What Medicare Covers for CPAP Machines and Supplies

Medicare covers CPAP machines and most 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, replacement masks, hoses, filters, and other supplies you need to use it. The coverage splits into two parts: your doctor's evaluation and prescription, and then the equipment and ongoing supplies through a Medicare-approved supplier.

The catch is that Medicare requires specific paperwork before it will pay. Your sleep study results must show you have obstructive sleep apnea, your doctor must write an order for CPAP therapy, and you must obtain the equipment from a Medicare-approved CPAP supplier — not just any medical equipment company. If you buy or rent from a non-approved supplier, Medicare will not reimburse you.

Key Takeaways

Your doctor must order CPAP therapy based on a sleep study showing obstructive sleep apnea; Medicare will not cover it without this documentation.
You must use a Medicare-approved CPAP supplier, which you can find by calling 1-800-MEDICARE or searching the Medicare Supplier Directory online.
Medicare Part B covers the CPAP machine, masks, hoses, filters, and other supplies, though you pay your share of the cost through your deductible and coinsurance.
Replacement masks and supplies are covered once every 12 months, though your doctor can request more frequent replacements if medically necessary.
If you have Medigap or a Medicare Advantage plan, your out-of-pocket costs may be lower, depending on your specific plan.

What Medicare Part B Actually Covers

Medicare Part B covers the CPAP machine itself, classified as durable medical equipment (DME). This includes the machine, the mask, the hose that connects the mask to the machine, filters, and the humidifier chamber if your machine has one. Medicare also covers replacement supplies like new masks and hoses when your existing ones wear out or no longer fit.

The standard coverage allows one replacement mask every 12 months. If your doctor documents that you need replacements more often — for example, because you have skin sensitivity or your mask breaks frequently — your doctor can request more frequent coverage. Medicare will review the request and may approve additional replacements.

What Medicare does not cover: the initial sleep study itself is usually covered under Part B as a diagnostic test, but some sleep studies done in a hospital setting may fall under Part A instead. Ask your doctor's office which setting they use, because it affects your cost. Medicare also does not cover CPAP machines purchased from non-approved suppliers, even if the machine itself is Medicare-approved.

How Your Costs Break Down

Under Medicare Part B, you pay 20 percent coinsurance of the approved amount for the CPAP machine and supplies, after you have met your annual Part B deductible. The approved amount varies by region and supplier, so your actual cost depends on where you live and which supplier you use.

For example, if Medicare's approved amount for a CPAP machine in your area is $800, and you have already met your deductible, you would pay $160 (20 percent). The supplier bills Medicare for the remaining $640. Replacement masks typically cost you $30 to $60 out of pocket per mask, depending on the type and your deductible status.

If you have a Medigap policy, it may cover some or all of your coinsurance, which would lower your out-of-pocket cost. If you have a Medicare Advantage plan, your costs depend on your plan's specific rules — some plans cover CPAP equipment with a copay instead of coinsurance, and some have different deductibles. Check your plan documents or call the plan directly to find out what you will owe.

Finding a Medicare-Approved CPAP Supplier

You must obtain your CPAP machine and supplies from a Medicare-approved supplier. The easiest way to find one is to call 1-800-MEDICARE (1-800-633-4227) and ask for suppliers in your area. Medicare's staff can tell you which suppliers near you are approved and can deliver to your home.

You can also search the Medicare Supplier Directory online at dmepos.cms.gov. Enter your ZIP code and select "CPAP" or "respiratory equipment" to see approved suppliers. The directory shows you which suppliers are currently enrolled and accepting new patients.

Once you have your doctor's prescription, contact the supplier directly. They will handle submitting the paperwork to Medicare, including your sleep study results and your doctor's order. The supplier should also verify your coverage before they ship the equipment, so you know your out-of-pocket cost ahead of time.

What Your Doctor Needs to Document

Medicare requires your doctor to document that you have obstructive sleep apnea based on a sleep study. The sleep study must show that you stop breathing or have shallow breathing during sleep, and that these events happen frequently enough to warrant treatment. A home sleep test or an in-lab sleep study both count.

Your doctor must also write an order for CPAP therapy that includes the pressure settings (measured in centimeters of water pressure, or cm H₂O) that your machine should deliver. If your doctor has not yet ordered a CPAP machine, ask them to do so at your next visit or call their office to request the order. The order is free — it is just a prescription, like any other.

If you had a sleep study years ago and no longer have the results, ask your doctor's office or the sleep clinic where you had the test to send a copy to your current doctor. Medicare will not process a CPAP order without documentation of the sleep study.

Renting Versus Buying Your CPAP Machine

Medicare covers both renting and buying a CPAP machine. Most people rent through a Medicare-approved supplier, which means you pay a monthly rental fee and the supplier maintains and replaces the machine if it breaks. After you have rented for 13 months, you own the machine outright and no longer owe rental payments.

If you prefer to buy the machine outright, you can do that too. Your out-of-pocket cost is the same whether you rent or buy — you pay 20 percent coinsurance of the approved amount. The difference is that if you buy, you own it when ready and are responsible for repairs, whereas if you rent, the supplier handles maintenance.

Most people choose to rent because it spreads the cost over time and because the supplier replaces the machine if it malfunctions. If you travel frequently or think you might stop using CPAP, renting gives you more flexibility. Ask your supplier about their rental and purchase options before you decide.

What to Do If Medicare Denies Your Claim

If Medicare denies your CPAP claim, the supplier will send you a notice called an Explanation of Benefits (EOB). The EOB explains why Medicare denied the claim — common reasons include missing sleep study documentation, a doctor's order that does not meet Medicare's requirements, or use of a non-approved supplier.

If the denial is because of missing paperwork, ask your doctor's office to send the missing documents to Medicare. If the denial is because your doctor's order did not include pressure settings or other required information, ask your doctor to submit a corrected order. The supplier can resubmit the claim once the paperwork is complete.

If you disagree with the denial, you have the right to appeal. The EOB will include instructions on how to file an appeal and the important date for doing so — usually 120 days from the date of the notice. You can appeal on your own or ask your doctor or supplier to help you gather the information Medicare needs to reconsider.

Frequently Asked Questions

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

Yes. Medicare requires a sleep study showing obstructive sleep apnea before it will cover CPAP. The study can be done at a sleep clinic or at home. If you had a sleep study years ago, ask your doctor's office to request the results from the clinic so they can submit them with your CPAP order.

Can I use my old CPAP machine from before I had Medicare?

Yes, you can use an old machine you already own. Medicare will still cover replacement masks, hoses, and other supplies for it, as long as your doctor prescribes CPAP and you obtain the supplies from a Medicare-approved supplier. You just will not get reimbursed for the machine itself since you already own it.

What if my CPAP machine breaks and I am still renting?

Contact your supplier when ready. If you are renting through a Medicare-approved supplier, they are responsible for repairing or replacing the machine at no cost to you. That is one of the main advantages of renting. If you bought the machine, you pay for repairs out of pocket unless you purchased a warranty.

Does Medicare cover CPAP if I have a Medicare Advantage plan?

Yes, but the coverage rules and your out-of-pocket costs may differ from Original Medicare. Some Medicare Advantage plans cover CPAP with a copay instead of coinsurance, and some have different deductibles or require prior approval. Check your plan documents or call your plan's customer service to find out what your plan covers.

How often can I get replacement CPAP masks?

Medicare covers one replacement mask every 12 months as standard. If your doctor documents that you need replacements more often due to skin irritation, allergies, or frequent breakage, your doctor can request more frequent coverage. Medicare will review the request and may approve additional replacements if medically necessary.

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.