Three months into using my CPAP (the machine that keeps your airway open while you sleep), I needed a new mask cushion. I called my supplier, ordered one, and got hit with a $75 bill. I was furious. Why wasn't my insurance covering this?
Turns out, I'd ordered too early. Insurance only covers replacement supplies on a specific schedule. Once I learned that schedule and how to work with it, I haven't paid for supplies out of pocket since.
Let me show you how this works so you don't waste money like I did.
Insurance Covers Supplies on a Schedule
Your health insurance doesn't cover CPAP supplies whenever you want them. They cover them on a replacement schedule.
That schedule is based on how long insurance companies believe each part should last with normal use.
Here's the standard schedule most insurance companies follow:
Every 3 months:
- Mask cushion (the part that touches your face)
- Full face mask (complete)
- Nasal mask (complete)
- Chinstrap
Every month:
- Disposable filters
- Nasal pillows
Every 6 months:
- Headgear (the straps)
- Tubing
- Water chamber
Every year:
- Reusable filter
If you try to order supplies before the schedule says you're due, insurance won't pay. You can still buy supplies early if you want, but you'll pay full price out of pocket.
Why Insurance Companies Use This Schedule
Insurance companies base these timeframes on how long supplies typically last with proper care and normal use.
If you wash your mask cushion daily and handle it carefully, it should last three months before the seal starts to weaken. After three months, most cushions start developing small leaks.
Filters get clogged with dust and need replacing monthly (disposable) or yearly (reusable).
Tubing and headgear wear out from regular washing and stretching.
The schedule isn't random. It's based on typical wear and tear.
What Medicare Specifically Covers
If you have Medicare, here's your exact replacement schedule:
Masks:
- 1 cushion every 3 months OR
- 1 complete mask every 3 months OR
- 2 nasal pillows every 3 months
Tubing:
- 1 tube every 3 months
- 1 heated tube every 3 months (if you have a heated tube system)
Headgear:
- 1 headgear every 6 months
Filters:
- 2 disposable filters every month OR
- 1 reusable filter every 6 months
Water Chamber:
- 1 water chamber every 6 months
Chinstrap:
- 1 chinstrap every 6 months
You can't mix and match beyond what's allowed. For example, you can't get a cushion in January and then get a complete mask in February. It's one or the other within that three-month window.
How to Know When You're Due for Supplies
The easiest way is to ask your supplier to track this for you.
Most good suppliers keep a record of when you last received each supply. They can tell you when you're eligible for your next order.
Some suppliers send reminders automatically. When you're due for supplies, they'll call or email asking if you need to reorder.
If your supplier doesn't do this, set yourself reminders:
- First of every month for filters
- Every 3 months for mask cushions
- Every 6 months for tubing, headgear, and water chamber
What If You Need Supplies Early?
Sometimes you need something before insurance will cover it.
Your dog chewed your tubing. Your cushion tore. You lost your headgear while traveling.
You have three options:
Buy it out of pocket. You'll pay the full retail price. Ask your supplier for just the one part you need, not a full replacement kit.
Ask your supplier about spare parts. Some suppliers keep samples or damaged-box items they can give you to tide you over until insurance covers your next scheduled replacement.
Check if your insurance has an exception process. Some plans will cover early replacement for lost or damaged equipment if you call and explain what happened. Don't count on this, but it's worth asking.
Setting Up Automatic Shipments
Many suppliers offer automatic shipment programs.
You tell them what supplies you want, and they automatically ship them to you when you become eligible. You don't have to remember to reorder or call every few months.
This works great for most people. You get fresh supplies right when insurance covers them, without thinking about it.
The one thing to watch: make sure you can pause or adjust your automatic orders. Your needs might change over time. Maybe you switch mask styles or find you don't need new tubing every six months.
How Copays and Deductibles Work
Even though insurance covers CPAP supplies on this schedule, you still might pay part of the cost.
