If you’ve been diagnosed with sleep apnea, chances are you’ve heard about CPAP machines. CPAP stands for Continuous Positive Airway Pressure, and it’s one of the most common and effective treatments for obstructive sleep apnea. But while the machine can make a huge difference to your sleep (and your health), the cost can be a bit of a shock, especially if you’re not sure what’s covered.
So, are CPAP machines covered by Medicare in Australia? What about private health insurance? And what do you actually need to know when starting treatment? This guide breaks it all down. We’ll cover how Medicare Australia treats CPAP devices, what support is available, and how health insurance can help cover the cost of equipment, accessories, and ongoing care. Whether you’re new to treatment or looking to upgrade your machine, you’ll find everything you need to make informed decisions and sleep easier.
What is CPAP Therapy?
Once you’ve been diagnosed with obstructive sleep apnea, CPAP therapy is often the first treatment recommended. The machine works by keeping your airway open while you sleep, preventing those repeated breathing pauses that disrupt rest and strain the body.
By delivering a steady stream of air through a mask, CPAP reduces snoring, supports deeper sleep, and lowers your risk of related health problems, such as high blood pressure, heart issues, and daytime fatigue.
It can take a little time to adjust to the equipment, especially the mask, but for many people, the improvement in sleep and energy is well worth it.
Eligibility, Diagnosis and Starting CPAP Therapy
Before you can access CPAP therapy or claim any rebates, you’ll need a proper diagnosis. That usually starts with a chat with your GP, especially if you’re experiencing symptoms like loud snoring, choking during sleep, or feeling constantly tired during the day.
Your doctor may refer you for a sleep study, either at home or in a sleep clinic, to see what’s happening while you sleep. These studies track your breathing, heart rate, and oxygen levels to find out if you have obstructive sleep apnea.
If the results show that CPAP therapy might be suitable, a respiratory specialist will confirm your diagnosis and help create a treatment plan. This step is important because both Medicare and private health insurance usually require a confirmed diagnosis before they will cover any part of the equipment or therapy.
So while the process might take a bit of time, getting diagnosed is what unlocks your access to support, both medical and financial.
Are CPAP Machines Covered by Medicare in Australia?
It depends on your situation, but in short, Medicare does not cover the cost of buying a CPAP machine outright. Unlike some other types of medical equipment, CPAP machines aren’t listed under standard Medicare Australia benefits for most people. That said, there are a few exceptions.
If you hold a Pensioner Concession Card or Health Care Card, you may be eligible for subsidised CPAP machines or ongoing support through state-based programs. Each state and territory handles this differently, so what’s covered can vary depending on where you live.
For example:
- In NSW, you might access CPAP support through a public hospital sleep unit.
- In Victoria, the Department of Health runs equipment programs for concession card holders.
- QLD Health also provides CPAP equipment to eligible patients through public health services.
These programs may cover the machine itself, part of the cost, or just the setup and ongoing support. You’ll usually need a diagnosis confirmed by a sleep or respiratory specialist and to meet specific eligibility criteria.
If you’re not eligible for Medicare-funded support, you’ll need to buy the CPAP machine yourself, but private health insurance may help (more on that in the next section).
So while standard Medicare coverage for CPAP is limited, it’s still worth checking if you qualify for state-based help or concession-based support.
Can Private Health Insurance Help Cover the Cost of a CPAP Machine?
In many cases, yes, but it depends on your policy. Private health insurance can help with the cost of a CPAP machine, but it’s usually covered under extras cover, not hospital cover. That’s the part of your policy that helps with out-of-hospital expenses like dental, physio, and in some cases, medical equipment like CPAP machines.
However, not every extras policy includes CPAP equipment, and coverage amounts can vary a lot between funds. Some will reimburse a set dollar amount per machine, while others might cover a percentage of the cost up to a yearly limit. Some funds also require you to use approved suppliers or submit a treatment plan from your doctor.
Here’s what to check with your insurer:
- Is a CPAP machine covered under my extras policy?
- What’s the maximum benefit or yearly limit?
- Are there any waiting periods?
- What documents do I need to make a claim?
To make a claim, you’ll usually need a copy of your sleep study or diagnosis, a receipt from the supplier and a completed claim form (or just use your fund’s app if it has one).
Some funds also cover CPAP masks, tubing, or ongoing machine hire, so it’s worth asking what’s included. Bottom line? If you have extras cover, it’s definitely worth checking the fine print, you might be able to save hundreds on your machine. If you’re shopping for a new policy, look for one that specifically includes medical devices or respiratory equipment.
