Is a CPAP Machine Covered by Medicare?

A Continuous Positive Airway Pressure (CPAP) machine treats obstructive sleep apnea, a condition where breathing repeatedly stops and starts during sleep. These devices deliver a continuous stream of air pressure to keep the airway open, helping individuals achieve more restful sleep and improve overall health. For many, understanding how Medicare covers the cost of such a device is an important consideration when seeking treatment. This article provides an overview of Medicare’s coverage policies for CPAP machines, outlining criteria, process, and financial responsibilities.

Understanding Medicare Coverage for CPAP

Medicare classifies CPAP machines as Durable Medical Equipment (DME). DME includes medical equipment that is used in the home, can withstand repeated use, is primarily for a medical purpose, and is not useful to someone who is not sick or injured. Medicare Part B, which covers medical services and outpatient care, provides coverage for DME, including CPAP machines, when deemed medically necessary. For a CPAP machine to be considered medically necessary, a licensed physician must prescribe it for use in the home. This prescription must be based on a documented diagnosis of obstructive sleep apnea.

Meeting Coverage Criteria

Medicare requires specific medical documentation to cover a CPAP machine. A diagnosis of obstructive sleep apnea (OSA) must be established through a sleep study, which can be conducted either in a sleep lab or as a home sleep test. The results of this study must show an Apnea-Hypopnea Index (AHI) or Respiratory Disturbance Index (RDI) above certain thresholds to qualify for coverage. For example, an AHI/RDI of 15 or more events per hour qualifies, or an AHI/RDI of 5 to 14 events per hour with documented symptoms such as excessive daytime sleepiness, hypertension, or heart disease.

Following the initial diagnosis and prescription, Medicare covers a three-month trial period for the CPAP machine. A follow-up appointment with the prescribing physician is required after the trial period to assess the effectiveness of the treatment and confirm continued medical necessity. Ongoing coverage beyond the trial period depends on demonstrating continued compliance with therapy. Medicare requires evidence that the beneficiary is using the CPAP machine for at least four hours per night on 70% of nights. This usage data is downloaded from the machine by the DME supplier and submitted to Medicare to justify continued coverage for the device.

Getting Your CPAP Machine

Once the medical necessity criteria are met, obtaining a CPAP machine involves working with a Medicare-approved Durable Medical Equipment (DME) supplier. It is important to confirm that the supplier accepts Medicare assignment, meaning they agree to accept the Medicare-approved amount as full payment.

Medicare covers the CPAP machine on a rental basis for a period of 13 months. After the 13-month rental period, if medical necessity and compliance requirements continue to be met, the beneficiary typically owns the CPAP machine. Medicare also covers supplies for the CPAP machine, such as masks, tubing, and filters. These supplies are covered on a regular replacement schedule. The DME supplier manages the resupply process, coordinating with Medicare for billing and delivery.

Your Financial Contribution

Beneficiaries have out-of-pocket costs associated with Medicare coverage for a CPAP machine. Before Medicare begins to pay its share, the annual Medicare Part B deductible must be met. For 2025, this deductible is set at $240. Once the deductible is satisfied, Medicare Part B pays 80% of the Medicare-approved amount for the CPAP machine and its supplies. This means that the beneficiary is responsible for the remaining 20% coinsurance of the Medicare-approved amount. For example, if the Medicare-approved monthly rental for a CPAP machine is $100, the beneficiary would pay $20 per month after meeting their deductible.

Many beneficiaries have supplemental insurance plans, such as Medigap policies or Medicare Advantage Plans (Part C), which can help cover these out-of-pocket expenses. Medigap plans pay the Part B coinsurance after Medicare pays its share. Medicare Advantage Plans, offered by private companies, must cover at least the same benefits as Original Medicare, but they may have different cost-sharing structures, including copayments or coinsurance for DME.