Yes, Medicare covers sleep apnea machines, but only after a sleep study and a doctor's prescription

Medicare Part B covers continuous positive airway pressure (CPAP) machines and similar devices used to treat obstructive sleep apnea, but the coverage comes with specific requirements. You must have a sleep study on record showing you have sleep apnea, a doctor must prescribe the machine, and you must meet Medicare's rules about where you rent or buy it. Medicare pays 80 percent of the approved amount after you meet your Part B deductible; you pay the remaining 20 percent.

The machine itself is covered as durable medical equipment (DME). This means Medicare treats it the same way it treats wheelchairs, oxygen tanks, and hospital beds — you can rent it month to month, or buy it outright. Most people rent through a Medicare-approved DME supplier, which is usually simpler than buying.

Key Takeaways

  • You need a sleep study showing obstructive sleep apnea and a written prescription from your doctor before Medicare will cover any machine.
  • Medicare pays 80 percent of the approved rental or purchase price after your Part B deductible is met; you pay 20 percent.
  • You must order the machine from a Medicare-approved DME supplier, not directly from a manufacturer or online retailer.
  • If you rent, Medicare covers the first 13 months; after that, you own the machine and Medicare stops paying for it.
  • Supplemental insurance (Medigap) may cover your 20 percent share, depending on which plan you have.

What Medicare requires before covering a CPAP machine

Medicare will not pay for a sleep apnea machine without proof that you have the condition. This proof comes from a sleep study — either an in-lab study at a sleep center or a home sleep test ordered by your doctor. The study must show that you have obstructive sleep apnea (OSA). If the study shows mild sleep apnea, Medicare may still cover the machine, but your doctor must document that you tried other treatments first or that other treatments are not suitable for you.

Your doctor must then write a prescription for the specific machine and settings you need. The prescription goes to a Medicare-approved DME supplier, not to you. You cannot order directly from the manufacturer or from a non-approved retailer and expect Medicare to pay. The supplier will contact Medicare to confirm coverage before sending the machine to you.

If you have already been using a CPAP machine without a sleep study on file, you will need to have one done before Medicare will cover future rentals or a replacement machine. This is a common gap — many people bought machines years ago without formal testing.

How much you pay: rental versus purchase

The cost to you depends on whether you rent or buy, and on what Medicare's approved amount is in your area. Medicare sets an approved amount for each type of machine; the supplier can charge no more than that amount. You pay 20 percent of the approved amount after your Part B deductible ($240 in 2024, though this changes yearly).

If you rent, you typically pay a monthly fee. For example, if Medicare's approved amount is $150 per month, you would pay $30 per month (20 percent) after meeting your deductible. After 13 months of rental payments, you own the machine outright, and Medicare stops paying. At that point, you own it and can keep using it for free.

If you buy outright, you pay 20 percent of the purchase price upfront. A CPAP machine's approved purchase price ranges from roughly $500 to $3,000 depending on the type and features, so your 20 percent share could be $100 to $600. After you pay, the machine is yours, and Medicare does not cover future supplies like masks or filters — those are your responsibility.

Many people find renting cheaper in the short term because the monthly payment is small. But if you use the machine for more than 13 months, buying becomes the better deal because you own it after that and pay nothing more to Medicare.

Finding a Medicare-approved DME supplier

Not every medical supply store or online retailer is a Medicare-approved DME supplier. If you use a non-approved supplier, Medicare will not pay, and you will owe the full cost. To find an approved supplier, use the Medicare DME Supplier Locator on Medicare.gov, or call Medicare at 1-800-MEDICARE (1-800-633-4227) and ask for suppliers in your area.

When you contact a supplier, tell them you have a prescription for a CPAP machine and ask them to verify your Medicare coverage before you commit. A good supplier will do this automatically — they will contact Medicare, confirm your deductible status, and tell you exactly what you will owe. They will also handle the paperwork with Medicare so you do not have to.

