Medicare covers sleep apnea machines, but only after a doctor diagnoses the condition and prescribes the device
Yes, Medicare Part B covers CPAP machines (continuous positive airway pressure devices) and similar sleep apnea equipment, along with masks, tubing, and filters. However, coverage is not automatic. Your doctor must order the machine as medically necessary, you must have a sleep study that documents the condition, and you must meet Medicare's specific requirements for the type and severity of sleep apnea you have.
Medicare will pay 80 percent of the approved amount after you meet your Part B deductible. You pay the remaining 20 percent, unless you have a Medigap or Medicare Advantage plan that covers additional costs. The initial machine and first three months of supplies are covered under one benefit period, and replacement machines are covered every five years.
Key Takeaways
- Your doctor must refer you for a sleep study and write an order for the machine before Medicare will consider coverage.
- Medicare covers the CPAP machine itself, masks, tubing, filters, and humidifier cartridges as part of the durable medical equipment benefit.
- You pay 20 percent of the Medicare-approved cost after meeting your Part B deductible; the exact amount depends on your supplier and location.
- Replacement machines are covered once every five years, and replacement supplies (masks and filters) are covered based on wear and tear schedules Medicare sets.
- You must use a Medicare-approved supplier, and the machine must be used at least four hours per night on at least 21 days per month to remain covered.
What Medicare requires before covering a sleep apnea machine
Medicare does not cover a sleep apnea machine based on symptoms alone. Your primary care doctor or a sleep specialist must first refer you for an in-lab sleep study or a home sleep apnea test. The test must show that you have obstructive sleep apnea (OSA) with an apnea-hypopnea index (AHI) of 15 or higher, or an AHI of 5 to 14 if you also have symptoms like daytime sleepiness or witnessed breathing pauses.
After the sleep study confirms the diagnosis, your doctor writes an order for the CPAP machine or other approved device. Medicare then requires that the machine be set up and monitored by a Medicare-approved durable medical equipment (DME) supplier. You cannot buy the machine on your own and have Medicare reimburse you; the supplier must be enrolled in Medicare before you receive the equipment.
You will also need to sign a certificate of medical necessity, which your doctor completes. This document confirms that the machine is medically necessary for your condition. Without it, the claim will be denied.
How much Medicare pays and what you owe
Medicare Part B pays 80 percent of the approved amount for the CPAP machine and initial supplies after you meet your annual Part B deductible (which is $240 in 2024, though this amount changes yearly). You are responsible for the remaining 20 percent, called coinsurance.
The actual cost you pay depends on the Medicare-approved amount in your area and the specific machine your doctor prescribes. A CPAP machine typically has an approved amount between $600 and $900, meaning your 20 percent share could range from $120 to $180 after your deductible. Masks, tubing, and filters are covered separately, with their own approved amounts.
If you have a Medigap policy, it may cover some or all of your 20 percent coinsurance. If you have a Medicare Advantage plan, your out-of-pocket costs depend on your specific plan's rules and network suppliers. Contact your plan directly to learn what you will owe.
Masks, filters, and other supplies Medicare covers
Medicare covers the mask that attaches to your CPAP machine, the tubing that connects the machine to the mask, replacement filters, and a humidifier cartridge if your machine has one. These are considered part of the durable medical equipment benefit and are covered under the same 80/20 split as the machine itself.
Replacement supplies follow Medicare's wear-and-tear schedule. You can receive a new mask every month, new tubing every three months, new filters every three months, and a new humidifier cartridge every month. Your DME supplier tracks these dates and ships replacements automatically, or you can request them when you need them.
Medicare does not cover items like cleaning supplies, carrying cases, or travel adapters. Some suppliers include these items at no extra charge, while others charge you directly. Ask your supplier what is included in the Medicare-covered price and what costs extra.
Replacement machines and long-term coverage
Medicare covers a replacement CPAP machine once every five years. If your current machine breaks or stops working before five years have passed, you must contact your DME supplier to request a repair. Medicare will pay for repairs as long as the repair cost is less than 50 percent of the cost of a new machine.
