How Much Do CPAP, BiPAP, and APAP Machines Cost with Insurance?
Millions of people rely on positive air pressure (PAP) therapy to treat sleep apnea, a disorder that causes temporary loss of breath during sleep. The most common types of PAP therapy are continuous positive air pressure (CPAP), bi-level positive air pressure (BiPAP), and automatic positive air pressure (APAP) therapy. PAP therapies involve airflow generating machines that are typically sold within the following price ranges:
CPAP: $200 to $800
BiPAP: $800 to $1,700
APAP: $350 to $900
While these are average price ranges, it’s important to note that some PAP machine models cost $3,000 or more. In addition to the machines, PAP users must also purchase face masks and, in some cases, air humidifiers. For most individuals, these collective costs represent a significant financial investment.
Fortunately, PAP therapy is covered under most health insurance plans. By purchasing PAP supplies through insurance providers, sleep apnea patients can save hundreds — potentially even thousands — of dollars. This guide will address potential costs for CPAP, BiPAP, and APAP devices with or without insurance coverage, as well as other insurance questions related to PAP therapy.
Diagnosing Sleep Apnea and Prescribing PAP Therapy
All sleep apnea patients experience temporary loss of breath during the night — hundreds of nightly episodes, in some cases — and many also snore heavily. However, the condition is divided into three general categories based on root cause:
Central sleep apnea (CSA) occurs when the brain is unable to properly transmit signals to the muscles that control breathing.
Mixed sleep apnea (MSA) is essentially a combination of OSA and CSA.
Many sleep apnea patients treat their condition using positive air pressure therapy, or PAP, therapy. This form of therapy involves an airflow generator (or machine) with an electric fan that draws in outside air, humidifies and pressurizes the air, and then delivers the air to the sleeper via a connective hose and breathing mask. Pressure settings for the airflow are measured in centimeters of water, or cmH20; most PAP machines deliver air at a range of 4 to 20 cmH20 (usually in 1.0 or 0.5 increments).
PAP machines fall into the following three categories:
Bi-level positive air pressure (BiPAP) machines deliver airflow at two rates: one during inhalation (known as breathing in pressure, or IPAP) and one during exhalation (known as breathing our pressure, or EPAP). The rate for IPAP is normally higher than the EPAP rate. For example: 16cmH20 – IPAP, 13cmH20 – EPAP.
AutoPAP (APAP) delivers airflow at a variable range depending on the sleeper’s breathing patterns, such as 10cmH20 to 18cmH20.
There is also some variation in terms of face mask selection. Most face masks fall into one of the following categories:
Full face mask: The mask fits over the patient’s entire nose and mouth.
Nasal cradle: The mask forms a triangular seal from the bridge of the patient’s nose to the top of their lips without covering the mouth.
Nasal pillow: The mask covers both nares (nostril openings) but no other parts of the mouth, and connects using headgear at the sides.
Nasal prong: The mask covers both nares (nostril openings) but no other parts of the mouth, and connects using headgear at the sides and forehead.
According to the federal government, CPAP, BiPAP, and APAP machines are considered ‘Class II Medical Devices.’ The same is true of PAP machine humidifiers and face masks. By law, Class II Medical Devices always require a physician’s prescription. To learn more, please visit our CPAP, BiPAP, and APAP device prescriptions guide.
Insurance Coverage for CPAP, BiPAP, and APAP Devices
Insurance is not needed to purchase CPAP, BiPAP, or APAP machines, humidifiers, or face masks. However, insurance coverage for these products requires a prescription.
Most — but not all — insurance providers cover PAP therapy. This trend is due in part to increased recognition of sleep apnea as a precursor of more serious medical conditions, such as cancer and heart disease. Additionally, PAP treatment has proven to be an effective treatment method for millions of people with sleep apnea.
However, it’s important to note that all insurance plans are different in terms of coverage and authorization requirements. The following factors determine how much coverage the insurance company will provide and, consequently, how much the insured patient should expect to pay in out-of-pocket costs:
Deductible. An insurance deductible is a baseline amount that must be reached before the insurance coverage kicks in. For example, let’s say a patient has an insurance plan with a $1,000 deductible. They are required to pay out-of-pocket until the costs reach $1,000. Deductibles range anywhere from less than $300 to more than $3,000. Typically, plans with higher premiums (monthly costs) carry lower deductibles.
