Medicare covers CPAP supplies for as long as you use the machine, but the coverage rules change after the first year

Medicare Part B pays for CPAP equipment and supplies if your doctor prescribes it for sleep apnea. The coverage does not stop at a set date — it continues month to month or year to year. However, the way Medicare pays shifts after your first 13 months of use, and you must follow specific rules about where you order supplies or Medicare will deny the claim.

The first 13 months are called the rental period. Medicare pays the supplier directly, and you pay 20 percent of the approved amount (after you meet your Part B deductible). After 13 months, you own the machine, and Medicare switches to paying for supplies only — filters, tubing, masks, and cushions — at a different rate.

Key Takeaways

  • Medicare covers CPAP equipment for 13 months as a rental, then switches to covering supplies only for as long as you use the machine.
  • After 13 months, you own the CPAP device and Medicare pays 80 percent of approved costs for replacement supplies like masks and filters.
  • You must order supplies from a Medicare-approved CPAP supplier, or Medicare will not pay; ordering from the manufacturer or a non-approved vendor means you pay the full cost.
  • Medicare requires a new prescription from your doctor every five years to continue covering supplies.
  • If you stop using CPAP for 12 months or longer, Medicare may require a new prescription and sleep study before restarting coverage.

What happens during the first 13 months (the rental period)

During your first 13 months of CPAP use, Medicare treats the machine as a rental. Medicare pays the supplier a set monthly amount, and you pay 20 percent of that amount (after your Part B deductible is met). The supplier provides the machine, masks, tubing, filters, and any adjustments or replacements needed during this time.

You do not own the machine yet. If the machine breaks or stops working, the supplier replaces it. If a mask no longer fits or a filter wears out, the supplier sends a replacement. You are responsible only for your 20 percent coinsurance on each monthly payment.

The supplier must be Medicare-approved. If you order from a non-approved vendor or directly from the manufacturer during this 13-month period, Medicare will not pay, and you will owe the full cost. Your doctor's prescription will list which supplier to use, or you can ask your doctor's office which suppliers are approved in your area.

What changes after 13 months (the ownership period)

After 13 months, you own the CPAP machine outright. Medicare stops paying a monthly rental fee. Instead, Medicare now covers replacement supplies — masks, tubing, filters, cushions, and headgear — for as long as you use the machine.

The payment structure changes. Medicare now pays 80 percent of the approved amount for supplies, and you pay 20 percent coinsurance. You still must order from a Medicare-approved supplier. If you order from an unapproved source, Medicare will not pay.

Replacement supplies are typically covered once every 12 months for most items. Masks and cushions may be covered more frequently if your doctor documents that you need them more often. Filters are usually covered every three months. The exact frequency depends on the item and your specific prescription.

How to order supplies and avoid payment denials

After the first 13 months, you will need to reorder supplies regularly. The key step is ordering from a Medicare-approved CPAP supplier. You can find approved suppliers by calling 1-800-MEDICARE or searching the Medicare provider directory online at Medicare.gov.

When you are ready to reorder, contact your approved supplier directly. They will verify your Medicare coverage, confirm your prescription is current, and send the supplies. The supplier bills Medicare, and Medicare pays 80 percent. You receive an Explanation of Benefits (EOB) in the mail showing what Medicare paid and what you owe.

Do not order from Amazon, the CPAP manufacturer's website, or a non-approved local medical supply store, even if the price is lower. Medicare will deny the claim, and you will have to pay the full cost out of pocket. If you are unsure whether a supplier is approved, ask them directly or call Medicare before ordering.

When your prescription expires and how to renew it

Your doctor's CPAP prescription is valid for five years from the date it is written. After five years, you need a new prescription from your doctor to continue receiving Medicare coverage for supplies. Medicare will not pay for supplies ordered after your prescription expires, even if you have been using CPAP for years.

Contact your doctor's office about three months before your prescription expires. Your doctor may renew it based on your current use, or they may ask you to come in for a follow-up visit. Some doctors require a new sleep study; others do not. Ask your doctor's office what they need from you.

Once you have a new prescription, give it to your Medicare-approved supplier. They will keep it on file and use it for all future supply orders. If your supplier does not receive the new prescription before the old one expires, they may not be able to bill Medicare for your next order.

What happens if you stop using CPAP and want to restart

If you stop using your CPAP machine for 12 months or longer, Medicare may treat it as a new start. You may need a new prescription from your doctor and possibly a new sleep study before Medicare will cover supplies again. This is Medicare's way of confirming that you still have sleep apnea and still need the machine.

If you stop using CPAP for less than 12 months and then restart, you usually do not need a new sleep study. Your existing prescription remains valid. However, if your doctor has concerns about whether the machine is still appropriate for you, they may order a new study anyway.

If you are thinking about stopping CPAP use, talk to your doctor first. They can advise you on whether it is safe to stop and what will be required if you want to restart coverage later.

Medicare coverage limits and what you pay out of pocket

Medicare covers CPAP supplies indefinitely as long as you meet the conditions: you have a current prescription, you use an approved supplier, and you have not gone 12 months without using the machine. There is no lifetime limit on how many masks, filters, or tubing sets Medicare will pay for.

Your out-of-pocket cost depends on whether you have met your Part B deductible for the year. Once you meet the deductible, you pay 20 percent coinsurance on the Medicare-approved amount for each supply order. If you have supplemental insurance (Medigap) or Medicare Advantage, your coinsurance may be lower or covered entirely, depending on your plan.

Some Medicare Advantage plans cover CPAP supplies differently than Original Medicare. If you are on a Medicare Advantage plan, contact your plan directly to learn what your coinsurance is and which suppliers are in-network.

Frequently Asked Questions

Can I order CPAP supplies from the manufacturer after 13 months?

No. Medicare will not pay if you order from the manufacturer or any non-approved supplier, even after you own the machine. You must use a Medicare-approved CPAP supplier. If you order elsewhere, you pay the full cost yourself.

What if I need a new CPAP machine before 13 months are up?

If your machine breaks or stops working during the rental period, contact your supplier. They will replace it at no cost to you beyond your regular 20 percent coinsurance. If you want to upgrade to a different model, talk to your doctor and supplier — Medicare may cover the upgrade if medically necessary, but the rules vary.

Do I have to pay anything during the first 13 months?

Yes. You pay 20 percent coinsurance on the monthly rental fee (after you meet your Part B deductible). The amount varies by supplier and region, but typically ranges from $30 to $60 per month out of pocket. After 13 months, you own the machine and pay 20 percent coinsurance only on replacement supplies.

What if my doctor says I need masks more often than every 12 months?

Your doctor can write a prescription stating that you need masks more frequently — for example, every six months or every three months — due to skin breakdown or other medical reasons. If Medicare approves the medical necessity, your supplier can bill for more frequent replacements. You will still pay 20 percent coinsurance on each order.

Will Medicare cover CPAP if I have Medicare Advantage instead of Original Medicare?

Yes, Medicare Advantage plans must cover CPAP equipment and supplies because they are required to cover everything Original Medicare covers. However, your coinsurance, deductible, and approved suppliers may differ. Contact your plan to learn your specific costs and which suppliers are in-network.