Medicare covers sleep apnea testing and equipment, but only if your doctor orders them and you meet specific requirements

Medicare Part B covers a sleep study (called a polysomnography) if your doctor refers you to a sleep specialist or certified sleep center. If the study shows you have obstructive sleep apnea, Medicare will then cover a CPAP machine, BiPAP machine, or APAP machine — the devices that deliver pressurized air to keep your airway open while you sleep.

The coverage is not automatic. Your doctor must document that you have symptoms of sleep apnea (such as daytime sleepiness, witnessed breathing pauses, or high blood pressure) and order the test through a Medicare-approved facility. Once you have a diagnosis, your doctor writes a prescription for the equipment, and you obtain it from a Medicare-approved durable medical equipment (DME) supplier.

Medicare covers the machine itself, the mask, tubing, and filters. You pay 20 percent of the approved amount after you meet your Part B deductible. If you use a supplier outside the Medicare network, you may pay more out of pocket.

Key Takeaways

  • Your doctor must order a sleep study at a Medicare-approved center; you cannot order one yourself.
  • Medicare covers the sleep test, the CPAP or BiPAP machine, and supplies like masks and filters after diagnosis.
  • You pay 20 percent coinsurance after your Part B deductible; the exact cost depends on the equipment your doctor prescribes.
  • You must use a Medicare-approved DME supplier to get the lowest out-of-pocket cost.
  • Medicare requires a new prescription every 12 months and covers replacement equipment on a set schedule.

How the sleep study works and what it costs you

A sleep study can happen in a lab (where you sleep overnight while sensors monitor your breathing, heart rate, and oxygen levels) or at home using a portable device your doctor sends you. Both types are covered by Medicare Part B if ordered by your doctor.

You pay 20 percent of Medicare's approved amount for the study after you meet your Part B deductible ($240 in 2024, though this amount changes yearly). The lab or testing center bills Medicare directly, and you receive a bill for your share. If the study is done at home, the equipment supplier sends it to you, and Medicare covers the cost the same way.

Your doctor reviews the results. If sleep apnea is confirmed, your doctor writes a prescription for a CPAP, BiPAP, or APAP machine and specifies the pressure settings based on your test results.

What equipment Medicare covers and replacement schedules

Medicare covers three types of machines: CPAP (continuous positive airway pressure), BiPAP (bilevel positive airway pressure), and APAP (automatic positive airway pressure). Your doctor chooses which type based on your test results and how well you tolerate the pressure. Medicare also covers the mask (nasal, full-face, or nasal pillows), tubing, filters, and a humidifier if your doctor prescribes one.

You pay 20 percent coinsurance on the machine and supplies. The total approved amount varies by machine type and supplier, but a CPAP machine typically costs Medicare $500 to $800, meaning you would pay roughly $100 to $160 after your deductible.

Medicare covers a replacement machine every five years. Masks, tubing, and filters are replaced more often: masks every three months, tubing every three months, and filters every three months (or more frequently if you use a humidifier). Your DME supplier tracks these dates and sends replacements automatically if you stay with the same supplier.

How to find a Medicare-approved DME supplier

Not all medical equipment stores are Medicare-approved. Using an approved supplier ensures Medicare pays its share and you pay the correct coinsurance amount. You can search for suppliers on the Medicare website using the DME supplier locator tool, or ask your doctor which suppliers they work with.

When you contact a supplier, give them your Medicare number and your doctor's prescription. The supplier verifies your coverage, tells you what you will owe, and arranges delivery. Some suppliers offer setup and training on how to use the machine; ask whether this is included.

If you use a non-approved supplier, Medicare will not pay, and you pay the full cost. Even if a supplier claims to be Medicare-approved, verify this yourself on the Medicare website before ordering.

Your ongoing costs and what happens if you stop using the machine

After you meet your Part B deductible, you pay 20 percent of the approved amount for the initial machine and supplies. For replacement supplies (masks, filters, tubing), you pay 20 percent each time. If you have a Medigap or Medicare Advantage plan, your supplemental coverage may reduce or eliminate this coinsurance.

Medicare requires your doctor to recertify your need for the machine every 12 months. Your supplier will contact your doctor to renew the prescription. If your doctor does not recertify, Medicare stops covering supplies and replacements. If you stop using the machine for an extended period, tell your supplier so they do not send supplies you are not using.

If you switch suppliers, the new supplier can request your records from the old one, but you may experience a gap in supply delivery. Plan the switch during a time when you have extra masks and filters on hand.

What Medicare does not cover for sleep apnea

Medicare does not cover oral appliances (dental devices that reposition the jaw to open the airway), even though some people use them instead of CPAP machines. If your doctor recommends an oral appliance, you pay the full cost out of pocket, though some dental insurance plans may cover part of it.

Medicare also does not cover sleep apnea surgery (such as uvulopalatopharyngoplasty or UPPP) as a first-line treatment. Surgery is considered only after CPAP or other treatments have been tried and failed, and coverage varies by plan.

Accessories beyond the standard mask, tubing, and filters — such as travel cases, heated tubing, or specialty masks — are not covered. You can purchase these yourself if you want them.

Frequently Asked Questions

Do I need a sleep study if my doctor suspects sleep apnea?

Yes. Medicare requires a sleep study ordered by your doctor before covering a CPAP machine. Your doctor cannot prescribe the machine based on symptoms alone. The study confirms the diagnosis and measures the severity, which determines the pressure settings your machine needs.

Can I use my CPAP machine from a previous insurance after I turn 65 and get Medicare?

You can use your old machine, but Medicare will not pay for it retroactively. If you want Medicare to cover a new machine, you need a new sleep study and prescription from a Medicare-approved provider. If your old machine still works well, you can keep using it and pay for supplies yourself, or ask your doctor whether Medicare will cover replacement supplies for your existing machine.

What if I cannot afford the 20 percent coinsurance?

Talk to your DME supplier about payment plans. Some suppliers offer monthly payment options. If you have limited income, you may be may be able to access for Medicaid in your state, which could cover your coinsurance. Contact your state Medicaid office or a local Area Agency on Aging to learn what programs may be available in your area.

Will my Medicare Advantage plan cover sleep apnea equipment the same way?

Medicare Advantage plans must cover at least what Original Medicare covers, but they may have different copays, coinsurance, or supplier networks. Check your plan's coverage details or call the plan before ordering equipment. Some Advantage plans cover oral appliances or other treatments that Original Medicare does not.

How do I know if my DME supplier is actually Medicare-approved?

Use the Medicare DME supplier locator on Medicare.gov and search by your zip code. Call Medicare at 1-800-MEDICARE if you are unsure. Never rely on a supplier's word alone — verify the approval yourself before placing an order.