If you have Medicare, you pay 20% of the Medicare-approved amount for supplies. Medicare pays 80%.
If you have private insurance, you might pay a copay or a percentage based on your plan.
If you haven't met your deductible yet this year, you might pay full price for supplies until you hit that deductible. After that, insurance kicks in.
Ask your supplier to check your benefits before ordering. They can tell you exactly what you'll owe.
What Supplies Can You Order at the Same Time?
You can order any combination of supplies you're eligible for at the same time.
For example, at 3 months you might order:
- Mask cushion
- Tubing
- Filters
At 6 months you might order:
- Mask cushion
- Tubing
- Headgear
- Water chamber
- Filters
Your supplier will usually combine everything into one shipment if you're due for multiple items at the same time.
Tips for Making Supplies Last
If you take care of your supplies, they'll easily last until the replacement schedule kicks in.
Wash your mask daily. Use a damp cloth to wipe out the cushion every morning. This prevents oil and skin cells from breaking down the silicone.
Deep clean weekly. Once a week, wash the mask, tubing, and headgear in warm soapy water. Rinse thoroughly and air dry.
Use distilled water in the humidifier. Tap water leaves mineral deposits that can clog the water chamber.
Don't hang your tubing in direct sunlight. UV light breaks down the plastic over time.
Store your mask properly. Don't just toss it on the nightstand. Put it in a clean place where it won't get stretched or damaged.
Supplies that are well cared for will last their full replacement period. Supplies that aren't will need replacing sooner, which you'll have to pay for out of pocket.
What If Your Supplier Isn't Helpful?
Some suppliers make ordering supplies difficult. They don't return calls, they won't set up automatic shipments, or they push you to buy extra supplies you don't need yet.
You're not stuck with them. You can switch to any other Medicare-approved supplier.
Your replacement schedule follows you, not the supplier. If you just got a mask from Supplier A, you can't get another mask from Supplier B until you're due in three months. But you can absolutely take your business to a supplier who treats you better.
Your Next Step
Right now, today, do this:
1. Call your supplier and ask: "When am I due for my next CPAP supplies?"
2. Mark that date on your calendar
3. Ask if they offer automatic shipments
4. If yes and you want it, sign up
5. If no, set a reminder to call them when you're due
If you don't have a good supplier who makes this easy, use our directory to find one who will. Getting supplies shouldn't be a battle every three months.
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Not sure which suppliers track your schedule for you automatically? Search CPAPLocator.com by ZIP code and look for ones that offer supply reminders.
Frequently Asked Questions
What if I lose or break a supply before insurance will cover a replacement?
You have three options: buy it out of pocket, ask your supplier if they have any spare parts on hand, or call your insurance and ask about a loss or damage exception. Don't just go without. A torn cushion or broken tubing means your therapy stops working.
Does the replacement schedule reset when I switch suppliers?
No. The schedule follows you, not the supplier. If you got a mask cushion from Supplier A in January, you can't get another from Supplier B until April. The clock doesn't restart just because you switched.
What if my private insurance covers less than Medicare does?
Private insurance schedules vary by plan. Some are more generous than Medicare, some are less. Ask your supplier to verify your specific benefits before ordering. They can pull up your exact coverage and tell you what you'll owe out of pocket.
Does insurance cover a CPAP cleaner like a SoClean or Lumin?
Almost never. Medicare and most private insurance don't cover CPAP sanitizing devices. These are considered optional accessories, not medically necessary supplies. Check with your plan if you're not sure, but don't count on coverage.
Can I order supplies from a different supplier than where I got my machine?
Yes, as long as the new supplier is also Medicare-approved. Just know the replacement schedule follows you. If you were recently due for supplies from your old supplier, you'll wait for the next cycle before a new supplier can bill insurance for replacements.
*CPAPLocator.com is a directory service only. We are not a medical provider. Content is for informational purposes only. Always consult your healthcare provider.*