Does Medicare Pay for CPAP Equipment?

Continuous Positive Airway Pressure (CPAP) machines serve as a primary treatment for sleep apnea, a condition where breathing repeatedly stops and starts during sleep. This device delivers a continuous stream of air pressure through a mask, keeping the airway open and allowing for uninterrupted breathing. CPAP therapy can significantly improve sleep quality and reduce health risks associated with sleep apnea, such as heart disease and stroke. Understanding how Medicare covers this equipment is important for beneficiaries seeking treatment.

Medicare Coverage Requirements for CPAP

Medicare Part B generally covers CPAP equipment as durable medical equipment (DME) when it is considered medically necessary. For Medicare to cover CPAP therapy, a diagnosis of obstructive sleep apnea (OSA) must be established through a sleep study. This study can be conducted in a Medicare-approved facility or at home using a qualifying device. Your doctor must document the medical necessity and provide a prescription for the CPAP machine and its accessories.

Medicare typically covers a 3-month trial period for CPAP therapy, including the machine and necessary accessories like masks and tubing. Continued coverage beyond this initial trial period depends on demonstrating consistent usage, referred to as compliance. Medicare defines compliance as using the CPAP machine for at least 4 hours per night on 70% of nights within a consecutive 30-day period. A face-to-face follow-up visit with your doctor is required between day 31 and day 90 of the trial to confirm adherence.

The Process of Getting CPAP Equipment

After meeting the medical requirements, your doctor will provide the necessary prescription and documentation, which outlines the type of CPAP machine and settings. This documentation is necessary for Medicare approval.

Select a durable medical equipment (DME) supplier that is enrolled in and accepts Medicare assignment. Accepting assignment means the supplier agrees to accept the Medicare-approved amount as full payment, limiting your out-of-pocket costs to the deductible and coinsurance. You can find Medicare-approved suppliers by asking your doctor for recommendations or by using Medicare’s online supplier directory. Once the supplier receives your prescription, they will arrange for the delivery of the equipment and provide initial setup and training on its proper use. Ongoing monitoring of your CPAP usage data is often shared electronically with your doctor and supplier to ensure compliance with Medicare requirements.

Costs for CPAP Equipment and Supplies

When Medicare covers CPAP equipment, the annual Medicare Part B deductible must be met before coverage begins. For 2025, the Part B deductible is $257. Once the deductible is met, Medicare typically pays 80% of the Medicare-approved amount for the CPAP machine and supplies. The beneficiary is responsible for the remaining 20% coinsurance.

CPAP machines are often rented before ownership transfers to the beneficiary. Medicare covers the rental of the CPAP machine for 13 continuous months, provided compliance requirements are met. After this 13-month rental period, the beneficiary gains ownership of the machine.

Medicare Part B also covers necessary accessories and replacement parts, such as masks, tubing, and filters, as they are considered DME. Replacement schedules for these supplies vary; mask cushions and disposable filters are often replaced monthly, while tubing and full masks typically have a 3-month replacement cycle. Non-disposable filters and humidifier water chambers may be replaced every six months.