How Long Will Medicare Pay for CPAP Supplies?

Key Takeaways

• Medicare will pay for CPAP supplies indefinitely for as long as you continue to meet the requirements.
• To qualify for Medicare coverage, you first need to pass a 3-month trial period to prove that CPAP therapy is helping you.
• Medicare also covers the cost of replacement parts according to pre-established replacement schedules.

Does Medicare Cover CPAP Supplies?

Under the Durable Medical Equipment (DME) Act, Medicare may cover the cost of CPAP if you’ve had it prescribed for medical reasons, such as to treat obstructive sleep apnea (OSA). This includes the CPAP device, as well as necessary accessories and their replacements, such as filters, tubing, and humidifier water chambers. However, it doesn’t cover optional accessories such as mask liners or CPAP pillows.

CPAP therapy falls under Medicare Part B coverage, an optional component of Medicare that covers outpatient medical services, including physician visits, preventative care, and DME like CPAP. 

Each year, you must pay a certain amount of your healthcare costs, called a deductible, before Medicare coverage kicks in. Once you meet the Part B deductible, Medicare will cover 80% of the Medicare-approved cost to rent a CPAP machine and the necessary accessories. You’re responsible for paying the remaining 20%, called the “coinsurance,” and any extra cost over and above the Medicare-approved amount. 

Medicare typically pays its share of the cost directly to participating providers through assignment, meaning you only have to pay your share and don’t have to wait for Medicare to reimburse you. For providers who don’t accept assignment, you may need to pay up front and apply for reimbursement from Medicare.

To ensure you qualify for coverage under Medicare, be sure to double-check that your provider is enrolled in Medicare. Details regarding out-of-pocket costs and qualified DME providers may vary if you use Medicare Advantage, also called Part C.

How Long Will Medicare Pay for CPAP Supplies?

Since CPAP therapy is considered an ongoing treatment, Medicare will continue to pay for CPAP supplies and replacement parts for as long as you can prove the therapy is helping manage your obstructive sleep apnea.

Initially, Medicare foots the bill for a 12-week trial period. During this time, your CPAP device monitors whether the therapy is helping with your OSA symptoms. At the end of the 12-week trial period, once you meet with your doctor and they confirm that CPAP therapy is helping you, Medicare will extend coverage on an ongoing basis, as long as CPAP usage recorded by the machine meets minimum usage requirement.

Under Medicare, you rent the CPAP machine from the DME supplier for the first 13 months through monthly payments that are subsidized by Medicare. If you meet the usage criteria, the machine then becomes yours, and you can continue using it until it’s time for a new one.

Medicare CPAP Supplies Replacement Schedule

CPAP accessories undergo heavy use and need to be replaced periodically to ensure the system can perform at its best. Medicare establishes schedules to determine how often you can apply for coverage of replacement parts and replacement CPAP machines.

How to Get Medicare to Cover Your CPAP Supplies

To get Medicare to cover your CPAP supplies, you’ll need to present a diagnosis of obstructive sleep apnea and a prescription for CPAP therapy. You can get a diagnosis for obstructive sleep apnea by asking your doctor to refer you for a sleep test in a lab, called polysomnography. 

An easier alternative to in-lab polysomnography is to do an at-home sleep apnea test. Sleep Doctor offers at-home sleep studies in which you work with a licensed physician to carry out sleep apnea testing and diagnosis in the comfort of your own home.

To qualify for CPAP supply coverage from Medicare, you first need to pass a 3-month trial period. Your CPAP machine records information about how many hours you use your CPAP therapy every night, and statistics on whether it’s helping your breathing during sleep.

During this trial period, Medicare requires that you meet a minimum usage requirement: using your CPAP device for at least 4 hours on at least 70% of nights during a 30-night period for the first 90 days. This means you need to meet the 4-hour minimum on 21 nights or more. That said, research shows that using CPAP therapy for 5 or 6 hours is better than using it for just 4 hours, so try to use it as much as possible.

If the stats show that CPAP therapy is beneficial and that you’re using it regularly, Medicare will approve ongoing CPAP therapy. You’ll need to continue meeting minimum usage requirements — referred to as “compliance” or “adherence” — to remain eligible for Medicare coverage.

You may also be able to apply for coverage if you already use a CPAP device before you signed up for Medicare. The procedure for applying may be different if you already use a CPAP device.