Medicare Part B covers CPAP machines, but only after a doctor diagnoses obstructive sleep apnea and you meet specific equipment and documentation requirements

Medicare Part B will pay for a CPAP (continuous positive airway pressure) machine if your doctor documents that you have obstructive sleep apnea. The coverage includes the machine itself, a mask, tubing, and filters. However, Medicare does not pay for the machine outright — instead, you rent it through a Medicare-approved supplier, and Medicare covers 80 percent of the approved amount after you meet your Part B deductible. You pay the remaining 20 percent.

The rental model matters because it affects your costs over time. You typically rent the machine for 13 months, at which point it becomes yours to keep. If you stop using it before 13 months, you still owe for the months you rented it. After the 13-month rental period ends, Medicare stops covering the machine, but you own it and can continue using it without further payments to Medicare.

Key Takeaways

  • Your doctor must order the CPAP machine and document obstructive sleep apnea on the prescription — Medicare will not cover it based on a sleep study alone.
  • You must obtain the machine from a Medicare-approved CPAP supplier, not from a retail store or online retailer, or Medicare will not pay.
  • You pay 20 percent of the approved rental cost after your Part B deductible; the exact amount depends on your supplier and your deductible status.
  • The 13-month rental period is a fixed timeline — if you need the machine longer, you own it after month 13 and pay nothing more to Medicare.
  • Replacement masks, tubing, and filters are covered under the same 80/20 split, but only if ordered through your approved supplier.

What Your Doctor Must Do Before Medicare Will Pay

Medicare requires a face-to-face evaluation by a doctor (MD, DO, or nurse practitioner in some cases) who documents obstructive sleep apnea. This is not automatic after a sleep study. The doctor must write an order that includes the diagnosis code for obstructive sleep apnea, the prescribed pressure settings (if known), and the type of mask needed. Without this order, Medicare will deny the claim.

The sleep study itself — whether done at a lab or at home — is separate from the CPAP order. Medicare covers sleep studies under Part B, but the study result alone does not trigger CPAP coverage. Your doctor must review the study, confirm the diagnosis, and then write the CPAP prescription. If your doctor says "you probably have sleep apnea, try a CPAP," that is not enough. The order must state the diagnosis clearly.

If you had a sleep study done before Medicare coverage began, or if your study was done by a provider outside Medicare, bring those records to your doctor's appointment. Your doctor can use them to support the diagnosis, but they will still need to perform their own evaluation and write the order.

How to Find a Medicare-Approved CPAP Supplier

You must order your CPAP machine from a supplier enrolled in Medicare, not from a retail medical supply store, pharmacy, or online retailer. Medicare maintains a searchable list of approved suppliers on its website. You can search by ZIP code to find suppliers near you. Call at least two suppliers to compare their rental costs and mask options, because approved suppliers can charge different amounts within Medicare's approved range.

When you contact a supplier, have your doctor's order ready. The supplier will verify that your doctor's order meets Medicare requirements, confirm your Medicare coverage, and calculate your out-of-pocket cost based on your deductible status. Some suppliers offer same-day or next-day delivery; others may take longer. Ask about delivery time when you call, especially if you need the machine urgently.

The supplier will also help you choose a mask style (nasal, full-face, or nasal pillow) based on your comfort and the pressure settings your doctor prescribed. If the first mask does not fit well, you can request a different style during the rental period, and the supplier will provide it at no extra cost to you.

What Medicare Pays and What You Pay

Medicare's approved amount for CPAP rental varies by region but typically ranges from $50 to $70 per month. Medicare pays 80 percent of this amount; you pay 20 percent. However, your Part B deductible ($240 in 2024, though this changes yearly) must be met first. Once you meet the deductible, Medicare pays 80 percent of all CPAP-related costs for the rest of the calendar year.

Your actual out-of-pocket cost depends on when in the year you start renting. If you begin in January and have not yet met your deductible, you will pay the full deductible plus 20 percent of the rental cost for each month. If you begin in November, you may only owe a small amount before the deductible resets on January 1. After you meet the deductible, you pay roughly $10 to $14 per month for the machine rental, plus 20 percent of any replacement supplies.

Replacement masks, tubing, and filters are covered under the same 80/20 split. Most suppliers include these in your rental at no extra charge for the first 13 months. After the rental period ends and you own the machine, Medicare does not cover replacement supplies, so you will need to purchase them yourself or through a retail supplier.