If your machine cannot be repaired or the repair cost exceeds that threshold, your supplier can request an exception from Medicare for an early replacement. This requires your doctor to document that the machine is no longer working and that repair is not possible. The process typically takes one to two weeks.
After five years, you are may be able to access for a new machine at no additional out-of-pocket cost beyond the 20 percent coinsurance and any deductible that applies in that calendar year. Your doctor must write a new order, and you must have a current sleep study on file (usually within the past year) for Medicare to approve the replacement.
Using an out-of-network or non-Medicare supplier
If you purchase a CPAP machine from a supplier who is not enrolled in Medicare, Medicare will not pay for it. You can still buy the machine yourself and pay the full cost out of pocket, but you cannot submit the bill to Medicare for reimbursement.
Some people choose to do this if they want a specific brand or model that their local Medicare-approved supplier does not carry, or if they want to purchase the machine faster than Medicare's approval process allows. If you decide to buy privately, confirm with your doctor that the machine is appropriate for your condition, and keep your receipt in case you need to document the purchase later.
If you later want Medicare to cover supplies for a privately purchased machine, you will need to switch to a Medicare-approved supplier and have your doctor write a new order. Medicare will then cover masks, filters, and other supplies for that machine going forward, but not the machine itself.
What to ask your doctor and when to seek care
Before your sleep study, ask your doctor whether an in-lab study or home test is more appropriate for you. Ask how long the results take and when you should expect to hear back. Once you have a diagnosis, ask your doctor to write the order for the CPAP machine and to specify which type of machine (CPAP, BiPAP, or APAP) is best for your condition.
Ask your doctor which DME suppliers are in your Medicare network and whether they have a preferred supplier. Ask about the expected out-of-pocket cost and whether your doctor's office will help you understand your bill. If your machine stops working or you are having trouble using it, contact your supplier first; they can troubleshoot problems or arrange a repair or replacement.
Seek care from your doctor if you continue to have daytime sleepiness, morning headaches, or gasping awake at night even after using the CPAP machine for several weeks. These symptoms may mean the machine settings need adjustment, or that a different type of device would work better for you. Your doctor can order a follow-up sleep study to check how well the machine is controlling your sleep apnea.
Frequently Asked Questions
Do I need a sleep study to get Medicare coverage for a CPAP machine?
Yes. Medicare requires a sleep study that documents obstructive sleep apnea before it will cover a CPAP machine. The study can be done in a lab or at home, but the results must show an apnea-hypopnea index of at least 15, or 5 to 14 if you have symptoms. Your doctor orders the study and interprets the results.
What if I already own a CPAP machine and want Medicare to cover supplies for it?
Medicare will cover masks, tubing, and filters for a machine you own, but only if you have a current sleep study on file and a doctor's order. You must also use a Medicare-approved DME supplier. Contact a supplier in your area and provide your sleep study results and doctor's order to get your free guide.
Can Medicare Advantage plans deny coverage for a CPAP machine that Original Medicare would cover?
Medicare Advantage plans must cover the same basic benefits as Original Medicare, including CPAP machines. However, they may require prior authorization, use different suppliers, or have different out-of-pocket costs. Contact your plan before starting the process to understand their specific rules.
What happens if I do not use my CPAP machine enough?
Medicare requires that you use the machine at least four hours per night on at least 21 days per month. If you do not meet this threshold, Medicare may stop covering supplies or deny coverage for a replacement machine. Your supplier can check your usage data, so talk to your doctor or supplier if you are having trouble using the machine regularly.
Will Medicare cover a different type of sleep apnea device, like a BiPAP or oral appliance?
Medicare covers BiPAP machines and APAP machines under the same rules as CPAP machines. Oral appliances (dental devices) are covered only in specific cases when CPAP is not tolerated or not effective. Your doctor must document why the alternative device is medically necessary and request it in writing to Medicare.