. You can purchase so-called Medigap insurance, or supplemental Medicare insurance, to help decrease or eliminate these copayment.
Also remember that in certain areas CPAP equipment will come under competitive bidding rules. That means the government will pay for machines and equipment only from approved suppliers.
If you have any questions about CPAP machines and insurance coverage, talk to your insurer. You are also welcome to call us toll-free at RespShop. In addition, you may email us, communicate with us via instant chat or fill in our quick online question form for answers to your questions.