The 13-Month Rental Period and What Happens After

Medicare's CPAP coverage works as a rental-to-own model. You rent the machine for 13 consecutive months. During this time, you pay your 20 percent share each month. At the end of month 13, the machine becomes your property, and Medicare's coverage ends. You can continue using the machine indefinitely at no cost to Medicare.

The 13 months run continuously from the date your supplier delivers the machine. If you stop using the machine after two months and want to restart later, the clock does not reset — you still owe for the months you did not use it, and the 13-month period continues. If you return the machine before 13 months are up, you are still responsible for the rental payments through the end of month 13 in most cases, though some suppliers may negotiate differently.

If your machine breaks or malfunctions during the 13-month period, your supplier will repair or replace it at no cost to you. After month 13, repairs and replacements are your responsibility. Many people choose to purchase a new machine after the 13-month period ends, rather than pay out-of-pocket for repairs on an older rental unit.

When Medicare Denies CPAP Coverage and What to Do

Medicare denies CPAP claims most often because the doctor's order does not clearly state the obstructive sleep apnea diagnosis, the supplier is not Medicare-approved, or the claim is submitted to the wrong Medicare contractor. If your claim is denied, the supplier will send you a notice explaining the reason. Read it carefully — it will tell you whether the issue is with the order, the supplier status, or something else.

If the denial is due to the doctor's order, contact your doctor's office and ask them to resubmit the order with the diagnosis code clearly stated. If the denial is because the supplier is not approved, you will need to switch to an approved supplier and restart the process. If you believe the denial is wrong, you have the right to request a reconsideration from Medicare. The denial notice will include instructions for how to do this.

Some people are denied because they do not have Part B coverage active or because their Part B coverage lapsed. Check your Medicare status before ordering. If you are in a Medicare Advantage plan (Part C) instead of Original Medicare, your coverage for CPAP may differ — contact your plan directly to learn what it covers.

Medicare Advantage Plans and CPAP Coverage

If you are enrolled in a Medicare Advantage plan (Part C), your CPAP coverage may differ from Original Medicare. Some Advantage plans cover CPAP under the same terms as Original Medicare; others have different rules, higher out-of-pocket costs, or require prior authorization from the plan before you order the machine.

Contact your Advantage plan directly before seeing your doctor or ordering a machine. Ask whether the plan covers CPAP, what the out-of-pocket cost is, whether you need prior authorization, and which suppliers are in-network. Some plans have a smaller network of approved suppliers, which may limit your choices. Getting this information upfront will prevent delays and unexpected bills.

Frequently Asked Questions

Do I need a sleep study to get Medicare to cover a CPAP machine?

A sleep study is not required by Medicare, but your doctor must document obstructive sleep apnea through some clinical method — usually a sleep study, but sometimes based on symptoms and examination. The study itself does not trigger coverage; your doctor's written order does. If you had a sleep study years ago, your doctor can use it to support a new CPAP order.

What if I have a Medigap or Medicaid plan in addition to Medicare?

Medigap plans typically cover your 20 percent coinsurance after Medicare pays its 80 percent, so your out-of-pocket cost may be zero or very low. Medicaid rules vary by state; some states cover CPAP under Medicaid, others do not. Contact your Medigap or Medicaid plan to learn what they cover before you order.

Can I buy a CPAP machine instead of renting it from Medicare?

Yes, you can purchase a machine from a retail supplier or online retailer, but Medicare will not pay for it. You would pay the full cost yourself. Many people choose this route if they want a specific brand or model that their approved supplier does not stock, or if they want to own the machine when ready rather than wait 13 months.

What happens if I move during the 13-month rental period?

Contact your supplier and let them know your new address. They will arrange delivery to your new location. The rental period continues uninterrupted. If you move to a state where your current supplier does not operate, you may need to switch to a new approved supplier in your new state, but Medicare will continue to cover the machine under the same terms.

Do I need to pay anything out of pocket if I have met my Part B deductible?

Yes, you still pay 20 percent of the approved rental cost each month, even after the deductible is met. If the approved amount is $60 per month, you pay $12 per month. This 20 percent coinsurance continues for all 13 months of the rental period.