Medicare covers CPAP machines and most supplies you need to use them, but only after your doctor documents that you have sleep apnea and prescribes the device.
Medicare Part B pays for a CPAP machine itself, the mask, tubing, filters, and a humidifier if your doctor says you need one. You typically pay 20% of the approved amount after you meet your Part B deductible. The machine is considered durable medical equipment, which means Medicare covers it under specific rules about how often you can get replacements and what paperwork your doctor must file first.
The catch is that your doctor must order the CPAP through a Medicare-approved supplier, and that supplier has to submit the paperwork showing your sleep apnea diagnosis before Medicare will pay anything. If you buy a CPAP on your own without this step, Medicare will not reimburse you later.
Key Takeaways
- Your doctor must document sleep apnea with a sleep study and write a prescription for CPAP before Medicare will cover any equipment or supplies.
- Medicare Part B covers the CPAP machine, mask, tubing, filters, and humidifier, and you pay 20% of the approved cost after your deductible.
- You must order through a Medicare-approved supplier, not buy the equipment yourself, or Medicare will not pay.
- Medicare covers a replacement CPAP machine every five years and masks or tubing every three months, but only if your doctor continues to prescribe them.
- If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower, so check your plan documents or call your plan.
What Your Doctor Needs to Do First
Before any CPAP equipment reaches you, your doctor must order a sleep study to confirm you have obstructive sleep apnea. This is usually an overnight test at a sleep lab, though some doctors now order home sleep tests. The results show how many times per hour your breathing stops during sleep, which determines whether Medicare will cover treatment.
Once the sleep study confirms sleep apnea, your doctor writes a prescription for CPAP and specifies the pressure settings the machine should deliver. Your doctor also has to document that you have tried other treatments first or that CPAP is medically necessary for you. This paperwork goes to the Medicare-approved supplier you choose, not directly to Medicare.
If your doctor has not ordered a sleep study yet, ask for one at your next visit. Tell your doctor about daytime sleepiness, loud snoring, or pauses in breathing that your bed partner has noticed. These are the signs that lead to a sleep study order.
How to Find a Medicare-Approved Supplier
You cannot walk into a medical supply store and buy a CPAP with Medicare coverage. The supplier must be on Medicare's approved list. You can search for suppliers in your area on the Medicare website under "Durable Medical Equipment, Prosthetics, Orthotics, and Supplies" (DMEPOS), or you can ask your doctor's office which suppliers they work with.
Call the supplier and tell them you have a CPAP prescription. They will ask for your doctor's contact information and your Medicare number. The supplier then contacts your doctor to get the prescription and sleep study results, and submits a form to Medicare asking for coverage. This process usually takes one to two weeks.
Do not pay anything upfront. The supplier should tell you what your 20% cost-share will be once Medicare approves the claim. If a supplier asks you to pay the full price and promises to bill Medicare later, that is a red flag — legitimate suppliers handle the Medicare paperwork before you receive equipment.
What Medicare Pays and What You Pay
Medicare approves a set dollar amount for each piece of CPAP equipment based on national pricing rules. Your cost is 20% of that approved amount. For example, if Medicare approves $800 for a CPAP machine, you pay $160 (after your Part B deductible is met). The supplier bills Medicare for the remaining $640.
The approved amounts vary slightly by region and by the type of mask or machine. A nasal mask costs less than a full-face mask, and a basic machine costs less than one with a humidifier built in. Your supplier can tell you the exact approved amount for each item before you agree to anything.
If you have already met your Part B deductible for the year, you pay 20% right away. If you have not met it, you pay the full deductible first, then 20% of the approved amount. Your deductible resets every January.
Replacement Schedules and When Medicare Covers New Equipment
Medicare covers a replacement CPAP machine once every five years. This means if you get a machine in 2024, Medicare will not cover a new one until 2029, even if yours breaks. If your machine fails before five years, you have to pay out of pocket for a replacement, or your doctor can request an exception if there is a medical reason you need a new one sooner.
Masks, tubing, and filters are considered supplies and have a different schedule. Medicare covers replacement masks every three months and replacement tubing and filters every month. You can order these through your supplier whenever you need them, and Medicare will pay its share as long as your doctor's prescription is still active.
To keep getting supplies covered, your doctor must continue to prescribe CPAP. If you have not seen your sleep doctor in over a year, call and schedule a follow-up visit. Some doctors require a visit every one to two years to renew the prescription.
Medicare Advantage and Medigap Plans
If you have a Medicare Advantage plan (Part C), your coverage for CPAP may be different from Original Medicare. Some Advantage plans cover CPAP with no cost-share, while others charge a copay instead of 20%. Call your plan to ask what you will pay for a CPAP machine and supplies.
If you have a Medigap policy, it may cover some or all of your 20% cost-share, depending on which Medigap plan you have. Plans C, D, G, and M typically cover the Part B coinsurance, which means you would pay little to nothing out of pocket for CPAP. Check your Medigap policy documents or call your insurance company to confirm.
What to Ask Your Doctor
Before you leave your doctor's office with a CPAP prescription, ask these questions:
- Do I need a sleep study, or do you already have results showing I have sleep apnea?
- Which Medicare-approved suppliers do you work with, or do you have a preferred one?
- What pressure settings should the machine be set to?
- Do I need a humidifier, or is the basic machine enough?
- How often do I need to come back for follow-up visits to keep my prescription active?
- If my machine breaks before five years, what should I do?
When to Contact Medicare or Your Supplier
Contact your supplier if you receive equipment that does not work, if your mask does not fit, or if you have questions about your bill. The supplier is responsible for making sure the equipment is set up correctly and that you know how to use it.
Contact Medicare directly if you believe you were charged more than your 20% cost-share, if your claim was denied, or if you want to appeal a denial. You can call Medicare at 1-800-MEDICARE (1-800-633-4227) or visit Medicare.gov. Have your Medicare number and the date you received the equipment ready.
If you are having trouble using your CPAP or adjusting to wearing the mask, ask your doctor or supplier for help. Many suppliers offer training sessions, and some doctors have sleep technicians who can troubleshoot problems by phone.
Frequently Asked Questions
What if I already bought a CPAP before I knew Medicare would cover it?
Medicare does not reimburse you for equipment you bought on your own. However, if you have a receipt and your doctor's prescription, contact Medicare to ask whether they will make an exception. Some regional Medicare offices have discretion to cover equipment purchased before the claim was submitted, but this is not may provide.
Can I use a CPAP machine I bought online or from a non-Medicare supplier?
Yes, you can use any CPAP machine. But Medicare will only pay for machines and supplies ordered through a Medicare-approved supplier. If you buy elsewhere, you pay the full cost yourself. Supplies like masks and filters ordered through non-approved suppliers also will not be covered by Medicare.
Do I have to use the supplier my doctor recommends?
No. You can choose any Medicare-approved supplier. Your doctor's office will send your prescription to whichever supplier you pick. If you want to compare prices or service, call a few suppliers in your area and ask what they charge for your 20% cost-share.
What happens if Medicare denies my claim?
Your supplier will send you a notice explaining why. Common reasons are that your sleep study did not show enough sleep apnea, or that your doctor did not submit the required paperwork. You have the right to ask Medicare to review the decision. Your supplier or doctor can help you file an appeal.
Will Medicare cover a CPAP if I have not been diagnosed with sleep apnea yet?
No. You must have a sleep study showing obstructive sleep apnea before Medicare will cover any equipment. If you think you have sleep apnea, ask your doctor for a sleep study. Do not buy a CPAP on your own hoping Medicare will cover it later.