Medicare Part B covers CPAP machines, but only after a doctor diagnoses obstructive sleep apnea and you meet specific equipment rules
Medicare Part B will pay for a CPAP machine if your doctor orders it to treat obstructive sleep apnea, you have a sleep study on record showing the diagnosis, and the machine meets Medicare's equipment standards. Medicare covers the machine itself, the mask, tubing, and filters. You typically pay 20 percent of the approved amount after you meet your Part B deductible; Medicare pays the remaining 80 percent.
The process takes time. Your doctor must refer you to a durable medical equipment (DME) supplier that Medicare recognizes. That supplier orders the machine, fits you for a mask, and handles the paperwork with Medicare. From referral to delivery usually takes two to four weeks. If Medicare denies the claim, it is usually because the sleep study is missing, the diagnosis code is wrong, or the supplier is not in Medicare's network.
Key Takeaways
- Your doctor must document obstructive sleep apnea with a sleep study before Medicare will cover a CPAP machine.
- You must use a Medicare-approved DME supplier; ordering directly from a retailer or online means you pay the full cost yourself.
- Medicare covers the machine, mask, tubing, and filters, but you pay 20 percent coinsurance after your Part B deductible.
- Replacement masks and supplies are covered once per year, though some suppliers will bill for additional masks if medically necessary.
What Medicare actually covers and what you pay
Medicare Part B covers the CPAP machine as durable medical equipment. The approved amount varies by machine type and region, but typically ranges from $500 to $3,000 for the device itself. You pay 20 percent of that approved amount once your Part B deductible is met for the year. If you have not yet met your $240 deductible (2024 amount), you pay the full approved amount until you do, then 20 percent after.
Masks, tubing, and filters are also covered. Medicare allows one mask per month and one set of tubing and filters per month. If your mask wears out or stops fitting, you can request a replacement within that monthly allowance. Some suppliers will bill for extra masks if your doctor documents that you need them — for example, if you use both a nasal mask and a full-face mask — but this requires prior authorization.
Replacement machines are covered once every five years. If your machine breaks or becomes obsolete before five years, Medicare will not cover a new one unless your doctor writes a letter explaining medical necessity. Rental is not an option under Medicare; you own the machine outright.
How to get a CPAP machine through Medicare
Start with your primary care doctor or a sleep specialist. Tell them you suspect you have sleep apnea or that you have been told you snore heavily and stop breathing at night. Your doctor will order a sleep study. This can happen in a sleep lab (you spend a night there) or at home with a portable monitor that you wear for one or two nights. The study must show an apnea-hypopnea index (AHI) score of 15 or higher for Medicare to cover treatment; some doctors will order treatment at a score of 5 or higher if you have symptoms, but Medicare's threshold is 15.
Once the sleep study confirms obstructive sleep apnea, your doctor writes an order for a CPAP machine and refers you to a Medicare-approved DME supplier. You can ask your doctor which suppliers they work with, or you can search Medicare's supplier directory at dmepos.cms.gov. Call the supplier and schedule a fitting. The supplier will take your measurements, show you different mask styles, and help you choose one that fits. They submit the order and your doctor's paperwork to Medicare.
Medicare reviews the claim. If everything is in order, they approve it and send payment to the supplier. The supplier then ships the machine and mask to you. This entire process typically takes two to four weeks from the time you call the supplier.
Common reasons Medicare denies CPAP coverage
The most common denial is a missing or incomplete sleep study. Medicare requires the study to be done by a certified sleep lab or with an approved home testing device. If your doctor diagnosed sleep apnea based only on symptoms or a questionnaire, Medicare will not cover the machine. You will need an actual sleep study on file.
The second common reason is using an out-of-network supplier. If you order a CPAP machine from an online retailer, a big-box store, or a supplier not in Medicare's network, Medicare will not reimburse you. You pay the full cost. Always confirm the supplier is Medicare-approved before you place an order.
A third reason is an AHI score below Medicare's threshold. If your sleep study shows an AHI of 14 or lower, Medicare will deny coverage even if your doctor thinks you need treatment. Some people in this situation pay out of pocket for the machine, or they ask their doctor whether a second sleep study might show a higher score.
Denials also happen when the diagnosis code on the claim is wrong, when the supplier submits paperwork to the wrong Medicare contractor, or when the machine model does not meet Medicare's specifications. If you receive a denial, ask the supplier to review the reason and resubmit if there was an error.
What happens after Medicare approves your machine
Once you receive your CPAP machine, you own it. You are responsible for cleaning it, replacing filters, and maintaining it. Medicare covers replacement masks and supplies once per month, but you must order them through the same DME supplier or another Medicare-approved supplier. If you switch suppliers, make sure the new one has your prescription on file.
If your machine breaks or malfunctions, contact the supplier. They may repair it under warranty or, if it is beyond repair, work with Medicare to cover a replacement if you are still within the five-year window. Keep your receipt and warranty information.
Your doctor should check in with you every six to twelve months to make sure the machine is working and you are using it regularly. Medicare may ask for proof that you are using the machine — some machines track usage data — before approving a replacement or additional supplies. If you stop using the machine for several months, the supplier or Medicare may deny future supply requests.
CPAP machines and other insurance plans
If you have a Medigap or Medicare Advantage plan in addition to Part B, your coverage may differ. Medigap plans typically cover your 20 percent coinsurance, so you pay little or nothing out of pocket. Medicare Advantage plans vary; some cover CPAP the same way Part B does, others have different copays or deductibles, and a few require prior authorization. Check your plan documents or call your plan's customer service to confirm what you will pay.
If you are still working and have employer health insurance, that plan may cover a CPAP machine before Medicare does. Some employers cover CPAP at a lower out-of-pocket cost than Medicare. If you have both employer insurance and Medicare, coordinate benefits with both plans to understand which one pays first and what you owe.
Frequently Asked Questions
Do I need a sleep study if my doctor already diagnosed me with sleep apnea?
Yes. Medicare requires a sleep study on file, even if you were diagnosed years ago. If your records do not include a sleep study, your doctor will need to order one before Medicare will cover a CPAP machine. A questionnaire or clinical diagnosis alone is not enough.
Can I buy a CPAP machine myself and have Medicare reimburse me?
No. Medicare only reimburses when you use a Medicare-approved DME supplier. If you buy a machine on your own, Medicare will not pay for it, and you cannot submit a claim for reimbursement. Always work through a Medicare-approved supplier from the start.
What if I cannot afford the 20 percent coinsurance?
If you have a Medigap plan, it typically covers your coinsurance. If you do not, ask the DME supplier whether they offer payment plans. Some suppliers will let you pay the coinsurance in installments. You can also contact your local Area Agency on Aging to ask about programs that help with medical equipment costs.
How often can Medicare cover a new CPAP machine?
Medicare covers a replacement machine once every five years. If your machine breaks before five years, your doctor must document medical necessity in writing for Medicare to cover a new one. After five years, you can request a replacement machine as routine maintenance.
Will Medicare cover a CPAP machine if I have not been formally diagnosed with sleep apnea yet?
No. You must have a sleep study showing obstructive sleep apnea before Medicare will cover the machine. Your first step is to see your doctor and request a sleep study. Once the study confirms the diagnosis, the coverage process can begin.