Will My Health Insurance Pay for a CPAP Machine?

Health insurance coverage is a tricky thing.  For most people, when you sign up for health insurance, you don’t ask too many questions about the coverage; and once you need the coverage, it’s too late to ask questions.

An example is when someone with sleep apnea is prescribed a sleep apnea machine.  People with sleep apnea stop breathing temporarily at intervals throughout the night, which prevents them from getting a good night’s rest.  When their sleep is interrupted night after night, it has dramatic consequences on their alertness, their ability to function cognitively, and other areas of their lives.

Depending on how bad the person’s sleep apnea is, the doctor might prescribe a BiPAP or a CPAP machine.  These machines prevent the person’s airways from closing, so that the person continues to breathe throughout the night.  As a result, the person’s sleep is uninterrupted.

Typically, your health insurance company will pay for a CPAP machine if the doctor diagnoses you with sleep apnea and if he issues a prescription for the machine.  Most likely you will have to pay some portion — a copay, a percentage (usually 20 or 40 percent) of the total amount, and/or a deductible.  Your contract with your health insurance company should explain the policy, but if you have questions your best bet is to call your health insurance company directly.

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