Are CPAP Machines Covered by Medicare?
Learn how Medicare supports CPAP therapy. Understand the full process for coverage, obtaining your device, and managing associated financial details.
Continuous Positive Airway Pressure (CPAP) machines provide a steady flow of air to help individuals with sleep apnea breathe consistently during sleep. This therapy prevents breathing interruptions caused by obstructive sleep apnea (OSA). Medicare, the federal health insurance program, offers coverage for CPAP machines and related supplies for eligible beneficiaries. This coverage is subject to specific criteria and processes to ensure medical necessity and proper utilization.
Medicare’s Coverage Criteria for CPAP Machines
Medicare covers CPAP machines and supplies as Durable Medical Equipment (DME) under Medicare Part B. A medical diagnosis of obstructive sleep apnea (OSA) and a doctor’s order are required for coverage. Both the prescribing doctor and the equipment supplier must be enrolled in Medicare.
Coverage includes the CPAP machine, masks, tubing, headgear, and humidifiers. Replacement supplies like filters and mask cushions are also covered on a regular schedule to maintain effectiveness and hygiene.
Medicare’s coverage begins with an initial 3-month trial period. Continued coverage beyond this period depends on a follow-up appointment with the prescribing physician, who must document therapy effectiveness and adherence. Ongoing coverage for supplies is contingent on demonstrating compliance with CPAP use.
Steps to Qualify for CPAP Coverage
Qualifying for Medicare coverage begins with a diagnosis of sleep apnea. This diagnosis involves a sleep study, conducted either in a lab or at home. A qualified physician must interpret the results and formally diagnose obstructive sleep apnea based on specific criteria.
Following a confirmed diagnosis, the treating physician must issue a written prescription for a CPAP machine. This prescription serves as the medical order. Medicare requires this physician’s order to initiate coverage for the equipment.
The initial 3-month trial period monitors adherence to the prescribed therapy. CPAP machines record usage data, which is reviewed to confirm consistent use, typically for at least four hours per night on 70% of nights within a 30-day period. This data supports the follow-up appointment with the doctor after the initial trial. During this visit, the physician evaluates the therapy’s effectiveness and confirms the continued medical need, documenting this assessment to support ongoing Medicare coverage.
Acquiring Your CPAP Machine Through Medicare
Once qualification requirements are met, acquiring the CPAP machine involves working with a Durable Medical Equipment (DME) supplier. Select a supplier enrolled in and accepting Medicare assignments to ensure Medicare processes the claims for the equipment.
The DME supplier handles claim submission directly to Medicare on behalf of the patient. Patients should confirm their chosen supplier manages this to avoid unexpected charges.
Medicare typically covers CPAP machines on a rental basis for 13 continuous months. After this period, the patient generally owns the machine. During the rental period, ongoing compliance with usage requirements must be maintained for Medicare to continue payments. Replacement supplies like masks, tubing, and filters can be ordered through the DME supplier, with Medicare covering these items as long as medical necessity and compliance standards are met.
Understanding Your Share of Costs
When Medicare covers a CPAP machine, the annual Medicare Part B deductible must be met before Medicare pays its share. For 2025, the deductible is $257. After this is satisfied, Medicare generally pays 80% of the Medicare-approved amount for Durable Medical Equipment, including CPAP machines and supplies.
The patient is responsible for the remaining 20% coinsurance of the Medicare-approved amount. This coinsurance applies to rental payments during the 13-month rental period. Once the machine is owned, the 20% coinsurance continues to apply to the cost of ongoing replacement supplies.
Some beneficiaries may have additional insurance, such as Medigap policies or Medicare Advantage plans, which can help cover these out-of-pocket costs. Medigap plans may pay the 20% coinsurance not covered by Original Medicare. Medicare Advantage plans must provide at least the same coverage as Original Medicare Part B, but their specific cost-sharing structures can vary by plan.