Sleep apnea can have devastating effects on your health in the absence of treatment. Properly addressing the condition is important, but the potentially high medical costs associated with diagnosis and treatment can make some patients feel hesitant. Here’s what you need to know about sleep apnea treatment and the costs that you could get covered by health insurance.
How Much Does Sleep Apnea Treatment Usually Cost?
The cost of sleep apnea treatment will depend on the type of treatment.
A common treatment method is a continuous positive airway pressure (CPAP) machine, which is a device that helps you breathe during sleep. These machines address breathing interruptions by directing pressurized air into your airway while you sleep.
The average price of a CPAP machine prior to insurance coverage can be $500-$3,000, according to the American Sleep Association. Other machines, like a bilevel positive airway pressure (BiPAP) machine, are typically more expensive due to newer technology that adjusts to your breathing.
If CPAP therapy proves unsuccessful for you, there are other options, like a mandibular advancement device (MAD). These are like mouth guards, and do not require the use of face masks. The American Sleep Association reports that, prior to insurance contributions, MADs can cost anywhere from $40 to $2,000—depending on if you get a generic or custom-fitted device.
Surgery is usually the last resort when other methods have not worked. Sleep apnea surgery can involve moving tissue that is blocking your airways or re-aligning your jaw, according to Mayo Clinic.
The cost of these surgeries depends on how invasive they are, but expenses can reach upwards of thousands of dollars.
Does Insurance Cover Sleep Apnea Treatment?
Your specific insurance policy will determine how much coverage you'll get for sleep apnea treatment. Some insurance providers, such as BlueCross BlueShield of North Carolina, will cover certain surgical treatments if you were diagnosed with sleep apnea and meet specific guidelines. They can also provide some coverage for certain devices like MADs or CPAPs.
In addition, Medicare will cover some costs of CPAP therapy, including a 3-month trial. According to the official U.S. government website for Medicare, this trial may be extended if you:
- Meet in-person with your doctor
- Obtain documentation from your doctor that verifies your fulfillment of certain conditions regarding CPAP usage as well as the efficacy of your CPAP treatment
It's not uncommon for both private insurance policies and Medicare ones to require specific conditions be met or a particular sequence of treatment trials before extending coverage. In fact, Kaiser Health News recently noted that Medicare and private insurers often require patients to use their CPAP machines consistently, and may even monitor usage as a condition of coverage.
Ways to Save
There are different ways to save on health insurance costs, such as:
- Asking your doctor which tests and equipment are “nice-to-haves” and which are “necessary”
- Asking your doctor if there are wellness or lifestyle treatment options that don’t involve potentially costly surgeries or devices
- Making sure that you understand your coverage for the specific diagnostic procedures and treatment equipment you need
- Considering telemedicine options that may offer lower base costs and accept health savings account (HSA) or flexible spending account (FSA) payments
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