Is CPAP Considered Durable Medical Equipment?

Yes, CPAP machines and supplies are considered durable medical equipment in the United States. And this means that they may be covered by your health insurance.

However, this coverage will vary by state, as well as provider. Durable medical equipment, or DME, tends to include equipment and supplies authorized by your doctor for at-home treatment of medical conditions.

Note that some may be for a short-term injury or illness, such as crutches for a broken leg. Other DME can be used to treat long-term chronic conditions, such as CPAP machines for sleep apnea.

CPAP stands for Continuous Positive Airway Pressure. The CPAP Machine is known to increase the air pressure in your throat to prevent your airway from collapsing while you inhale; it also helps you to snore less.

Have it in mind that the purpose of this machine is to help people with Sleep Apnea breathe easily and regularly every night while they sleep. The CPAP Machine comes with a Humidifier and you will need to get supplies like a Filter, Tube, Mask, etc, in order for it to work properly.

Indeed there are enormous benefits to using a CPAP Machine. It is the most effective treatment for Sleep Apnea that doesn’t involve surgery. It helps to reduce daytime sleepiness, heart problems and lowers blood pressure during both the day and night.

Aside a CPAP, durable medical equipment includes oxygen concentrators, nebulizers, and other respiratory supplies. These are just some of the items on a long list of equipment that meets the criteria of DME. Note that private health insurance companies are not required to cover DME, so it is crucial to check coverage with your provider.

Although some may cover DME, your particular plan may only cover certain items or provide only partial coverage. Nonetheless, prior to receiving your equipment, the insurance company will need you to provide a valid prescription from a licensed physician. Online retailers who don’t work with insurance companies still need a prescription to purchase equipment.

Other Examples of Durable Medical Equipment and How They Are Treated By Insurance Companies

1. Mobility Devices

Wheelchairs are indeed the most common type of mobility device that is covered by medical insurance. Note that once your doctor has determined that you need a wheelchair, you would be able to get at least a portion of the cost covered by your insurance.

In addition, if you’re looking to upgrade to a power scooter, electric wheelchair, or another type of mobility device, getting the cost covered could be more challenging. Most times, these can only be covered if the device is going to be used in place of a wheelchair, and your doctor has confirmed it medically necessary for you to have a powered mobility aid, based on your condition.

This also entails that your medical condition must be severe enough that a standard wheelchair is not substantial to help you maintain a good quality of life. If your doctor states this in writing, your odds of having a powered mobility device covered by insurance improves, but it is still not guaranteed.

2. Diabetes Equipment

Once you have been diagnosed with diabetes, the equipment needed to monitor your condition—namely, blood glucose monitors and testing strips—would be considered DME. In most scenarios, this equipment would be covered by Medicare or your personal health insurance.

It doesn’t matter if you have Type 1 or Type 2 diabetes, and you aren’t expected to use insulin either; if you’ve been diagnosed and require testing your blood glucose levels on a regular basis, you should be able to request coverage from your insurance.

3. Lift Chairs

Note that these chairs are a tricky type of DME especially when it comes to having the costs covered by insurance. This is due to the lifting mechanism is sometimes considered to be a medically necessary piece of equipment, but the chair itself often is not.

Medicare, for instance, only provides coverage for the seat-lift mechanism, and not for the lift chair. Therefore, while you might be able to get partial coverage on this type of purchase, it is unlikely you’ll be able to have a lift chair fully covered.

4. Treatment and Therapy Equipment

Have it in mind there are many types of medical conditions that may require at-home treatment or therapy. A few common examples include sleep apnea and asthma. These conditions require regular use of a CPAP machine and a nebulizer, respectively. Note that if there is a piece of equipment you are medically required to use to treat an existing medical condition, it should qualify as a DME, and therefore, be eligible for coverage by most insurance.

5. Rental Devices

If you decide instead to rent your necessary DME and not purchasing them outrightly, this should not impact your eligibility. Most insurance will offer almost the same level of coverage for the equipment, irrespective of whether it is purchased or rented. Private insurance companies like Medical Xpress and Arlington Medical Supply offer rental options on many types of medical equipment, so be sure to ask about this option if you’re interested.

Conclusion

Indeed a CPAP Machine is considered to be Durable Medical Equipment and most insurance policies cover them. However, you will have to call your insurance to find out exactly how you would be covered. Supplies for the CPAP Machine are covered separately and the amount of coverage varies by each state; you will need to ask your insurance about that as well.