Medicare covers CPAP machines and supplies, but only after a sleep study confirms obstructive sleep apnea and your doctor writes an order for the equipment.

Medicare Part B pays for CPAP (continuous positive airway pressure) machines, masks, hoses, and replacement parts when three conditions are met: you have had a sleep study showing obstructive sleep apnea, your doctor has ordered the equipment in writing, and you obtain it from a Medicare-enrolled supplier. The coverage is not automatic — you must follow the specific steps Medicare requires, and the supplier must handle the paperwork correctly or the claim will be denied.

Medicare pays 80 percent of the approved amount after you meet your Part B deductible. You pay the remaining 20 percent, plus the full deductible if you have not met it yet. The approved amount varies by region and by equipment type, so your out-of-pocket cost depends on where you live and which machine your doctor prescribes.

Key Takeaways

  • A sleep study ordered by your doctor is the first requirement; Medicare will not cover CPAP without documented sleep apnea diagnosis.
  • Your doctor must write a written order for the CPAP machine and specify the pressure settings based on your sleep study results.
  • You must buy or rent from a Medicare-enrolled CPAP supplier, not from a retail store or online retailer, or Medicare will not pay.
  • Medicare covers the machine itself, masks, tubing, filters, and humidifier chambers, but coverage rules differ for rentals versus purchases.
  • You pay 20 percent coinsurance after your Part B deductible, with the exact amount depending on your region's Medicare-approved price.

How the Sleep Study and Doctor's Order Work

Before Medicare will consider covering a CPAP machine, your doctor must order a sleep study. This is usually an overnight test at a sleep lab, though home sleep tests are also covered in some cases. The study measures how many times per hour you stop breathing and how low your oxygen drops — these numbers determine whether you have obstructive sleep apnea and how severe it is.

Once the sleep study confirms sleep apnea, your doctor writes a written order (called a prescription) that includes the specific pressure setting the machine should deliver. Medicare requires this order to be in writing and to be dated within the past 12 months. The order must also state that the equipment is medically necessary. Without this order, no Medicare-enrolled supplier will submit a claim on your behalf.

If you already have a CPAP machine from before you turned 65 or before you enrolled in Medicare Part B, you may still need a new sleep study and order to have Medicare cover a replacement. The rules depend on how long you have been using the machine and whether your settings have changed.

Finding and Working With a Medicare-Enrolled CPAP Supplier

Not every medical supply store or online retailer is enrolled with Medicare. If you buy from a supplier that is not enrolled, Medicare will not pay, and you will be responsible for the full cost. To find an enrolled supplier, use the Medicare Supplier Directory on Medicare.gov or call 1-800-MEDICARE and ask for suppliers in your area.

Once you have chosen a supplier, give them your doctor's written order and your Medicare card. The supplier will verify your coverage, confirm that you meet Medicare's requirements, and handle the claim submission. Ask the supplier upfront what your out-of-pocket cost will be — they should be able to tell you the Medicare-approved amount for your region and calculate your 20 percent coinsurance.

Some suppliers rent CPAP machines month to month, while others sell them outright. Medicare covers both options, but the payment structure differs. With a rental, Medicare pays the supplier a monthly fee for up to 13 months, after which you own the machine. With a purchase, Medicare pays a one-time amount toward the cost.

What Equipment Medicare Covers

Medicare covers the CPAP machine itself, along with masks (nasal, full-face, or nasal pillows), tubing, filters, and humidifier chambers. Replacement masks and supplies are also covered, though there are limits on how often you can get new ones. Medicare typically covers one mask per month and one set of tubing per month, though the exact limits depend on the type of equipment and your supplier's contract with Medicare.

Accessories like heated tubing, travel cases, or machine-cleaning devices are usually not covered. If your doctor prescribes a specific type of mask because of a skin condition or other medical reason, that mask may be covered even if it is more expensive than the standard option — but your doctor's order must document the medical reason.

