What Medicare Covers for CPAP Machines and Sleep Apnea Equipment

Medicare Part B covers CPAP machines, but only after a sleep study confirms you have obstructive sleep apnea and your doctor writes an order for the device

Medicare will pay for a CPAP machine, the tubing, the mask, and replacement parts — but the coverage comes with conditions. You must have a diagnosis of obstructive sleep apnea confirmed by an in-lab sleep study or a home sleep test that meets Medicare's standards. Your doctor must then order the CPAP as medically necessary. Without that documented diagnosis and order, Medicare will not cover the machine.

Coverage is split between what Medicare pays and what you pay. Medicare Part B covers 80 percent of the approved amount after you meet your annual deductible. You pay the remaining 20 percent, plus any difference between what the supplier charges and what Medicare allows. If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower.

Key Takeaways

You need a sleep study showing obstructive sleep apnea and a doctor's written order before Medicare will cover a CPAP machine.
Medicare Part B pays 80 percent of the approved amount; you pay 20 percent after meeting your deductible.
The first month of rental is covered separately, and then Medicare covers up to 13 months of rental before you own the machine outright.
You must use a Medicare-enrolled CPAP supplier, and the supplier must submit the claim with your sleep study results and doctor's order attached.
If you already own a CPAP or have one from another insurance, tell Medicare before starting — you may not be covered for a second machine.

How the sleep study requirement works

Medicare requires proof that you have obstructive sleep apnea before covering a CPAP. That proof comes from either an in-lab sleep study (polysomnography) or a home sleep apnea test. The test must show an apnea-hypopnea index (AHI) of 15 or higher, or an AHI of 5 to 14 if you also have symptoms like daytime sleepiness or witnessed breathing pauses.

Your primary care doctor can order the sleep study. If you do not have one, ask your insurance plan for a referral to a sleep medicine specialist. The study itself is usually covered by Medicare Part B before you ever get a CPAP, so the cost to you is your deductible and 20 percent coinsurance. Keep the sleep study report — you will need to give it to the CPAP supplier when you order the machine.

What Medicare pays for and what you pay

Medicare Part B covers the CPAP machine itself, the mask, the tubing, filters, and replacement parts like headgear straps. The coverage works as a rental-to-own arrangement. You rent the machine for 13 months, and Medicare pays 80 percent of the monthly rental fee. After 13 months, you own the machine outright and Medicare stops paying for it.

Your costs depend on the approved amount Medicare sets for your area. If the supplier charges more than the Medicare-approved amount, you pay the difference in full — Medicare does not count it toward your deductible or coinsurance. For example, if Medicare approves $150 per month and the supplier charges $200, Medicare pays $120 (80 percent of $150), you pay $30 (20 percent of $150), and you also pay the $50 difference out of pocket.

After you own the machine (after month 13), Medicare covers replacement masks and supplies for another 5 years, paying 80 percent of the approved amount. You pay 20 percent. After 5 years, you can rent or buy a new machine and the cycle repeats.

Finding a Medicare-enrolled CPAP supplier

You must order your CPAP from a supplier enrolled in Medicare. Not all medical equipment companies are enrolled, and not all enrolled suppliers serve your area. The easiest way to find one is to call your Medicare plan or visit the Medicare provider search tool at Medicare.gov. You can also ask your sleep doctor or primary care doctor for a referral — they often work with specific suppliers.

When you contact a supplier, have your sleep study report and your doctor's order ready. The supplier will verify that you are enrolled in Medicare Part B, confirm your deductible status, and explain your out-of-pocket costs. They will also handle submitting the claim to Medicare, but they need your sleep study results and doctor's order attached to the claim or Medicare will deny it.

What happens if you already own a CPAP

If you bought a CPAP before enrolling in Medicare, or if another insurance covered one, tell Medicare and your new supplier before ordering. Medicare will not cover a second machine if you already own one that is in working condition. The same rule applies if you are switching from one Medicare plan to another — you cannot get a new machine covered just because your plan changed.

The exception is if your machine is broken beyond repair and cannot be fixed. In that case, your doctor can write a new order and you can rent a replacement machine. You will need documentation from a repair technician showing the machine cannot be repaired, or a statement from your doctor that it is no longer medically appropriate.

Medicare Advantage plans and CPAP coverage

If you have a Medicare Advantage plan (Part C) instead of Original Medicare, your coverage for CPAP machines may differ. Some Advantage plans cover CPAP the same way Original Medicare does. Others require prior authorization before you order, or they may have a different list of approved suppliers. A few plans cover CPAP at a lower out-of-pocket cost than Original Medicare.

Call your Medicare Advantage plan before you order a CPAP to ask about their specific rules. Ask whether they require prior authorization, which suppliers they prefer, and what your coinsurance will be. If your plan denies coverage, you have the right to appeal — ask the plan for their appeal process.

Common reasons Medicare denies CPAP coverage

The most common reason for denial is a missing or incomplete sleep study. If your test was done at home but did not follow Medicare's technical standards, or if the results do not show an AHI high enough to meet Medicare's threshold, the claim will be denied. Ask your doctor or the testing facility to confirm that the study meets Medicare requirements before you order the machine.

A second common reason is using a non-enrolled supplier. If the supplier is not enrolled in Medicare, Medicare will not pay for the machine even if you are covered. Always verify enrollment before ordering. A third reason is ordering without a doctor's written order. The supplier must have a signed order from your doctor stating that CPAP is medically necessary — a verbal conversation is not enough.

If Medicare denies your claim, the supplier will send you a notice explaining why. You can ask the supplier to resubmit if the denial was due to a missing document, or you can file an appeal with Medicare. The appeal process usually takes 30 to 60 days.

Frequently Asked Questions

Do I have to rent the CPAP for 13 months, or can I buy it outright?

Medicare's coverage is structured as a rental-to-own plan, so you cannot skip the rental period and buy when ready. You must rent for 13 months before you own it. Some suppliers offer the option to buy before 13 months, but Medicare will not reimburse you for the purchase — you would pay the full cost yourself.

What if my CPAP mask does not fit or I need a different style?

Medicare covers mask replacements and different mask styles as medically necessary supplies. Your doctor or the supplier can request a different mask type if the first one does not work for you. The supplier will submit the request to Medicare, and if approved, Medicare will cover 80 percent of the new mask. You may need a note from your doctor explaining why the change is medically necessary.

Does Medicare cover CPAP machines for central sleep apnea?

Medicare covers CPAP for obstructive sleep apnea only. If you have central sleep apnea or mixed sleep apnea, your doctor may prescribe a different device, such as a BiPAP or APAP machine. Coverage for those devices follows the same rules as CPAP — you need a sleep study, a doctor's order, and a Medicare-enrolled supplier.

What happens after I own the machine — do I have to keep paying?

After 13 months, you own the machine and Medicare stops paying for the machine itself. However, Medicare continues to cover replacement masks, filters, and tubing for up to 5 years total from the start date. You pay 20 percent coinsurance for those supplies. After 5 years, you can order a new machine and start the rental-to-own cycle again.

Can I use my CPAP if I travel outside the United States?

Medicare covers your CPAP machine itself, so you can take it with you when you travel. However, Medicare does not cover repairs or replacements outside the United States. If your machine breaks while you are abroad, you will have to pay for repairs out of pocket or wait until you return home.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.