CPAP Machine Prices and Insurance Coverage

CPAP Machine Prices and Insurance Coverage

Getting diagnosed with sleep apnea can be difficult to accept, it usually means using some breathing apparatus for the rest of yours. The last thing you should be worrying about is how you’re going to pay for said equipment, let alone learning how to use it and clean and sterilize it. Insurance companies usually consider CPAP cleaner and sanitizer machines unnecessary. Unfortunately, that is something that can be a barrier to some sleep apnea patients. From healthcare to no insurance we’ll look over the cost of CPAP machines and equipment when dealing with insurance. The primary insurance companies include Blue Cross Blue Shield, Medicare, Medicaid, Humana, and Aetna; they all have their plans and types of coverage. If you’re interested in what the cost may be, contact your insurance company about their durable medical equipment and what may or may not be covered before shopping around.

Prescriptions and Payments

Insurance companies consider CPAP machines to be durable medical equipment. As such, there is a process to obtaining a CPAP machine for permanent use.

One of the most critical parts of the process is documentation and testing. Mostly a sleep study to study studies the levels of apnea-hypopnea index (AHI) or respiratory disturbance index (RDI). These indicate how many times an hour an event (usually decreased or cessation in breathing) happens. Depending on the number and the severity they will possibly prescribe you a CPAP machine. A CPAP machine is considered durable medical equipment, so most insurance companies like Blue Cross Blue Shield, Medicare, Medicaid, Aetna, and Humana. You need a prescription as it will have the doctors recommended pressure settings for the machine for the technician to program into the device. To get a CPAP machine, you need a doctor’s prescription, which a doctor gives you only after a sleep study confirms the need for it. Then you will have an initial set up on the device and a demonstration on how to use and CPAP cleaning it before being sent home. Depending on your insurance company you may have a deductible, co-pay, or may have to pay out of pocket and then be reimbursed for the equipment after the fact. Most CPAP machines range from $500 – $3000 with the average price of $850 if you have to pay for some or all of it out of pocket that can be difficult if you do not have some savings set aside.

CPAP Assistance Foundations

CPAP Assistance FoundationsThere is hope though; there are foundations that help with equipment, companies selling the CPAP machines will usually give you a discount for no insurance/pay with cash. One of the foundations: CPAP Assistance Program (CAP), they give out ‘free’ kits if you’re application is accepted.

You need to turn in a valid application and prescription to apply for a kit. It is considered free, but they ask for $100 donation to help with the cost of the equipment, which is usually a high discount from what they would pay. Another foundation is the Reggie White Foundation, they require an application available here, $25 fee, and proof of economic hardship. Then if accepted it’s a $10 supply fee and evidence of financial hardship. There are possibly other more local companies, trying Salvation Army or Goodwill sometimes turns up durable medical equipment, but most doctors will advise against it. Without being sure how well it works or how long the machine was in use before, it is hard to determine how useful it is or if it may not be as clean as thought.

Rent to Buy CPAP Machines

There is also the rent-to-buy option that a lot of durable medical equipment companies offer. The amount paid is usually the co-pay or deductible that you are paying, and then once you pay off your portion, your insurance company will often come in and finish paying off the rest. So for the time you are making payments to the company you are renting, once you pay off your portion you now own the machine. Depending on the device, the durability, and how much usage it has had, you can get multiple CPAP machines in your lifetime. A device does not last a lifetime; in fact, most don’t even last more than 7 – 10 years without needing replacement. A new CPAP device will usually require a new script along with your original diagnosis.

Compliance

Some insurance companies will also ask you to be compliant with treatment.

Some insurance companies will also ask you to be compliant with treatment. Compliance in this instance means that you use the machine on a 70% of nights throughout the month. Sometimes before the insurance will cover the remaining amount they will have you come in for one more evaluation. A lot of the newer machines have monitoring programmed in and even have a cloud type storage the doctor can check on if the patient is complying with their recommendations.

Needing a CPAP machine can be daunting, and then needing to shop around for the best price if you find out your insurance company might not be paying for as much as you’d hoped or they don’t offer the machinery you need. Some insurance companies limit the brand or type of machine even if you need a different one. This limitation can lead to people trying to cash discounts or buying used or refurbished devices, sometimes it works out, but sometimes it doesn’t, and they end up needing a new one anyway, or it’s not as effective as required.

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