In order to offer you the very best value, we do not deal with health insurance companies directly. This allows us to save a great deal on overhead and administrative expenses and pass along the savings to you.

While many insurance companies will provide reimbursement for devices, we do not directly accept any insurance outside of health savings accounts (HSAs) and flexible spending accounts (FSAs). We are happy to provide you with an invoice for purchased medical products and services that you may submit to your insurer for reimbursement. We suggest confirming with your insurance plan regarding what benefits are included for DME (durable medical equipment).

Most insurance plans offer partial coverage for PAP machines once you meet your deductible. Medicare participants are responsible for paying their deductible, plus 20% of the machine rental. If you have a high deductible under your health insurance policy, you may inadvertently end up covering the full cost of your PAP machine.

Typically, your deductible applies to essential PAP equipment, not including optional accessories. Most providers have replacement schedules for components such as tubes, masks, and filters that indicate how often replacements are covered. If you require more frequent replacements of certain components, those costs may be out of pocket.

Most insurance plans cover a portion of the cost of your sleep studies, including studies conducted in a sleep lab or at home. Typically, you need a referral for a sleep study in order to receive coverage. Your doctor must determine which type of study is right for you. Insurance providers almost always request that you present an obstructive sleep apnea diagnosis before starting coverage for a PAP machine and related equipment.

Medicare considers CPAP devices to be durable medical equipment and provides 80% coverage under Part B as long as you meet certain conditions. First, your doctor must diagnose you with obstructive sleep apnea following an approved laboratory sleep study or an at-home sleep study, and give you a prescription for a CPAP machine.

Then, Medicare covers a 12-week initial period of CPAP therapy for obstructive sleep apnea, as long as you meet the following requirements:

• You have an hourly AHI between 5 and 14 and a comorbid condition related to obstructive sleep apnea, including hypertension, history of stroke, heart disease, excessive daytime sleepiness, insomnia, mood disorders, and impaired cognition; or
• You have an hourly AHI of 15 or higher.

You must also meet Medicare’s compliance requirements, which state that you must use the machine at least 4 hours per night, 70% of the time or more, during the first 3 months. If you fail to meet these requirements, you have to begin the process again. This involves completing another sleep study, either in a lab or at home, and obtaining another prescription from your doctor.

If the CPAP therapy helps improve your sleep apnea symptoms during the 12-week period, Medicare continues to cover the cost of your CPAP equipment. With Original Medicare coverage, you pay 20% of the machine rental plus the cost of supplies such as the CPAP mask and tubing. Once you meet your Medicare Plan B deductible, Medicare pays for the rental of the machine for 13 months if you use it continually. Once the 13 months have passed, you own the machine.

Generally speaking, it can take a few weeks to several months to receive a PAP device by going through your insurance provider. The time it takes can vary depending on a number of factors related to the process and your provider’s policies. We recommend checking with your provider for more information to get a better idea of how long the process would take.

You may also want to verify that the device you’ll be receiving through your DME provider is a new device, rather than a used one.