Does Medicare Cover CPAP Machines?

Key Takeaways

• Medicare covers CPAP machines and necessary supplies for people who have been prescribed them for a medically necessary reason, like obstructive sleep apnea.
• After a person has reached their Medicare Part B deductible, they're responsible for 20% of the Medicare-approved total cost for CPAP therapy and supplies.
• CPAP machines are initially covered by Medicare for a 12-week trial to see if a person uses the machine regularly and if the therapy helps reduce symptoms.

Medicare CPAP Coverage

Medicare Part B, the portion of Original Medicare that covers outpatient and medical services, helps pay for both the diagnosis and treatment of OSA, including CPAP therapy.

Who’s Eligible?

People with Medicare Part B coverage who have been prescribed CPAP therapy by a doctor for medically necessary reasons, like obstructive sleep apnea, are eligible to have Medicare cover CPAP therapy.

What’s Covered?

Medicare CPAP coverage begins with a 12-week trial, during which both the CPAP machine and any needed accessories are covered. For continued coverage beyond the trial period, a person must have an in-person appointment with their doctor to confirm that they're regularly using their CPAP device and that the therapy is working.

Generally, Medicare will cover CPAP machines that are being rented from suppliers enrolled in Medicare. These are considered covered durable medical equipment (DME) suppliers. 

Medicare pays for a prescribed CPAP machine for 13 months, as long as the person is using the machine regularly. During this time, a person must pay 20% of the Medicare-approved amount owed for the CPAP rental, beyond their Part B deductible. After 13 months, the patient owns their CPAP machine. 

How Do You Qualify?

People who have been prescribed CPAP therapy for obstructive sleep apnea qualify for Medicare coverage of the therapy. OSA is generally diagnosed through an overnight sleep study conducted in a sleep lab, called polysomnography. A diagnosis may also be made through an at-home sleep test.

Medicare and CPAP Compliance

Medicare will only cover CPAP therapy long term if a person is compliant, which means they regularly use the CPAP machine. Compliance is also called adherence, and it's defined as using the CPAP machine for at least 4 hours per night on 70% or more of the nights in a 30-day period, which comes out to 21 out of every 30 nights.

A doctor will check for CPAP compliance after a patient’s initial 12-week CPAP trial. Modern CPAP machines collect data on usage, including how many hours a person uses the machine each night. By looking at this data, doctors can confirm a patient is meeting the minimum adherence requirements.

Does Medicare Cover CPAP Supplies?

Medicare covers the CPAP supplies that are necessary to use a prescribed CPAP machine, such as tubing and masks. As with the machine itself, the person prescribed CPAP therapy must pay for 20% of the cost of supplies beyond their Part B deductible, while Medicare covers the rest. 

However, Medicare doesn't cover any specialty supplies, like cleaners, wipes, hose holders, and mask liners.

Medicare CPAP Supplies Replacement Schedule

Medicare covers CPAP supplies on a specific schedule and will not cover supplies that are purchased more frequently than that schedule. Medicare covers the following supplies on their listed schedules.

Frequently Asked Questions

What treatment does Medicare cover for sleep apnea?

Medicare covers CPAP therapy for people who have been diagnosed with obstructive sleep apnea. Medicare also covers hypoglossal nerve stimulation, which is an implantable device that treats obstructive sleep apnea. And as of November 2024, Medicare Part D covers Zepbound (tirzepatide), a weight-loss medication that can treat obstructive sleep apnea among people who also have obesity.

How much does a CPAP machine cost with Medicare?

Once a person has met their Medicare Part B deductible, they are responsible for paying 20% of the total cost of a CPAP machine. Medicare pays the remaining 80%. 

The total cost of a CPAP machine commonly falls between $800 and $1,200, so a person on Medicare who is prescribed a CPAP may be responsible for between $160 and $240 total for the machine. Accessories would be an additional cost.

CPAP machine payments are spread out over 13 months, then the sleeper owns the machine and isn't required to make further payments.

How often can I get a new CPAP on Medicare?

Medicare generally covers a new CPAP machine every 5 years. Medicare may replace a CPAP machine sooner if it malfunctions or for some other reason isn't providing effective therapy any longer.

How long will Medicare pay for CPAP supplies?

Medicare provides coverage for CPAP supplies for as long as a person is being prescribed CPAP therapy. After meeting their Medicare Part B deductible, a person receiving this coverage is responsible for 20% of the cost of supplies. Before meeting their deductible, they may be responsible for the full cost of supplies.