Coinsurance. Once the deductible has been reached, the insurance provider will begin paying some of the patient’s insurable medical costs. The amount the patient pays is known as coinsurance. For instance, a patient might pay 20% in coinsurance for medical costs after reaching their deductible; the provider will pay the remaining 80%. The coinsurance ratio varies by plan.
Copays. Copays are fixed fees for certain services built into insurance plans. Patients with sleep apnea may be able to establish copays for doctor visits. Copay fees vary significantly by provider and services, but generally fall between $30 and $60. For most plans, copays will be lower for in-network physicians and higher for out-of-network physicians.
The majority of insurance providers cover PAP therapy costs based on their deductible and copay agreements. However, some may impose special rules for obtaining CPAP, BiPAP, or APAP devices. For example, the provider may mandate that the patient rent their equipment from a medical supplies company for a certain length of time before buying it outright. Others require patients to document that they are complying with their prescribed therapy in order to receive insurance coverage.
Bottom line: because every insurance provider and plan is different, it’s important to contact your specific provider and inquire about requirements and stipulations for PAP therapy.
Out-of-Pocket Cost Expectations for CPAP, BiPAP, and APAP Devices
As we’ve discussed, the out-of-pocket costs for PAP devices depend on the patient’s insurance plan. The table below lists average out-of-pocket costs for patients who have already reached their deductible and pay 50% in coinsurance, as well as out-of-pocket costs without insurance.
Average Out-of-Pocket Costs with Insurance (50/50)
Average Out-of-Pocket Costs without Insurance
Full Face Mask
Nasal Cradle Face Mask
Nasal Pillow Face Mask
Nasal Prong Face Mask
Additional Questions about Insurance Coverage for CPAP, BiPAP, and APAP Devices
Next, we’ll answer some other common questions about insurance costs for PAP devices.
Am I required to pay all out-of-pocket costs with my own money?
Out-of-pocket costs, by definition, must come from the insured individual. However, this does not mean the individual needs to dip into their checking account or savings to pay these expenses. The following tax-advantaged savings accounts are available through select employers:
Health savings account (HSA): An HSA is technically owned by the individual employee. The employer, the employee, or both may make deposits. In 2018, the maximum annual contribution for HSAs is $3,450 for individuals and $6,850 for families. It’s important to note that HSA recipients must be covered under high-deductible health plans (HDHPs) with a minimum deductible of $1,350 (individual plan) or $2,700 (family plan); however, the HSA funds are available to the account-holder regardless of whether or not the until the HDHP deductible is reached.
Health reimbursement account (HRA): An HRA is technically owned by the individual’s employer, but held in the employee’s name. Only the employer makes deposits into the HRA. There is no contribution limit, and there is no fixed deductible requirement.
Flexible spending account (FSA): An FSA is technically owned by the individual’s employer, but held in the employee’s name. Contributions may be made by the employee, employer or both. The contribution limit in 2018 is $2,650 per plan; there is no fixed deductible requirement.
To learn more about these options, please reach out to your employer’s human resources department to see which (if any) are available to you.
Are subsidies available to cover out-of-pocket PAP expenses?
Some organizations offer PAP therapy subsidization programs for people with sleep apnea. In some cases, apnea patients can access PAP machines, masks, tubing, humidifiers, and other supplies for as little as $100 or less. However, many of these programs provide equipment on a temporary basis; supplies may also be limited, depending on the available inventory. Financial hardship may be a prerequisite for recipients.
How do CPAP/BiPAP/APAP rentals work?
As we discussed earlier, some insurance companies require sleep apnea patients to rent their PAP equipment for a certain length of time before they can purchase the products under an insurance plan. These stipulations are normally put in place to ensure the patient will commit to their PAP therapy, as the equipment can be quite costly. Although the terms vary by provider, most mandate that the patient rent their equipment for six to 12 months before a purchase is authorized.
Can I purchase a PAP device online through my insurance company?
PAP devices are sold through various online retailers. However, many will not directly deal with insurance providers. In these cases, the purchaser must act as a middleman by submitting claims to their provider and obtaining reimbursements.
Does insurance cover travel-size CPAP, BiPAP, and APAP machines?
Although policies vary by provider, most insurance companies consider travel-sized PAP machines to be ‘luxury items,’ and will not cover their costs under any health plans. Expect to pay out-of-pocket for travel-sized machines — but reach out to your provider just in case.