Medicare Part B covers CPAP equipment, but only after a sleep study shows you have obstructive sleep apnea

Yes, Medicare Part B pays for CPAP machines and related supplies — but the coverage comes with specific requirements. You must have a sleep study (called a polysomnography) that documents obstructive sleep apnea, and your doctor must write an order for the equipment. Medicare then covers 80% of the approved amount after you meet your Part B deductible. You pay the remaining 20%, plus any difference between what Medicare approves and what the supplier charges.

The coverage includes the CPAP machine itself, the mask, tubing, filters, and other accessories needed to operate it. Medicare also covers replacement parts and supplies as they wear out — typically a new mask every three months and filters every six months, though the exact schedule depends on your equipment and usage.

Key Takeaways

  • You need a documented sleep study showing obstructive sleep apnea and a doctor's written order before Medicare will cover any CPAP equipment.
  • Medicare Part B pays 80% of the approved cost after your deductible; you pay 20% plus any amount the supplier charges above Medicare's approved price.
  • Coverage includes the machine, mask, tubing, filters, and replacement supplies on a regular schedule.
  • You must rent or purchase the equipment from a Medicare-enrolled supplier, not from a retail store or online retailer.
  • After 13 months of rental payments, you own the machine outright and Medicare stops paying for it.

How the sleep study requirement works

Medicare requires a sleep study before it will cover CPAP equipment. This study measures your breathing patterns, oxygen levels, and sleep stages while you sleep. The test can happen in a sleep lab (where you spend the night) or at home with portable equipment that you wear and return the next day.

Your primary care doctor or a sleep specialist orders the study. The results must show that you have obstructive sleep apnea — meaning your airway closes repeatedly during sleep, dropping your oxygen level. If the study shows mild apnea, Medicare may still cover CPAP, but the criteria are stricter. Ask your doctor what the study found and whether Medicare will cover treatment based on those results.

What Medicare pays and what you pay

Medicare Part B covers CPAP equipment at 80% of the amount Medicare has set as the approved price. You pay 20% of that approved amount. However, if the supplier charges more than Medicare's approved price, you also pay the difference — this is called balance billing.

Before any of this happens, you must meet your Part B deductible for the year (the amount is set annually by Medicare). Once you reach that deductible, Medicare's 80% coverage kicks in. If you have a Medigap or Medicare Advantage plan, it may cover some or all of your 20% share, depending on your plan.

Example: Medicare approves $1,000 for a CPAP machine. You have met your deductible. Medicare pays $800. You pay $200. If the supplier charges $1,200, you also pay the extra $200, for a total of $400 out of pocket.

Renting versus buying through Medicare

When you first get CPAP equipment through Medicare, you typically rent it from a supplier. Medicare pays the rental cost directly to the supplier. After 13 months of rental payments, you own the machine — Medicare stops paying, and the equipment is yours to keep.

Some suppliers offer the option to purchase the machine outright instead of renting. If you choose to buy, Medicare covers 80% of the purchase price (after your deductible). Buying upfront may cost less overall than renting for 13 months, but you pay the full amount at once rather than spreading payments over time. Ask your supplier to show you the total cost of renting for 13 months versus buying outright.

Finding a Medicare-enrolled CPAP supplier

You must obtain your CPAP equipment from a Medicare-enrolled durable medical equipment (DME) supplier. Medicare will not cover equipment from retail stores, online retailers, or suppliers who are not enrolled in the Medicare program.

To find an enrolled supplier in your area, use the Medicare Supplier Directory on Medicare.gov, or call 1-800-MEDICARE and ask for suppliers near you. When you call a supplier, confirm that they are Medicare-enrolled and ask whether they accept Medicare assignment — meaning they agree to accept Medicare's approved price and not balance-bill you for the difference.

Your doctor's office may have a preferred supplier they work with regularly. You can use that supplier, or you can choose a different one. Medicare does not restrict your choice, but using a supplier your doctor knows may speed up the paperwork.

Replacement supplies and ongoing coverage

After you receive your initial CPAP machine, Medicare continues to cover replacement supplies as they wear out. Masks typically need replacement every three months; filters every six months; and tubing every three months. The exact schedule depends on your equipment and how often you use it.

Your supplier will track when replacements are due and contact you to arrange them. You pay 20% of the Medicare-approved cost for each replacement, just as you did for the original equipment. If you own the machine outright (after 13 months of rental), Medicare still covers replacement supplies for as long as your doctor's order remains valid — usually five years from the date the order was written.

What happens if you have Medicare Advantage instead of Original Medicare

Medicare Advantage plans (Part C) must cover CPAP equipment at least as well as Original Medicare does, but the details vary by plan. Some Advantage plans cover the same 80% after deductible; others may have different cost-sharing or may require you to use specific suppliers.

Before you get a sleep study or order CPAP equipment, call your Advantage plan and ask about their CPAP coverage. Ask whether they cover the full cost of the sleep study, what your out-of-pocket cost will be for the machine and supplies, and which suppliers are in-network. Using an in-network supplier usually costs you less.

Frequently Asked Questions

Do I need a sleep study if my doctor thinks I have sleep apnea?

Yes. Medicare requires a sleep study with documented results showing obstructive sleep apnea before it will cover CPAP equipment. Your doctor cannot order CPAP based on symptoms alone. The study can be done in a lab or at home, and usually takes one night.

What if I already own a CPAP machine from before I turned 65?

If you have been using a CPAP machine and have a current doctor's order for it, Medicare may cover replacement supplies even if you did not get the original machine through Medicare. Contact a Medicare-enrolled supplier with your prescription and ask whether they can bill Medicare for your masks and filters.

Can I buy a CPAP machine online and have Medicare pay for it?

No. Medicare only pays for equipment obtained from Medicare-enrolled DME suppliers. Online retailers and retail stores are not enrolled, so Medicare will not cover the cost. You would have to pay the full price yourself.

What if the CPAP machine breaks or stops working?

Contact your supplier when ready. If the machine is still under warranty or you are still in the rental period, the supplier should repair or replace it at no cost to you. If you own the machine outright and it breaks, you may need to pay for repairs or buy a new one, though your doctor can write a new order and you can rent a replacement through Medicare.

Does Medicare cover CPAP if I have sleep apnea but do not use the machine regularly?

Medicare covers the equipment regardless of how often you use it, as long as you have a valid doctor's order. However, if you stop using it entirely, talk to your doctor about whether to continue the prescription. Suppliers may also ask about usage before ordering replacement supplies.