Is a Prescription Needed for a CPAP Machine?

Written by Lisa Bowman, Writer

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In This Article

You’ll find out all about CPAP machines whether we need a prescription, making it crucial to follow the proper process for acquisition, understand the necessity, and consider potential costs.

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CPAP machines, which stand for continuous positive airway pressure, are medical devices used at home to relieve the symptoms of obstructive sleep apnea. When someone has obstructive sleep apnea, they can experience periodic pauses in breathing when they sleep due to the throat muscles relaxing and obstructing the airway. The CPAP works by helping to keep the airway open through air pressure. 

If you suspect you have sleep apnea, it may be tempting to bypass the doctor and purchase a CPAP machine on your own. However, it’s not as easy to acquire a machine as you might think, as you need a prescription for a CPAP. To help you understand the process, we’ll explain how to get one, why you might need one, and what costs might be involved.

Do You Need a Prescription for a CPAP Machine?

Yes, you need a prescription for a CPAP machine. In 2018, the FDA reclassified PAP machines¹ from class III to class II medical devices, moving them from ‘high risk’ to ‘moderate to high risk’². Although the perceived risk has decreased, the law still states that class II devices require a prescription to be purchased. This is because a medical professional needs to prescribe the type of PAP machine that best suits your needs and calibrate it to the right level of air pressure for you. 

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How to Get a CPAP Machine Prescription 

If you think you have sleep apnea, you should speak to your doctor, who may refer you to a sleep center for further assessment. Tests for sleep apnea can involve an overnight stay at a sleep clinic or an at-home sleep test. These types of tests measure factors such as your blood oxygen levels, breathing patterns, movement, and heart, lung, and brain activity. 

If you’re diagnosed with sleep apnea, a CPAP titration study³ may be performed to calculate the correct level of air pressure required to resolve your apnea. This test involves sleeping while using PAP equipment. The results of the titration will determine the CPAP prescription. 

Who Would Benefit from a CPAP Machine

CPAP machines are the most common form of treatment⁴ for people diagnosed with obstructive sleep apnea. In some cases, if lifestyle changes don’t improve sleep apnea symptoms, a doctor or sleep specialist may suggest CPAP therapy. 

Along with better sleep and reduced sleep apnea symptoms, CPAP treatment could lead to long-term health benefits⁵, including a reduced risk of high blood pressure and stroke, as well as better memory and cognitive function. 

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Buying a CPAP Machine 

Once you have a prescription for a PAP machine, you have two options. You can purchase a machine directly or through your health insurance provider. You can buy CPAP devices online or in brick-and-mortar stores. If you plan to purchase a CPAP on your own, you should check that the specific device has been FDA-approved.  

Most insurers help cover CPAP equipment⁶. However, it’s best to check what your policy covers, as coverage may vary depending on which state you live in. CPAP supplies and accessories may be covered separately. There will also likely be strict compliance policies to adhere to, involving data collected from your machine to ensure you’re using it adequately. Also, insurers usually have an approved list of suppliers you must buy from.

How Much Does a CPAP Machine Cost? 

CPAP machine prices can vary greatly, depending on their features. Purchasing one outside of an insurance plan will likely cost you between $500 and $1,000 for the unit itself. Accessories come separately, and you should replace them regularly.

As mentioned, most insurers will have a list of approved suppliers from which you must purchase your machine and supplies, so it’s a good idea to work out if it might be cheaper to purchase outside of your insurance plan.

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Frequently Asked Questions

Does insurance pay for CPAP machines?

Most insurers pay for CPAP machines, but the level of coverage depends on your policy. In the case of Medicare⁷, 80 percent of the cost of equipment may be covered once you’ve met your Part B deductible and have completed a three-month CPAP trial. All insurers will require a valid prescription obtained from a licensed healthcare professional.

Will insurance pay for a CPAP machine?

The majority of insurers will pay for a CPAP machine if you have a valid prescription, but you should check your policy to see what percentage of the cost will be covered.

Can I just buy a CPAP machine?

You cannot buy a CPAP machine without a prescription from a healthcare professional because they’re considered class II medical devices by the FDA.² A prescription is necessary because a healthcare provider will understand which type of machine you require and the settings it should be calibrated to.