Types of CPAP Machines and Equipment
CPAP & BiPAP Machines
When you start CPAP therapy, the machine is just one part of the setup. The main device delivers a steady stream of air to keep your airways open while you sleep. Some machines offer a fixed air pressure all night, while others adjust the pressure based on how you're breathing. In some cases, especially if regular CPAP isn’t suitable, your doctor might suggest a BiPAP machine, which uses one pressure for breathing in and another for breathing out.
Humidifier
Many machines also come with a built-in humidifier. This helps add moisture to the air, which can make things more comfortable if you tend to wake up with a dry mouth, sore throat, or blocked nose.
Mask
You’ll also need a mask that fits well and suits your sleep style. Some masks sit just under your nose, others go over your nose, and some cover both your nose and mouth. The right one for you depends on how you sleep, whether you breathe through your mouth, and what feels comfortable through the night.
Tubing
Then there’s the tubing, which connects the machine to your mask, and filters, which keep the air clean. These are simple but important parts of the system and need to be replaced every so often to keep everything working properly.
Extras
There are also small extras you might come across, like travel bags, mask cushions, or holders for your hose. Some newer machines even have smart features that track your sleep and let your doctor see how your therapy is going.
How Much Does a CPAP Machine Cost and What Are Your Options?
CPAP machines can be a big investment, especially when you add in the cost of accessories like masks, filters, and tubing. On average in Australia, a standard CPAP machine can range from around $700 to over $2,000, depending on the brand, features, and whether it includes extras like a built-in humidifier or smart tracking.
Then there are the ongoing costs. Masks need to be replaced regularly, and things like filters and tubing wear out over time. These extra costs can add up, so it’s worth factoring them in when you’re deciding what’s right for you.
The good news is that there are ways to make CPAP therapy more affordable. Some providers offer interest-free payment plans, so you can spread the cost out over time rather than paying everything upfront. If you’re eligible, Medicare Australia may cover part of the cost of a diagnostic sleep study, which is often the first step toward starting treatment. However, Medicare doesn’t typically cover the cost of the CPAP machine itself.
Private health insurance might offer a benefit through your extras cover, depending on your level of cover and your fund’s policies. You’ll usually need to pay first, then submit a claim for reimbursement.
In some states, there are also government programs or hospital sleep clinics that may offer subsidies or loan machines for people with higher medical needs or financial hardship. Your doctor or sleep specialist can help guide you through what support is available in your area and how to access it.
Sticking with CPAP Therapy
Once you’ve started using a CPAP machine, sticking with the therapy is key to getting results. It’s not always easy at first, some people take time to adjust to sleeping with a mask or using the machine every night. But using your device consistently, as recommended, is what helps reduce the symptoms of sleep apnea and improve your sleep quality long term.
Most healthcare providers recommend using your CPAP for at least four hours per night, most nights of the week. If you stop or use it only now and then, the benefits drop off. That’s why compliance matters, not just for your health, but also for insurance and support services. In some cases, ongoing access to financial assistance or replacement gear depends on showing that you’re regularly using the machine.
Modern machines often come with built-in monitoring, so usage data can be shared with your respiratory physician or sleep clinic. This helps your care team see how the therapy is going, spot any issues early, and make changes if needed, like adjusting pressure settings or swapping mask types.
Wrapping Up
Managing sleep apnea can feel like a big task, but getting the right support and understanding your options makes a huge difference. Whether you're just starting out with a CPAP machine or looking to upgrade your equipment, knowing what Medicare and private health insurance can cover helps take some of the pressure off, financially and medically.
From diagnosis to daily use, CPAP therapy is most effective when it’s consistent and supported. Taking the time to understand your coverage, compare providers, and ask questions puts you in a better position to manage both your health and costs long term.
Compare Health Insurance CPAP Cover with Health Deal
If you’re unsure which health insurance policy covers CPAP machines or accessories, Health Deal can help. Our free comparison tool makes it easy to review private health policies side by side, so you can see what’s covered, how the benefits stack up, and which options fit your needs.
Looking for personalised advice? A Health Deal insurance specialist can walk you through the details and help you find a policy that suits your equipment needs, health goals, and budget. Call 1300 369 399 or email enquiries@healthdeal.com.au to get started.
Disclaimer
This guide is for informational purposes only and should not be taken as medical or financial advice. Health Deal is proud to partner with a range of health insurance providers. While we strive to provide accurate and up-to-date information, health insurance policies and benefits may change. Always check with a financial professional before making any decisions. Health Deal compares selected products from a panel of trusted insurers but does not compare all products in the market. Before signing up for any policy, make sure to read the Product Disclosure Statement (PDS) and check the fund’s official website for the most up-to-date information. For the most current information, please refer to your chosen health fund’s official website or speak with one of our health insurance experts.
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