INSURANCE GUIDE
Our comprehensive Insurance Guide is here to help you understand coverage options, ensuring you get the treatment you need with the support of your insurance plan.
FIND TREATMENT
Does Insurance Cover a CPAP Machine?
To get insurance coverage for your CPAP therapy, you first need a confirmed sleep apnea diagnosis. This can be done through a sleep study at a clinic or an at-home test. Once diagnosed, most insurance plans, including Medicare, cover CPAP machines, masks, and related treatments. However, meeting specific requirements is essential to qualify for coverage. Below, we outline the process for both diagnosis options and how to navigate the insurance steps with ease. At iSleep, we’re here to help make the process seamless and ensure you get the treatment you need.
Insurance PRocess
SLEEP STUDIES
1
Doctor Referral
Speak with your doctor about your symptoms and request a sleep study. Your doctor will provide you with a referral to a sleep center.
2
Sleep Study Center
Go to the sleep center overnight and catch some zzz’s.
3
Diagnosis
Once your sleep test is complete and your doctor diagnoses you with sleep apnea, you will receive a prescription and referral for a CPAP Machine.
4
iSLEEP
Ask your doctor to send your prescription and referral to iSLEEP. We will determine if prior authorization is needed for your insurance and walk you through the process.
5
Insurance Authorization
Once your insurance company authorizes your therapy treatment, you will receive an appointment from iSLEEP to get fitted for your new CPAP machine.
Insurance Process
At-Home Sleep Test
1
Purchase Test
Take our symptom quiz to see if you are at risk. If your number is high, purchase a WatchPAT® One.
WatchPAT® One
2
Sleep at Home
Go to sleep in your own bed and catch some zzz’s.
3
Diagnosis
Once your at-home sleep test is complete, you’ll throw away the device, receive a diagnosis and prescription for a CPAP Machine by a iSLEEP doctor.
4
iSLEEP
iSLEEP automatically receives your prescription. We will determine if prior authorization is needed for your insurance and walk you through the process.
5
Insurance Authorization
Once your insurance company authorizes your therapy treatement, you will receive an appointment from iSLEEP to get fitted for your new CPA machine.
Paying with Insurance
When purchasing a CPAP machine, mask, and supplies on the iSLEEP website, you'll typically buy the items upfront and then submit the receipt to your insurance company for reimbursement. It’s important to confirm the specific process with your insurance provider for submitting these expenses, as insurance requirements can vary. Alternatively, if iSLEEP is in-network with your insurance company, we can handle the billing directly with the insurance on your behalf.
Does Insurance Cover CPAP Machines?
CHECK YOUR PLAN
Insurance coverage for sleep apnea treatments, including CPAP machines and masks, varies depending on your insurance plan.
PRIVATE INSURANCE
Private insurance often covers a portion of the costs for CPAP machines, masks, and supplies, though you might need to meet deductibles or provide documentation of medical necessity.
MEDICARE
Medicare typically covers a three-month trial for CPAP therapy to ensure compliance, with continued coverage contingent on meeting usage requirements. It's important to note that not all accessories or replacement supplies may be fully covered.
IN-NETWORK
At iSleep, we’re in-network with some of the nation’s largest insurance providers like Medicare, Aetna®, Cigna®, Prominence®, Senior Care Plus℠, and more.
Private Insurance Requirements
When it comes to private insurance coverage for CPAP machines, requirements can vary widely depending on the provider and policy. To ensure you’re fully informed, here are some of the common requirements:
PRESCRIPTION
Most providers require a prescription from a healthcare professional confirming your need for CPAP therapy.
SLEEP STUDY RESULTS
You’ll often need to undergo a sleep study (either in a lab or at home) to diagnose obstructive sleep apnea and document its severity.
USAGE COMPLIANCE
Many insurance companies mandate a compliance period, requiring proof that you’re using your CPAP machine for at least 4 hours per night on 70% of nights within a 30-day period.
ANNUAL DEDUCTIBLES
Some policies require you to meet your annual deductible before coverage kicks in for CPAP equipment or supplies.
COVERAGE LIMITS
Insurance might only partially cover CPAP machines, masks, and accessories, with certain replacement items restricted to a set frequency.
RENT-TO-OWN AGREEMENTS
In some cases, insurers may offer CPAP machines on a rent-to-own basis, requiring you to use the machine for a set time before it becomes yours.
Medicare Requirements
Medicare may cover CPAP therapy if you meet specific requirements. iSLEEP is a provider approved by Medicare®:
DIAGNOSIS
A confirmed diagnosis of obstructive sleep apnea (OSA) through a sleep study.
TRIAL PERIOD
Medicare covers a 3-month trial to assess the effectiveness of CPAP therapy.
DOCTOR AND SUPPLIER ENROLLMENT
Your doctor and the CPAP supplier must be enrolled in medicare.
COMPLIANCE
You must use the CPAP machine for at least 4 hours a day on 70% of days for continued coverage.
COST
After meeting the part b deductible, you pay 20% of the medicare-approved amount for the machine and accessories.
RENTAL AND OWNERSHIP
Medicare rents the machine for 13 months, after which you own it.
How Much Are CPAP Machines With Insurance?
The cost of CPAP machines and related supplies can vary widely depending on your insurance plan, the specific equipment, and the supplier you use. On average, the cost of a CPAP machine with insurance coverage can range from $500 to $1,000, though the price billed to your insurance provider may be higher.
Many insurance companies, including Medicare, cover the machine itself as well as essential accessories.
Insurance typically only covers the cost of these supplies if they are deemed medically necessary and used in accordance with the prescribed therapy. You may still be responsible for out-of-pocket expenses, including deductibles and coinsurance, which can vary by plan. Some insurers may also only cover the initial rental period for the CPAP machine, after which ownership may transfer to you.
Optional accessories like CPAP cleaning wipes or travel bags are generally not covered by insurance.
POPULAR PRODUCTS
FAQ
Medicare covers CPAP machines and necessary supplies for individuals diagnosed with obstructive sleep apnea (OSA). To qualify, you must have a prescription from a doctor after undergoing a sleep study, and show that you are using the device regularly. Medicare typically covers the rental of a CPAP machine for the first 13 months, after which you own it, as long as you demonstrate consistent use.
Medicare covers CPAP machines and necessary supplies for individuals diagnosed with obstructive sleep apnea (OSA). To qualify, you must have a prescription from a doctor after undergoing a sleep study, and show that you are using the device regularly. Medicare typically covers the rental of a CPAP machine for the first 13 months, after which you own it, as long as you demonstrate consistent use.
Insurance companies typically require that you use your CPAP machine for at least 4 hours a night for a minimum of 70% of nights during the first 30 days of use. This is often monitored through data collected by the CPAP machine itself. Failure to meet these usage requirements may result in loss of coverage for the device and its accessories.
The cost of a CPAP machine with insurance can vary depending on the plan, deductible, and coinsurance. On average, the device itself may cost between $500 and $1,000. However, your out-of-pocket costs will depend on your insurance coverage, deductible, and whether your plan covers the full cost or requires you to pay a portion of it. Be sure to consult your insurance provider to understand the specifics of your coverage.
