CPAP Insurance Rules Too Stringent, Deny Device Coverage To Sleep Apnea Patients Who Would Benefit

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By Dennis Thompson HealthDay Reporter

Medically reviewed by Drugs.com

via HealthDay

THURSDAY, May 21, 2026 — It’s notoriously difficult for some sleep apnea patients to adapt to using a CPAP machine – but most will and should be given the chance before insurance companies cut off coverage for the devices, a new study says.

Despite not meeting Medicare requirements that would have ended coverage, more than one-third of patients still use their CPAP machines enough to sleep better and become healthier, researchers reported Wednesday at the annual meeting of the American Thoracic Society in Orlando.

“These findings challenge a long-standing assumption in clinical practice and policy,” said lead researcher Dr. Dennis Hwang, a sleep and pulmonary doctor at Kaiser Permanente Southern California in Yorba Linda.

“While clinicians know some patients take time to adapt, the scale of continued use we observed in those that did not initially meet Medicare adherence was striking,” Hwang said in a news release.

CPAP (continuous positive airway pressure) machines deliver a steady stream of pressurized air through a mask to prevent a person’s airways from collapsing during sleep, according to The Sleep Foundation. It’s this collapse that causes people with sleep apnea to repeatedly stop breathing in the night, waking up each time.

A Medicare policy requires patients with sleep apnea to use their CPAP machine for at least four hours a night on 70% of nights during a 30-day window within the first 90 days to maintain coverage, researchers said in background notes.

The research team suspected that this policy is too stringent and could cut off access for people who ultimately would adapt to and benefit from CPAP.

For the new study, researchers analyzed data on more than 132,000 people treated for sleep apnea within the Kaiser Permanente Southern California health network. Kaiser Permanente offers CPAP to patients regardless of whether they meet the Medicare threshold.

About 51% of the patients initially didn’t meet the 90-day Medicare criteria, researchers found.

But more than a third of those who didn’t meet the Medicare criteria were still using their CPAP machine one year later, the study showed.

Further, even those who weren’t meeting the four-hour threshold were still using CPAP at least two hours a night – an amount known to improve symptoms of sleep apnea, Hwang noted.

“Our findings suggest clinicians and policymakers should not rely solely on Medicare-defined adherence, given its reliance on early CPAP use and an arbitrary four-hour threshold, when making long-term treatment decisions,” he said. “Extending support and coverage beyond the first 90 days could help more patients achieve meaningful benefit.”

Next, the team plans to investigate which patients are more likely to become long-term CPAP users and evaluate alternative coverage policies that focus on patients’ symptoms rather than usage thresholds.

Researchers presented these findings Wednesday at the American Thoracic Society’s annual meeting in Orlando, Florida.

Findings presented at medical meetings are considered preliminary until published in a peer-reviewed journal.

Sources

  • American Thoracic Society, news release, May 20, 2026

    • Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions.

    Source: HealthDay

    Posted : 2026-05-21 21:57

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