Last updated: January 27, 2017
So, you have done your sleep study at a clinic and have been diagnosed with sleep apnea. Your next logical thought will likely be, “How much does a CPAP machine cost?” The answer, unfortunately, is not definitive; it just depends. Fortunately, you have many options when it comes to buying a CPAP machine and related equipment.
What I hope to do here is give you as many details about the typical CPAP buying process. With this information, you will be able to ask the right questions of your doctor and insurance company to understand the costs associated with using a CPAP machine.
More...
NOTE: All information provided in this article should only be taken as a reference, and not as fact. The information provided below is based off of my personal experience and additional research. You will need to contact your insurance company to understand what your CPAP machine cost will be.
Will my insurance company pay for my CPAP machine?
To determine if your insurance company will pay for all or part of your CPAP machine, the following conditions typically need to be met:
- A sleep study has been performed, and the sleep center recommends that a CPAP machine is medically necessary.
- Your doctor has provided a prescription for the use of a CPAP machine.
For a more in-depth view of the coverage requirements, see United Healthcare's CPAP requirements. If the conditions of your insurance have been met, they will most likely pay a partial amount as a minimum. Some plans will pay 90% or 100% of the cost after a certain out-of-pocket maxium has been met.
Read more about Blue Cross Blue Shield CPAP coverage.
Durable Medical Equipment Coverage
What is durable medical equipment? It is any type of medical equipment that isn't disposable and can handle repeated use. Your CPAP machine and other related equipment (such as masks, hoses, etc.) count as DME as well.
Before you make any decision regarding which CPAP machine you should buy, you need to call your insurance provider and ask them specifically what is covered under your plan. This will avoid any surprises when it comes to understanding how much a CPAP machine costs.
Some insurance companies require you to rent a machine for a period of time before the machine can be purchased outright. To fully invest in your therapy, your insurance company wants to know that it will actually work before committing to the full purchase price.
Insurance CPAP Machine Compliance
If your insurance company requires a CPAP machine rental, this typically means they also have compliance requirements. All of the major manufacturers today include a cell signal that sends your usage to a central repository. This information can be accessed by your insurance company, your doctor, and your DME supplier.
One example of how the compliance is checked happens like this. You will be required to use the CPAP machine for at least four hours per night, five nights a week, and for a period of 22 consecutive nights to get a compliance rating. That compliance means that you are actually using the machine as prescribed.
You might get a call after the first month of use stating that you have been deemed in compliance with insurance requirements and get to keep using it. If you are unable to meet the compliance requirements, you will want to discuss this with your doctor or your DME supplier contact. It is possible your current setup does not meet your needs to treat your sleep apnea successfully.
There may be a deductible that must be met before your insurance company will pay for the rental or purchase of your CPAP. That deductible could differ from your usual policy as they might have a different set of criteria specifically for a DME. Because of that, you are likely to incur some initial out-of-pocket expenses when starting your sleep apnea therapy.
I can’t give you a specific number of dollars that you will need to pay up front. What I can do is give you an idea of what items you will need to get started. At that point, it is up to you to contact your insurance provider and ask them about your policy coverage.
CPAP Machine Costs
Prices for a CPAP machine range anywhere from $200 to $3,000 depending on the model and where you purchase the machine. BiPAP machines and AutoCPAP machines are a bit more expensive.
Depending on your deductible, it may be much, much cheaper to buy your CPAP machine yourself online. When buying from a DME, your out-of-pocket cost is almost always the highest. Even if they give a special price for cash purchases, this is still typically your most expensive option.
The other benefit to buying online is the large selection you will have. Your DME provider might have a small selection of machines. Many times, when a patient is found to be non-compliant, it’s just a matter of finding the right machine. The more choices you have, the more likely you are to find the machine that you will actually use.
CPAP Equipment Costs
Additional costs add up, and they are often overlooked. You will need to buy a mask and hose as well.
There are three different types of masks: full face, nasal, and nasal pillow. The full face mask covers your mouth and nose together, the nasal mask just covers your nose, and the nasal pillows are inserts that go directly into your nostrils so you aren’t covered by a mask.
I have the Fisher and Paykel Eson mask. My insurance does not cover the mask cost until a high deductible is met. At my DME provider, they charged me $235. I was naive and unaware of this until a few weeks later when I was mailed the bill. I wish I had known the cost before I made the purchase. To find a much better price for CPAP masks, search online at a retailer like Amazon. The cost is a fraction of the cost that my DME supplier charged me, so I will be buying my replacements online from now on.
Learn from me, and recognize that it pays to do a little homework (just like you're doing now.) In my opinion, if you have to pay anything yourself that your insurance doesn’t cover right away, then it is almost always better to go online.
Ongoing CPAP Machine Costs
Your cushion and hose are not meant to last more than six months. If you go through your insurance company, they will typically have limits on when your mask cushion, hose, and CPAP machine can be replaced.
Depending on your insurance plan, it can be more cost effective to buy replacement CPAP parts online instead of going through your DME. Make sure you are taking care of your mask and hose so they will last longer; there is really no need to replace them unless they are no longer functioning. To keep your equipment in good condition, read my article on the best CPAP wipes, and my review of the SoClean 2 CPAP automated cleaner. Don't forget to factor in the cost of cleaning as part of your ongoing expenses.
Another item often overlooked are air filters. Most filters last about six months before they need to be replaced, but check your manual to confirm the replacement schedule. You may find yourself replacing them more often than that depending on your sleep environment. On the bright side, filters are cheap, and you can find a 12-pack of replacement CPAP air filters on Amazon for a fair price.
Your electricity bill won’t sky rocket using your CPAP machine all night. They are usually very energy efficient. Don’t expect to pay more than $3-5 more per month than you do now.
Buying A Used CPAP Machine
I would advise against buying a used CPAP machine because of the unknown factor. Not everyone can get past the "ick" factor of using someone else's medical equipment. In addition, you don't know how many hours the machine has been used. You will get the most effective treatment for sleep apnea using a new CPAP machine.
If you are still interested in buying a used one, I highly recommend looking for one listed as "refurbished." There is an online DME provider that sells refurbished models.
CPAP Machine Cost Conclusion
Don’t let the cost of a CPAP machine intimidate you, especially before you consult with your insurance company. You may just find that you have a good policy that will cover most of the expense associated with your CPAP therapy.
If you find that you must pay a significant amount of the costs up front, let your doctor or DME supplier know that you have some financial issues that might prevent you from buying your equipment.
Your doctor wants to see your health improve and may be of some assistance in exploring your options in finding a solution to getting you set up with the proper equipment you can afford.
Don’t let the cost of a CPAP machine be a barrier to getting the therapy you need. The immediate benefits and long-term health benefits gained are, without a doubt, worth the cost. If you have any questions or need additional assistance, leave a comment below, and I'll get back to you.
