Medicare will cover a CPAP machine if you have been diagnosed with obstructive sleep apnea and meet specific requirements

Medicare Part B covers CPAP machines, but not automatically. You need a sleep study that shows you have obstructive sleep apnea, a prescription from your doctor, and you must rent or purchase the machine from a Medicare-approved supplier. Medicare covers the machine itself, the mask, tubing, and filters. The coverage rules are the same whether you are on Original Medicare or a Medicare Advantage plan, though some Advantage plans may have different copays or require prior approval.

The process takes time. Your doctor must order a sleep study first — either in a lab or at home. Once the study confirms sleep apnea, your doctor writes a prescription that includes how many hours per night you should use the machine. You then contact a Medicare-approved CPAP supplier, who submits the prescription and documentation to Medicare for review. Medicare typically approves or denies the request within two to three weeks.

Key Takeaways

  • You must have a sleep study showing obstructive sleep apnea before Medicare will cover a CPAP machine.
  • Your doctor must prescribe the machine and specify the pressure settings and hours of nightly use.
  • You must purchase or rent from a Medicare-approved supplier, not from a retail store or online retailer.
  • Medicare covers the machine, mask, tubing, and filters, but you pay a copay or coinsurance amount depending on your plan.
  • The approval process usually takes two to three weeks after the supplier submits your prescription and medical records.

What Medicare covers and what you pay

Medicare Part B covers 80 percent of the approved amount for a CPAP machine after you meet your annual deductible. You pay the remaining 20 percent coinsurance. If you have a Medigap policy, it may cover some or all of that 20 percent, depending on which Medigap plan you hold. If you have a Medicare Advantage plan, your copay or coinsurance will be different — check your plan documents or call the plan directly.

The approved amount varies by region and supplier, but typically ranges from $600 to $1,000 for the machine itself. Masks, tubing, and filters are covered separately. You will need to replace the mask every three months and filters every one to three months, depending on use and the type of filter. Medicare covers these replacement parts as long as your prescription remains active.

If you rent the machine instead of buying it, Medicare covers the rental cost. After you have rented for 13 months, you own the machine outright. Some people choose to rent first to make sure the machine works for them before committing to purchase.

How to start the process with your doctor

Tell your primary care doctor that you think you might have sleep apnea. Common signs include loud snoring, pauses in breathing during sleep (usually noticed by a bed partner), daytime sleepiness, morning headaches, or waking up gasping for air. Your doctor will ask about these symptoms and may refer you to a sleep specialist or order a sleep study directly.

A sleep study can happen in two ways. A lab-based study means you spend a night in a sleep center where technicians monitor your breathing, heart rate, oxygen levels, and brain activity. A home sleep test means you wear a small device at home for one or two nights that records the same information. Home tests are faster and less expensive, but not all people are candidates — your doctor will decide which type is right for you.

Once the study is complete, the sleep specialist or your doctor will review the results. If you have obstructive sleep apnea, your doctor writes a prescription for a CPAP machine. The prescription must include the pressure setting (measured in centimeters of water pressure) and the number of hours per night you should use it. Medicare requires that you use the machine at least four hours per night on at least 70 percent of the nights you have it.

Finding a Medicare-approved CPAP supplier

You cannot buy a CPAP machine from a regular pharmacy, medical supply store, or online retailer and have Medicare cover it. You must use a Medicare-approved durable medical equipment (DME) supplier. You can find approved suppliers in your area by visiting the Medicare website and using their supplier directory, or by calling 1-800-MEDICARE.

Once you have your prescription, contact the supplier and give them your Medicare number, doctor's name, and the prescription details. The supplier will verify your coverage, explain your copay or coinsurance amount, and submit all the paperwork to Medicare. They handle the prior authorization process — you do not need to contact Medicare yourself.

The supplier will also fit you for a mask and show you how to use the machine. This is important because the right mask fit affects how well the machine works and how comfortable it is to wear. If the first mask does not fit well, ask the supplier to try a different size or style. Medicare covers mask replacements, so finding one that works for you is worth the time.

What happens after Medicare approves your claim

Once Medicare approves your claim, the supplier will contact you to arrange delivery or pickup. You will receive the CPAP machine, at least one mask, tubing, a humidifier (if prescribed), and filters. The supplier should also provide written instructions and offer to show you how to use everything.

Keep your prescription active by using the machine regularly. Medicare tracks usage data from your machine — it records how many hours per night you use it and sends that information to your doctor. If you use the machine fewer than four hours per night on fewer than 70 percent of nights, Medicare may stop covering replacement parts or deny future claims. If you are struggling to use the machine, tell your doctor — there are adjustments and different mask styles that can help.

After 13 months of rental, you own the machine. You can then purchase a new one if you want, and Medicare will cover it under the same rules as the first machine — but only once every five years. If your machine breaks or stops working within the five-year window, contact your supplier about repair or replacement options.

What to do if Medicare denies your claim

Medicare may deny your claim if the sleep study does not show obstructive sleep apnea, if your doctor's prescription is incomplete, or if you used a non-approved supplier. If you receive a denial letter, read it carefully — it will explain the reason and tell you how to appeal.

You have 120 days from the date on the denial letter to file an appeal. You can ask your doctor or the supplier to help gather additional information to support your appeal. If the denial was because the sleep study results were borderline, your doctor may recommend a second study or a different type of study. If the denial was because you used a non-approved supplier, you will need to start over with an approved supplier.

If you disagree with the appeal decision, you can request a hearing before a Medicare administrative law judge. This process is free, but it takes several months. Your doctor or a patient advocate can help you prepare for the hearing.

Medicare Advantage plans and CPAP coverage

If you are enrolled in a Medicare Advantage plan, your coverage for a CPAP machine is similar to Original Medicare, but the details may differ. Some Advantage plans require prior authorization before you have a sleep study, while others approve it after the study is complete. Some plans have a copay for the machine instead of coinsurance, and some cover rental but not purchase.

Call your Medicare Advantage plan before you see your doctor about sleep apnea. Ask whether the plan covers CPAP machines, whether you need prior authorization, what your copay or coinsurance will be, and which suppliers are in-network. Using an in-network supplier usually means a lower cost to you. If your plan denies coverage, you have the same appeal rights as with Original Medicare.

Frequently Asked Questions

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

Yes. Medicare requires a sleep study showing obstructive sleep apnea before it will cover a CPAP machine. Your doctor cannot prescribe one based on symptoms alone. The study can be done in a lab or at home, and usually takes one to two weeks to schedule.

What if I cannot afford the copay or coinsurance?

If you have a Medigap policy, it may cover part or all of your coinsurance. If you have a Medicare Advantage plan, ask about copay information programs. Some CPAP suppliers also offer payment plans. Contact your local Area Agency on Aging to ask about other financial information programs in your area.

Can I use a CPAP machine I already own, or one someone gave me?

Medicare will not cover a machine you already own or a used machine. You must obtain the machine from a Medicare-approved supplier after Medicare approves your claim. Used machines also carry infection risks and may not have the correct settings for your needs.

How often can Medicare cover a new CPAP machine?

Medicare covers a new CPAP machine once every five years. If your machine breaks before five years have passed, ask your supplier about repair options or whether they can replace it under warranty. Some suppliers offer extended warranties that cover accidental damage.

What if I stop using the CPAP machine?

If you stop using the machine, tell your doctor and your supplier. Your prescription will remain active for as long as your doctor keeps it active, but Medicare tracks usage and may question future claims if usage drops significantly. If you want to restart, contact your supplier — they can reactivate your account and check that your machine is still working properly.