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

Medicare will pay for the machine itself, the mask, tubing, and filters — but not all at once. The coverage splits into rental payments for the first 13 months, then ownership transfers to you. You pay 20 percent of the approved amount after you meet your Part B deductible. If you use a supplier outside Medicare's network, you may pay more out of pocket.

The sleep study that triggers coverage must happen in a lab or at home with equipment that meets Medicare's standards. Your primary care doctor or a sleep specialist can order it. Once the results confirm sleep apnea, your doctor submits an order to a DMEPOS supplier — that is, a Durable Medical Equipment, Prosthetics, Orthotics, and Supplies company approved by Medicare. The supplier handles the paperwork with Medicare and ships the machine to you.

Key Takeaways

  • Medicare Part B covers CPAP machines only after a sleep study confirms obstructive sleep apnea and your doctor writes an order.
  • You pay 20 percent of the Medicare-approved amount after your Part B deductible, and the machine is rented to you for 13 months before you own it.
  • The sleep study can happen at a hospital sleep lab or at home, but the equipment must meet Medicare's technical standards.
  • You must use a Medicare-approved DMEPOS supplier, or you will likely pay the full cost yourself.

What the Sleep Study Must Show

Medicare requires a sleep study that documents the number of breathing interruptions per hour — called the apnea-hypopnea index, or AHI. Your AHI must be 15 or higher to meet Medicare's threshold, or 5 to 14 if you also have symptoms like daytime sleepiness, gasping awake, or witnessed breathing pauses.

The study can be an in-lab test at a hospital or accredited sleep center, where technicians attach sensors and monitor you overnight. Or it can be a home sleep apnea test, where you wear a portable device at home for one or more nights. Both types are covered by Medicare if ordered by a doctor and performed by an approved facility. If you had a study done years ago, Medicare may ask for a new one if your symptoms have changed or if too much time has passed.

How Much You Pay and When

Your out-of-pocket cost depends on whether you have met your Part B deductible for the year. Once you have, you pay 20 percent of the Medicare-approved amount for the machine and supplies. The approved amount varies by region and supplier, but typically ranges from $600 to $900 for the machine over the 13-month rental period.

During the first 13 months, you make monthly rental payments. After month 13, Medicare stops paying and the machine becomes yours to keep. Replacement masks, tubing, and filters are covered separately — usually every few months — and you pay 20 percent of those costs as well. If you switch suppliers or the machine breaks, talk to your supplier about whether Medicare will cover a replacement.

Finding a Medicare-Approved Supplier

Not every medical supply store is approved by Medicare. You can search for approved DMEPOS suppliers in your area on the Medicare Supplier Directory at dmepos.cms.gov. Enter your ZIP code and select "CPAP" to see which suppliers Medicare recognizes near you.

Once you have your doctor's order, contact the supplier directly. They will verify your Medicare coverage, confirm your deductible status, and explain what you owe. Some suppliers are more responsive than others, so if one is slow to return calls or ship supplies, you can switch to another approved supplier without penalty. Your doctor's order stays valid for 12 months, so you have time to find a supplier that works for you.

What Happens If You Use an Out-of-Network Supplier

If you buy a CPAP machine from a supplier not on Medicare's approved list, Medicare will not pay anything toward it. You pay the full cost yourself. Some people do this because they want a specific brand or model, or because they could not find an approved supplier quickly. That choice is yours, but understand that you lose Medicare's cost protection.

If you are unsure whether a supplier is approved, ask them directly or check the Medicare Supplier Directory before you buy. Approved suppliers must accept Medicare's approved amount as payment in full (after your 20 percent coinsurance), so they cannot bill you extra.

Coverage for Masks, Tubing, and Replacement Parts

Medicare covers the mask, headgear, tubing, filters, and humidifier chamber as part of CPAP therapy. These are considered supplies, and you pay 20 percent of the approved amount for each item. Masks typically need replacement every three to six months depending on wear and fit. Your supplier can order replacements for you, or you can request them from any approved supplier.

If your mask no longer fits because your weight or face shape has changed, or if you switch to a different mask style, Medicare will cover a new one. Some suppliers are better than others at helping you find the right fit, so do not hesitate to ask questions or request a different style if the first one is uncomfortable.

What Medicare Does Not Cover

Medicare does not cover CPAP machines for people who have not had a sleep study, or whose sleep study results do not meet the AHI threshold. It also does not cover machines ordered without a doctor's written order, or machines purchased before the sleep study is complete.

Upgrades or add-ons beyond the basic machine — such as heated humidifiers, data cards, or wireless connectivity features — may not be covered, depending on whether your doctor documents medical necessity. Ask your supplier which features are covered under your plan before you choose a machine.

Frequently Asked Questions

Can I use a CPAP machine I already own, or do I have to rent one from Medicare?

If you own a machine already, Medicare will not reimburse you for it. Medicare's coverage is for new machines ordered through an approved supplier after a sleep study. If you want to use your own machine, you can, but you will not receive any payment from Medicare.

What if my sleep study was done at my doctor's office instead of a sleep lab?

Medicare requires the sleep study to be done at a facility that meets its technical standards. Some doctor's offices have approved equipment, but not all. Ask your doctor whether the study was done at an accredited facility or whether you need a second study at a sleep lab or through an approved home test.

Do I have to pay the full 20 percent upfront, or can I make payments?

Your supplier handles billing. Most suppliers bill Medicare directly and send you an invoice for your 20 percent share. Some allow you to set up a payment plan, but that is between you and the supplier — Medicare does not set up payment plans. Ask your supplier about their billing options when you place your order.

What happens after 13 months when the rental period ends?

The machine becomes yours to keep. Medicare stops paying, but you can continue using it. If it breaks, you pay for repairs out of pocket, or you can buy a new one. If you want Medicare to cover a replacement machine, you would need a new sleep study and doctor's order, which Medicare typically does not approve unless several years have passed.

Can Medicare cover a CPAP machine if I have a Medigap or Medicare Advantage plan?

Yes. Medicare Part B coverage applies whether you have Original Medicare, a Medigap plan, or a Medicare Advantage plan. Your coinsurance amount (the 20 percent you pay) may be different under a Medigap or Advantage plan, so check your plan documents or call your plan to confirm what you owe.