Does Medicare Cover CPAP Machines for Sleep Apnea?

Continuous Positive Airway Pressure (CPAP) machines manage obstructive sleep apnea, a common condition where breathing repeatedly stops during sleep. This medical device delivers a steady stream of air pressure through a mask worn during sleep, keeping the airway open and allowing for uninterrupted breathing. For individuals diagnosed, understanding Medicare coverage for CPAP therapy is a frequent concern. Medicare covers CPAP equipment and related services, helping beneficiaries access treatment.

Medicare Part B Coverage for CPAP

Medicare Part B covers CPAP machines and associated supplies as durable medical equipment (DME) when medically necessary. This includes the core CPAP device itself, along with essential components such as the humidifier, air tubing, masks, headgear, and air filters.

Coverage requires a formal diagnosis of obstructive sleep apnea. Medicare Part B also covers diagnostic sleep studies, such as polysomnograms, performed in a sleep laboratory or as an approved home sleep test. These studies confirm sleep apnea’s presence and severity, supporting medical necessity for CPAP therapy.

Meeting Eligibility and Medical Necessity Criteria

Medicare coverage for CPAP therapy requires meeting specific medical criteria. The process begins with a physician’s order for the CPAP machine, following a confirmed diagnosis of obstructive sleep apnea. This diagnosis must be substantiated by a Medicare-approved sleep study, whether conducted in a sleep lab or at home. For example, Medicare considers an Apnea-Hypopnea Index (AHI) of 15 or more events per hour as sufficient for coverage, or an AHI between 5 and 14 events per hour when accompanied by symptoms such as excessive daytime sleepiness or conditions like high blood pressure.

After diagnosis and prescription, Medicare covers a three-month trial period for CPAP therapy. During this period, the beneficiary uses the machine, allowing assessment of its effectiveness. For continued coverage, the treating physician must conduct a follow-up assessment. This assessment documents that the CPAP therapy improves the patient’s condition and confirms consistent usage.

Ongoing compliance is required for continued Medicare coverage. This often means demonstrating that the CPAP machine is used for a specified duration, such as at least four hours per night on 70% of nights within a 30-day period. The physician must document adherence and the therapy’s continued benefit. If these usage and effectiveness criteria are not met, Medicare may discontinue coverage for the CPAP machine.

Getting Your CPAP Equipment and Supplies

Once eligibility and medical necessity criteria are satisfied, acquire CPAP equipment and accessories. Beneficiaries must obtain their CPAP machine and supplies from a Medicare-enrolled DME supplier that accepts assignment.

Medicare covers the CPAP machine through an initial rental arrangement. After 13 continuous months of rental payments, with consistent usage and medical necessity, Medicare considers the machine owned by the beneficiary. After the machine is owned, Medicare may cover a replacement machine every five years, or sooner if there is documented evidence of irreparable damage, loss, or theft.

Medicare also covers regular replacement of CPAP supplies, essential for hygiene and effective therapy. Common replacement schedules under Medicare guidelines include:
Mask cushions every month
Disposable filters monthly
Non-disposable filters every six months
Masks, tubing, and headgear every three to six months

Understanding Your Out-of-Pocket Costs

While Medicare covers CPAP therapy, beneficiaries are responsible for out-of-pocket costs. For items covered under Medicare Part B, such as CPAP machines and supplies, the annual Part B deductible applies. For 2025, this deductible is $257. After meeting this deductible, Medicare generally pays 80% of the Medicare-approved amount for CPAP machine rental and supplies.

The remaining 20% is the beneficiary’s coinsurance responsibility. For example, if the Medicare-approved amount for a service or item is $100, Medicare pays $80, and the beneficiary pays $20 after the deductible. Confirm that the DME supplier accepts “assignment.” An agreement to accept assignment means the supplier agrees to accept the Medicare-approved amount as full payment for covered services and cannot charge the beneficiary more than the deductible and coinsurance.

Supplemental insurance plans, such as Medigap policies or Medicare Advantage (Part C) plans, can help cover these out-of-pocket costs. Medigap plans are designed to pay for some or all of the coinsurance and deductibles that Original Medicare does not cover. Medicare Advantage plans, which are offered by private companies, must provide at least the same coverage as Original Medicare, but they may have different cost-sharing structures, including varying deductibles, copayments, and coinsurance amounts.