For those over the age of 65, Medicare coverage plays a vital role in managing health-related expenses. This federal health insurance program provides much-needed assistance for a wide variety of medical issues — but it doesn’t cover everything.
For example, Medicare doesn’t cover routine physical examinations or nursing home care. Because of these and other limitations, those who need to use a CPAP machine may find themselves wondering whether they can get any coverage for their medical equipment.
While some coverage is available, navigating the ins and outs of Medicare isn’t always easy — particularly in regards to CPAP therapy. Here’s what you should know.
Which Medicare Programs Cover CPAP Machines?
Those who have coverage under Original Medicare can receive some level of coverage for their CPAP equipment under Medicare Part B. Part of this section’s medical insurance coverage provides financial coverage for durable medical equipment — like CPAP and BiPAP machines.
As with other health insurance policies, however, your selection is somewhat limited. You can only get a prescription for a CPAP machine from a Medicare-approved healthcare provider. In some areas — particularly rural areas — Medicare-approved providers may not be located at a convenient distance.
While Medicare Part B offers coverage for CPAP equipment, this coverage only starts after you have already met your plan’s deductible. At this point, Medicare will cover 80 percent of select CPAP expenses (more details on this in the next section).
Those who have a Medicare Advantage (Part C) plan will need to do additional research to determine if their plan provides any additional coverage for CPAP equipment. Medicare Advantage Plans combine original Medicare with private insurance extras. You may get better CPAP coverage, but monthly premiums will be higher as a result.
It should come as no surprise that with either type of plan, you need a diagnosis of obstructive sleep apnea from your doctor. This, paired with a prescription for a CPAP machine, prove that the equipment is indeed “medically necessary.” Fortunately, Medicare Part B will typically cover the sleep study that is used to diagnose obstructive sleep apnea.
What Type of Coverage is Available?
Since the type of coverage you can get for CPAP equipment can vary significantly under individualized Advantage Plans, let’s focus on what type of coverage is — or isn’t available — under Medicare Part B.
For people who have been newly diagnosed with obstructive sleep apnea, Medicare will help cover a three month trial for a new CPAP machine. For those who are consistently using their device, Medicare will also help cover a CPAP rental for up to 13 months. However, it does not provide coverage if you want to buy the equipment outright after getting a diagnosis.
When first getting started with CPAP therapy, Medicare coverage may also be available for masks and tubing. Sometimes, however, you will still need to pay the full cost upfront and get reimbursed later.
Medicare does provide coverage for part replacements, however, this may not always be on a timetable that works with your needs. As with the initial equipment rentals and purchases, Medicare does not cover the complete cost of these replacement parts, meaning you will need to spend some money out of pocket.
For example, Medicare replacement guidelines allow you to replace the humidifier water chamber, headgear, and non-disposable filters twice a year. CPAP tubing and full face masks can be replaced up to four times a year. Nasal mask interface cushions, nasal pillows, and disposable filters can be replaced up to 24 times a year.
While these replacement guidelines mostly follow the same recommendations provided by the manufacturer, you never know when an unexpected issue with your equipment might occur. Whether your dog gets hold of your CPAP tubing or you misplace your filter replacements, you could find yourself in a situation where you need to replace equipment and Medicare coverage is no longer available.
Notably, CPAP machine replacements are not included in this coverage. While CPAP machines typically have an expected lifespan of five years, they still represent a big purchase on top of the monthly premiums you already pay for Medicare coverage.
It is also worth noting that coverage is limited to providers and suppliers who are contracted with Medicare. This means that you may not be able to get care from your preferred doctor, or that your selection of CPAP supplies could be limited based on what a local supplier has available.
Make CPAP Equipment More Affordable With Help Medical Supplies
Regardless of whether or not you have Medicare or another form of health insurance coverage, getting quality sleep matters. Controlling your obstructive sleep apnea will have a significant impact on your overall health and well-being, making a CPAP machine an absolute must for millions of Americans.
For those who need extra help to afford this vital equipment, there’s Help Medical Supplies. We assist those with limited healthcare coverage — or no coverage at all — by providing CPAP equipment at prices significantly discounted off MSRP. Many devices are available for hundreds of dollars off their standard pricing.
Available financing and free shipping on orders over $89 will make your purchase even more affordable. We also offer equipment rentals! In addition to quality products and great prices, we pride ourselves on offering outstanding customer service to ensure you get the right fit for your needs.
Nothing is more important than your health. With CPAP equipment from Help Medical Supplies, you will be able to get the quality sleep you need to make the most of your life.