What Medicare Covers for CPAP Machines and Supplies

Medicare covers CPAP machines and supplies, but only if your doctor documents that you have obstructive sleep apnea and prescribes the device as medically necessary.

Medicare Part B pays for the CPAP machine itself, the mask, tubing, and replacement supplies like filters and cushions. However, you do not automatically get coverage just by owning a CPAP. Your doctor must order it, you must meet specific requirements, and you will pay your share of the cost — usually 20 percent of what Medicare approves after you meet your Part B deductible.

The path to coverage involves a sleep study, a prescription, and a durable medical equipment (DME) supplier that accepts Medicare. Understanding each step helps you avoid delays and unexpected bills.

Key Takeaways

Your doctor must order a CPAP and document obstructive sleep apnea with a sleep study before Medicare will cover it.
Medicare Part B covers the machine, mask, tubing, and replacement supplies, but you pay 20 percent of the approved amount after your deductible.
You must use a Medicare-approved durable medical equipment supplier; buying a CPAP on your own and asking Medicare to reimburse you will not work.
Medicare requires a three-month trial period with the CPAP before it will pay for a replacement machine, even if the first one stops working.
Replacement supplies like masks and filters are covered indefinitely as long as your prescription remains active.

How Medicare Determines CPAP Coverage

Medicare will not pay for a CPAP based on a guess or a symptom checklist. Your doctor must order a sleep study — either an in-lab study at a sleep center or a home sleep apnea test — that actually records your breathing and oxygen levels while you sleep. The study must show that you stop breathing at least 15 times per hour (or 5 times per hour if you also have symptoms like daytime sleepiness or witnessed apnea). This number is called the apnea-hypopnea index, or AHI.

Once the study confirms obstructive sleep apnea, your doctor writes a prescription for a CPAP with specific settings tailored to your needs. The prescription is the document that Medicare uses to authorize coverage. Without it, no DME supplier can bill Medicare on your behalf.

Your doctor may also need to document that you have tried other treatments first or that CPAP is the right choice for your particular situation. Some doctors do this automatically; others only if Medicare asks. If your claim is denied, your doctor's office can appeal by providing additional medical records.

What You Pay Out of Pocket

Your costs depend on whether you have met your Part B deductible for the year. Once you have paid the deductible (which changes each year), Medicare pays 80 percent of the approved amount for the CPAP machine and supplies, and you pay 20 percent. The approved amount is set by Medicare, not by the supplier's list price, so your bill is based on what Medicare decides the equipment is worth.

For example, if Medicare approves $800 for a CPAP machine and you have already met your deductible, you pay $160 and Medicare pays $640. If you have not met your deductible, you pay the full approved amount until the deductible is satisfied, then the 20 percent split begins.

Replacement supplies — masks, tubing, filters, and cushions — are also covered at 80 percent after your deductible. Medicare allows a certain number of replacement items per month or per year depending on the type. Your DME supplier tracks this and will tell you when you can order more.

Finding a Medicare-Approved CPAP Supplier

You must order your CPAP through a durable medical equipment (DME) supplier that is enrolled with Medicare. This is not optional. If you buy a CPAP from a retail store, an online retailer, or directly from a manufacturer, Medicare will not reimburse you, even if you have a valid prescription.

To find a Medicare-approved supplier, use the Medicare Supplier Directory at dmesupplier.cms.gov. Enter your ZIP code and select "CPAP" or "respiratory equipment" to see which suppliers near you accept Medicare. You can also call your doctor's office — they often have a list of suppliers they work with regularly.

When you contact a supplier, tell them you have a CPAP prescription and ask if they accept Medicare assignment. Assignment means they agree to bill Medicare directly and accept Medicare's approved amount as payment in full (except for your 20 percent coinsurance). Most suppliers do accept assignment, but it is worth confirming before you place an order.

The Three-Month Trial and Replacement Rules

Medicare requires you to use your CPAP for at least three months before it will pay for a replacement machine. This is true even if the machine breaks down, stops working, or you lose it. The only exception is if your doctor documents that the machine is not working for medical reasons — for instance, if the pressure settings are wrong and cannot be adjusted to help you.

After three months, if you need a new machine, your doctor must write a new prescription and your DME supplier must submit it to Medicare. Medicare will then cover a replacement at 80 percent of the approved amount (after your deductible).

Replacement supplies do not have the same waiting period. Once your CPAP is covered, you can order new masks, tubing, filters, and other supplies as often as Medicare's frequency limits allow — usually monthly or every few months depending on the item. Your supplier will know the exact schedule and will remind you when you can reorder.

What Happens If Medicare Denies Your Claim

If your DME supplier submits a claim and Medicare denies it, you will receive a notice called a Explanation of Benefits (EOB). The EOB explains why the claim was denied — for example, "no sleep study on file," "prescription expired," or "medical necessity not documented."

Do not assume the denial is final. You have the right to appeal. Contact your doctor's office and ask them to review the reason for denial. Often, the sleep study results were not submitted with the claim, or the prescription was missing a required detail. Your doctor can resubmit the missing information or write a letter explaining why CPAP is medically necessary for you.

If your appeal is denied a second time, you can request a formal review by Medicare. Your DME supplier can help you file this appeal, or you can do it yourself by following the instructions on your EOB.

CPAP Supplies and Long-Term Coverage

Once your CPAP machine is approved and you have used it for three months, replacement supplies are covered indefinitely — as long as your doctor's prescription remains active and you continue to use the machine. You do not need a new sleep study or a new prescription every year just to get supplies.

However, your prescription can expire if your doctor does not renew it or if you have not seen your doctor in a long time. If you have not had a sleep medicine visit or a primary care visit in several years, ask your doctor to renew your CPAP prescription before you try to order supplies. Medicare may ask for proof that your prescription is current.

Masks wear out and need replacing every few months depending on use and care. Tubing, filters, and cushions also degrade over time. Your DME supplier can help you understand how often each item should be replaced and will coordinate with Medicare to make sure you stay within the allowed frequency.

Frequently Asked Questions

Can I use a CPAP I bought myself and have Medicare pay me back?

No. Medicare only covers a CPAP if you order it through a Medicare-approved DME supplier. Buying one on your own and submitting a receipt will not result in reimbursement, even if you have a valid prescription.

What if my doctor prescribed a CPAP but I do not have a sleep study?

Medicare will likely deny the claim. A sleep study is required to prove you have obstructive sleep apnea and that CPAP is medically necessary. Ask your doctor to order a sleep study before you place a CPAP order with a supplier.

Do I have to pay anything upfront, or does the supplier bill Medicare first?

If the supplier accepts Medicare assignment, they bill Medicare first. You pay your coinsurance (usually 20 percent) and any deductible you have not met. You should not have to pay the full price upfront and wait for reimbursement.

Can Medicare cover a second CPAP machine if I travel?

Medicare typically covers only one CPAP machine at a time. If you need a second machine for travel, you would likely have to pay out of pocket. Talk to your doctor and your DME supplier about whether a portable or travel-sized CPAP might be an option they can help you explore.

What if I stop using my CPAP — does Medicare stop covering supplies?

If you do not use your CPAP for an extended period, your doctor may decide not to renew your prescription, which would end supply coverage. Medicare does not automatically cut you off, but your doctor can choose to discontinue the prescription if you are not using the device as prescribed.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.