Does insurance cover sleep apnea therapy?

Does insurance cover sleep apnea therapy? If you’re diagnosed with sleep apnea, or suspect you may soon be, that’s one of the first questions you’ll probably ask. And – good news! – the short answer is yes.

Whether or not you’ll receive sleep apnea insurance coverage depends on your insurance provider’s specific policies, your geographic location and your exact sleep apnea treatment prescription. So, the fastest, most direct way to answer these questions and find out whether your insurance covers sleep apnea is to call and ask your provider, using the number on your insurance card.

The type of sleep apnea therapy your physician has prescribed is also a factor in whether you’ll receive insurance coverage. There are a variety of different treatment options, ranging from simple weight loss to advanced surgery, but the most common is continuous positive airway pressure therapy, or CPAP. (What is CPAP?)

It’s common for insurance providers to only offer coverage for major sleep apnea therapy like surgery in the case that less extreme treatment options, like CPAP and oral sleep apnea appliances, have been tried and proven to be ineffective.

Sleep apnea insurance coverage for CPAP therapy

Since CPAP is the most common form of sleep apnea therapy, it’s generally covered by most insurance policies. CPAP is “considered to be durable medical equipment,” writes Dr. Helene A. Emsellem, director of the Center for Sleep and Wake Disorders.

“Supplies are covered separately, and the amount of coverage varies by state,” Dr. Emsellem adds. “Deductibles and copayments may apply depending on whether or not you have a secondary insurance.”

Oral appliances for sleep apnea are also generally covered by insurance, but this area can get a little complicated. Typically, oral treatments will be covered by your medical insurance, and not by your dental insurance. Since a dentist specializing in sleep medicine will fit your sleep apnea oral appliance, this means you’ll have to work with both your dentist and your medical insurance coverage provider to figure out what level of coverage you’re eligible for.

So, does insurance cover sleep apnea therapy? Chances are good that, if you’ve been diagnosed with a form of sleep apnea, your condition is considered medically necessary enough to be covered. And chances are also good that your doctor will only recommend therapy that your insurance provider will cover. But since every situation is different, the only way to find out for sure is to call your insurance provider and ask.

Finally, ResMed.com does offer a variety of resources designed to help you find out whether you’ll be eligible for sleep apnea insurance coverage – you can find the list of options here.