If you already have a supplier you trust, check whether they are Medicare-approved by searching the locator or asking them directly. Many local medical supply stores are approved; so are large national chains. Online retailers are sometimes approved and sometimes not — do not assume.

What happens after 13 months of rental

If you rent a CPAP machine through Medicare, the rental period lasts 13 months. After 13 months, you own the machine, and Medicare's payment obligation ends. You keep the machine and can use it indefinitely at no cost to Medicare.

If the machine breaks or stops working after you own it, Medicare does not cover repair or replacement. You would have to buy a new one out of pocket, or start a new rental agreement (which would restart the 13-month clock). Some people choose to buy a replacement machine at that point rather than rent again.

Supplies like masks, tubing, filters, and headgear are covered separately under Medicare Part B as replacement supplies. After you own the machine, Medicare will still cover 80 percent of approved replacement supplies for as long as you use the machine — you just have to order them from an approved DME supplier.

Medigap and Medicare Advantage coverage of your 20 percent share

If you have a Medigap (supplemental insurance) plan, it may cover your 20 percent coinsurance. Most Medigap plans cover Part B coinsurance, which includes the 20 percent you owe for the CPAP machine. Check your plan documents or call your Medigap insurer to confirm. If your plan covers it, you will owe nothing out of pocket once your Part B deductible is met.

If you have Medicare Advantage (Part C), coverage works differently. Medicare Advantage plans must cover at least what Original Medicare covers, but they set their own copays and coinsurance amounts. Some plans cover CPAP machines with a small copay; others require 20 percent coinsurance like Original Medicare. Check your plan's formulary or call the plan directly to find out what you will owe.

If you do not have supplemental coverage and cannot afford the 20 percent share, ask the DME supplier whether they offer payment plans or whether there are any programs in your area that help with equipment costs.

Common reasons Medicare denies CPAP coverage

Medicare denies CPAP coverage most often because there is no sleep study on file, the study did not show obstructive sleep apnea, or the prescription came from a provider who is not a doctor (such as a nurse practitioner or physician assistant, depending on your state's rules). If your claim is denied, the denial letter will say why. You have the right to appeal.

Another common reason is ordering from a non-approved supplier. If you buy a CPAP machine from an online retailer or manufacturer and then submit the receipt to Medicare, Medicare will deny it because the supplier was not approved. This is why checking the supplier's status before you order is critical.

If your denial was because of the supplier, you can still get coverage by ordering from an approved supplier and resubmitting. If the denial was because of the sleep study, you will need to have a study done and resubmit the claim with the study results attached.

Frequently Asked Questions

Do I need a new sleep study if I already have one from years ago?

Medicare will usually accept a sleep study that is more than a few years old, but your doctor may want a new one if your symptoms have changed or if you have not been treated in a long time. Ask your doctor whether the old study is still valid for Medicare purposes. If Medicare questions it, you can always have a new study done — home sleep tests are quick and often covered by insurance.

Can I use a CPAP machine from a family member or buy a used one?

Medicare will not cover a used machine or one that was not prescribed to you. You need your own prescription and your own machine ordered from an approved supplier. Using someone else's machine also means you will not have the correct settings for your airway, which reduces how well it works.

What if I have both Medicare and Medicaid?

Medicare is the primary payer, and Medicaid may cover costs that Medicare does not. Contact your state Medicaid office to ask whether they cover the 20 percent coinsurance or any other CPAP-related costs. Rules vary by state.

Does Medicare cover BiPAP or other machines besides CPAP?

Yes. Medicare covers CPAP, BiPAP (bilevel positive airway pressure), and APAP (automatic positive airway pressure) machines under the same rules. Your doctor will prescribe whichever type is best for your condition. The coverage and cost-sharing are the same regardless of machine type.

What if I cannot tolerate the machine or want to stop using it?

If you are renting and decide to stop, contact the DME supplier and ask to end the rental. You will stop paying, and Medicare will stop paying. If you have already paid for 13 months and own the machine, it is yours to keep or discard. There is no penalty for stopping treatment, but untreated sleep apnea does carry health risks — talk to your doctor before you quit.