Why Won’t My Insurance Company Pay for the CPAP Supplies I Need?

Our patients get extremely frustrated when they contact us to order replacement supplies- at the usual 90 to 120 day intervals- but their health insurance company won’t pay. It’s especially hard because we’ve been saying- since the initial set-up- how important it is to regularly replace CPAP equipment, like the mask, cushions, filters and tubing.

Your CPAP’s accessory equipment is a lot like other frequently used health products, such as your toothbrush or a razor: it deteriorates, ceases to function optimally, and can become unsanitary. Just like you wouldn’t use the same toothbrush for months on end, it’s important to replace your CPAP equipment to make sure that your machine is as clean, effective, and comfortable as possible. There are three main reasons you should regularly replace your PAP equipment: 

  1. Hygiene. PAP equipment, such as tubing and masks, can get germy over time. Replace regularly to keep your machine sanitary. 
  2. Effectiveness. It is vital that your equipment be replaced regularly so that it functions properly. For instance, as masks age, they can crack or stretch, causing irritation and leaks. 
  3. Comfort. Old equipment, especially masks and cushions, can irritate your face and lead to lack of compliance. 

Health insurance companies are supposed to cover the regular replacement of CPAP supplies, but increasingly, our patients are having issues getting approval for new supplies.

What gives?

In this short blog series, we’ll cover the top reasons why health insurance companies are denying regular 90-120 day replacement CPAP supply orders and what you can do about it.

Reason #1: You’ve exceeded your allowance for one or all of the items requested.

We work with many different types of insurance in Southern California: PPOs, government insurance, HMOs, medical groups and IPAs. While many of these payers base their coverage on Medicare standards, like their rates, there is a lot of variation between plans. For example, most PPO plans and Medicare will allow for one new mask every 90 days, while another plan only allows one new mask once per year! 

We recommend following the Medicare replacement schedule because routine replacement of supply components such as cushions, filters and tubing can have a profound effect on your comfort. If CPAP therapy is comfortable, you’re more likely to use your CPAP every night. That’s our goal.

Here’s the Medicare supply replacement schedule:

Even though your insurance may not cover the regular replacement of CPAP supplies outlined above, it is still extremely important that you replace the equipment anyway. Many of the components are not designed to last for more than a few weeks without replacement, such as mask cushions, and they may become uncomfortable and less effective when used for too long (read more here).

What to do if your insurance doesn’t allow more supplies:

  • Call the member services department of your health insurance company. Tell them that you need to replace your CPAP supplies more often so that you can remain complaint. You can refer to the Medicare guidelines above or found online here. While your complaint may not change the outcome, a call to member services can sometimes get you a long way. At the very least, your making sure they hear that you take your therapy seriously and want them to follow Medicare guidelines.
  • Talk to your equipment provider about paying cash for the minimum supplies that will get you through to your next full supply order through insurance. If your insurance only covers one mask per year, you should consider paying for a new mask every three months (that’s three masks per year that you buy out-of-pocket). You can use any HSA or FSA funds to pay for these supplies (read more about how these accounts work here). We’ve also compiled a list of organizations that provide free or low-cost CPAP supplies to those with financial need (see the link at the bottom of this post).
  • Make sure that you are following the manufacturer’s guidelines for cleaning your mask assembly, tubing and filters. Daily cleaning can go a long way to making sure your equipment is in good shape for as long as possible (check out our recommended cleaning schedule here). This is especially important if you are trying to make your equipment last as long as possible.

Maximizing your health insurance benefits is essential. Make sure that you know as much as possible about what your health insurance coverage and work closely with your equipment provider and healthcare providers to take charge of your CPAP therapy.

We’ll cover the #2 reason why insurance companies won’t pay for replacement CPAP supplies in our next post. Stay tuned!


Other posts you may find interesting:


  1. Ed Bingham Reply

    My insurance is bad newspapers

  2. Theodore R. Sutherland Reply

    I have had my C-pap machine since 2014. I have never had a new mask. Why won’t Medicare cover one mask and one hose? I have had the same mask for 8 years. This is a disgrace.

    Theodore R. Sutherland
    360 Rogers Circle
    Castlewood, VA 24224

    • Charles Reply

      That’s your fault for not finding a way to get it replaced, any way necessary and using nasty 4 year old CPAP parts.

  3. Roz Arbel Reply

    I just found out the Kaiser won’t cover a replacement CPAP machine that’s finally giving out. My machine is 8 years old! He told me it was because I had an individual plan, and only plans that go through employers cover CPAP machines. Isn’t this a serious health issue? I just can’t believe that Kaiser won’t help with the situation. I’m extremely disappointed

  4. Gumby Reply

    Anthem is Outrageous! Before you reach your deductible you have to pay for a CPAP rental for 10 months out of my own pocket, plus supplies. $1512.50 total.

  5. thomas conley Reply

    I have used a CPAP for more than 15 yrs. Bennett medical is the worst telling me every yr i have to have my dr rewrite my prescription, then order supplies i just ordered mask head gear now they canceled it they want me to bring my chip in so they read it. I personally do not believe this is their business this is between me snd my dr not them. I own my cpap machine. Why do they make this so difficult. Before i used them i did not have to do any of the thing they are requesting for me to do.

  6. Rebecca Anderson Reply

    The military insurances Tricare and U.S. Family Health will not pay for a sleep study and the ENT will not issue a Cpap or Bipap without one.

  7. Janet Reply

    How do I apply for cpap machine

  8. Jacob C Reply

    Buy your CPAP supplies on Amazon/eBay. Medical supplies are the biggest, unregulated scam in the US.

    If they use the wrong tax ID with your insurance, you will be responsible for it – and there aren’t usually unlimited supply chains to choose between.

    Call your insurance before you agree to anything, never trust your doctor or hospitals medical cost estimator, and never trust that the person is actually in network.

  9. LOL Beans Reply

    Very informative blog post. Keep it up!

  10. run 3 Reply

    I appreciate you taking the time to discuss it since I have strong opinions regarding it and I want to find out more information about it. Could you perhaps add some details to the post you made on your blog? It will actually be to our collective advantage.

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