Best CPAP Suppliers in
Ohio

Yes, insurance, including many employer and marketplace plans, Medicare, and Medicaid, often covers CPAP machines, as long as you’ve been diagnosed with sleep apnea and have a current prescription for CPAP from your doctor.

CPAP machines are considered durable medical equipment (DME), which means insurers usually have a few rules to follow like starting with a rental period and checking that the device is being used regularly (also known as compliance). 

However, you may still have out-of-pocket costs, such as deductibles or copays, and replacement supplies like masks and filters are typically covered on a set schedule. While CPAP coverage details vary by plan, there’s a good chance your insurance will cover some of the expense. Always make sure to double-check with your provider to confirm your specific plan’s coverage details.

Yes, Blue Cross Blue Shield (BCBS) plans typically cover CPAP machines and related supplies. Most BCBS members can get coverage for a CPAP machine, masks, tubing, filters, and other essential parts, but first, you have to be diagnosed with sleep apnea and get a CPAP prescription from your provider. 

Like other insurers, BCBS requires documentation like rental paperwork and compliance data. If you want specific coverage details and information about out-of-pocket costs, call the customer service number on your insurance card. Requirements can vary by state and plan, so it’s best to find out what your BCBS policy will pay for.

Yes, Medicare (Part B) often helps pay for CPAP machines and related supplies to treat sleep apnea if you’ve been diagnosed and have a prescription for CPAP therapy. First, your provider and the CPAP supplier must accept Medicare. 

Next, Medicare usually starts with a CPAP trial period of about 12 weeks to see whether you’re using the machine as prescribed. If your provider documents that therapy is helping, Medicare will continue to cover the device as a rental for up to 13 months. Then, you’ll own the machine.

With Medicare, you’ll pay your Part B deductible first, then Medicare generally pays about 80% of the approved amount for the CPAP machine and covered supplies. You’ll be responsible for the remaining 20%. Coverage can continue for replacement supplies like masks, filters, and tubing on a regular schedule, as long as you still need and use the CPAP. 

Details can vary slightly depending on whether you have Medicare Part B or a Medicare Advantage plan, so check your specific benefits or talk to your supplier if you’re unsure.

Yes, Medicaid often covers CPAP machines and related supplies when they’re medically necessary to treat sleep apnea. However, you’ll need a sleep apnea diagnosis and a CPAP prescription from your doctor. 

Like other insurance programs, Medicaid treats CPAP machines as durable medical equipment (DME), which means there may be requirements, such as prior authorization, a rental period, or proof that the machine is being used regularly.

Because each state runs its own Medicaid program, coverage details, replacement schedules for supplies, and out-of-pocket costs can vary. To understand exactly what’s covered for you, contact your state Medicaid office or your CPAP supplier.

There isn’t one fixed price for CPAP with insurance, because coverage and costs depend on your plan. But here’s a simple way to think about it: CPAP machines usually range from about $500 to $1,000 or more before insurance. Some basic models are at the lower end of that range, while machines with extra features can cost more. BiPAP or auto-adjusting models tend to be more expensive.

If you have insurance that covers CPAP as durable medical equipment, your plan may pay a large portion of the machine’s cost once you meet any deductible and coverage requirements. With programs like Medicare, for example, after the Part B deductible, you’re generally responsible for about 20% of the approved amount for the machine and supplies, and Medicare pays the rest.

The cost of CPAP machines with insurance usually breaks down like this:

• You may pay the full cost up to your deductible before insurance starts to help.
• Once insurance kicks in, you’ll usually pay your share such as coinsurance or copays.
• Supplies like masks, tubing, and filters are usually covered separately on a replacement schedule.

Because plans vary, the best way to know your exact cost is to check your benefits or call your plan’s customer service.

The cost of a CPAP machine without insurance varies, depending on the model and features you choose. Most basic CPAP machines fall roughly in the $500 to $1,200 range. Some very simple or travel machines can cost less, while bilevel (BiPAP) and auto-adjusting (APAP) devices usually cost more, often $1,700 or higher. 

When weighing CPAP cost, remember that you also need to purchase supplies, such as masks, tubing, and filters. These are essential for CPAP therapy and need to be replaced as you use your machine. 

Most insurance plans will pay for a new CPAP machine about every 5 years, as long as you still need CPAP therapy and have a current prescription. This 5-year timeline is based on Medicare guidelines, which many private insurers also follow. Coverage rules can vary by plan, so check your benefits or ask your CPAP supplier before replacing your device.

Most insurance plans pay for CPAP supplies on a regular replacement schedule rather than all at once. Exact timing can vary by plan, but many insurers follow Medicare guidelines. Under this schedule, you can replace your mask frame, headgear, and chin strap every 6 months; full-face mask cushions every month; and nasal cushions or pillows twice a month. To know exactly what your plan covers and when, check your benefits or ask your CPAP supplier.

Most insurance plans don’t cover travel CPAP machines. While your insurance will probably help pay for a standard CPAP machine when it’s medically necessary, travel CPAP devices are often classified as convenience items rather than essential equipment. Because of this, many insurers, including Medicare and Medicaid, expect you to use your primary CPAP machine when traveling. 

In rare cases, partial coverage or reimbursement may be possible with prior authorization and documentation of medical necessity, but this varies by plan. Contact your insurer and find out if these units are covered or if an exception is possible. The insurer may ask for documentation from your provider explaining a medical necessity for a second or travel CPAP, especially if having a portable CPAP is essential for frequent travel or work.

You can always pay for a travel CPAP out-of-pocket by using an FSA or HSA, even if your insurance will not reimburse you for the purchase.