If your machine breaks and cannot be repaired, Medicare will cover a replacement, but you must go through your supplier and have your doctor confirm that the machine is no longer usable. straightforward wanting a newer model is not a covered reason for replacement.

Rental Versus Purchase: How Medicare Pays

If you rent a CPAP machine from a Medicare-enrolled supplier, Medicare pays the supplier a set monthly rental fee. You pay 20 percent of that fee as coinsurance (after your deductible). After 13 months of rental payments, you own the machine outright, and Medicare stops paying. At that point, replacement supplies like masks and filters continue to be covered under the same 80/20 split.

If you purchase a CPAP machine, Medicare pays 80 percent of the approved purchase price in your region, and you pay 20 percent. There is no monthly payment — it is a one-time transaction. After purchase, replacement supplies are covered the same way as with a rental machine.

Which option costs less depends on your region's approved prices and how long you plan to use the machine. Some people find renting cheaper upfront but prefer purchasing to avoid monthly payments. Your supplier can show you the cost of both options before you decide.

Common Reasons Medicare Denies CPAP Claims

The most common reason for denial is using a supplier that is not Medicare-enrolled. Always verify enrollment before you buy or rent. The second most common reason is a missing or incomplete doctor's order — if the order does not include the pressure setting or does not state medical necessity, Medicare will deny the claim.

A third reason is a sleep study that does not meet Medicare's criteria. Medicare has specific rules about how the study must be conducted and what results may have access to for coverage. If the study was done at home but your doctor did not order it as a home study, or if the results do not show enough apnea events, Medicare may deny coverage. Your doctor should know these rules, but it is worth asking before the study is done.

Lastly, if you have not met your Part B deductible for the year, you will owe the full cost of the equipment until the deductible is satisfied. After that, you owe 20 percent. Some people are surprised by this and think Medicare is not covering the equipment at all — but it is straightforward the deductible working as designed.

What Happens if Medicare Denies Your Claim

If your claim is denied, the supplier should send you a notice explaining the reason. Read it carefully — it will say whether the denial is because of a missing sleep study, an incomplete doctor's order, a non-enrolled supplier, or something else. Many denials can be fixed by getting your doctor to submit a corrected order or by switching to an enrolled supplier.

If you disagree with the denial, you have the right to appeal. The notice will explain how to file an appeal and what important date you have. For CPAP equipment, appeals often succeed when the issue was a paperwork mistake rather than a medical one. Contact your supplier or call 1-800-MEDICARE if you need help understanding the denial or filing an appeal.

Frequently Asked Questions

Do I need a sleep study if I already know I have sleep apnea?

Yes. Medicare requires a sleep study on record within the past 12 months, even if you were diagnosed years ago. If your last study is older than that, your doctor will need to order a new one before Medicare will cover a replacement machine or continued supplies.

Can I use a CPAP machine I bought before I had Medicare?

You can use it, but Medicare will not pay for it or for replacement supplies unless you have a current sleep study and doctor's order on file. If you want Medicare to cover supplies going forward, you will need to meet the same requirements as someone getting a machine for the first time.

What if my doctor prescribes a CPAP machine but I do not have sleep apnea?

Medicare will not cover it. Coverage requires a sleep study showing obstructive sleep apnea. If your doctor believes you have sleep apnea but the study results are borderline, ask your doctor whether a second study or a different type of study might provide clearer results.

Will Medicare cover a CPAP machine if I have a Medigap or Medicare Advantage plan?

Original Medicare (Part A and Part B) covers CPAP as described here. If you have a Medicare Advantage plan, coverage may differ — some plans cover CPAP the same way, while others have different rules or require prior approval. Contact your plan directly to confirm what is covered before you order equipment.

How often can I get a new CPAP machine?

If you rent, you own the machine after 13 months and Medicare stops paying for the machine itself. If the machine breaks after you own it, Medicare will cover a replacement only if your doctor confirms it cannot be repaired. If you purchase, Medicare typically covers a replacement machine every five years, though this can vary.