Medicare Part B covers CPAP machines, but only after a sleep study shows you have obstructive sleep apnea and your doctor prescribes one

Medicare Part B will pay for a CPAP machine if you meet three conditions: you have had a sleep study (either in a lab or at home) that diagnosed obstructive sleep apnea, your doctor has written a prescription for the device, and you are using it under medical supervision. Medicare does not pay for CPAP machines bought over the counter or without a diagnosis.

The coverage includes the machine itself, the mask, tubing, and replacement supplies. However, Medicare pays a set amount for the rental or purchase, and you are responsible for any cost above that amount. The exact payment depends on whether you rent or buy, and whether you go through a Medicare-approved supplier.

Key Takeaways

  • You must have a sleep study diagnosis of obstructive sleep apnea and a doctor's prescription before Medicare will pay for a CPAP machine.
  • Medicare Part B covers the machine, mask, tubing, and replacement supplies, but pays only a set amount — you pay the difference if the supplier charges more.
  • You must use a Medicare-approved CPAP supplier; buying from a non-approved seller means Medicare will not pay.
  • Medicare covers CPAP rentals for up to 13 months, after which you own the machine; if you buy outright, Medicare pays a one-time amount.
  • You pay 20 percent of the Medicare-approved amount after you meet your Part B deductible.

How the sleep study diagnosis works

Before Medicare will cover a CPAP machine, your doctor must order a sleep study to confirm you have obstructive sleep apnea. This study can happen in a sleep lab (where you spend a night hooked to monitoring equipment) or at home using a portable device you wear overnight. Medicare covers the cost of the sleep study itself under Part B.

The sleep study measures how many times per hour your breathing stops or becomes shallow during sleep. If the results show obstructive sleep apnea, your doctor can then prescribe a CPAP machine. Without this diagnosis documented in your medical record, Medicare will not pay for the device, even if you buy it yourself and ask for reimbursement later.

Renting versus buying: what Medicare pays

Medicare allows you to rent a CPAP machine for up to 13 months. During this rental period, you pay 20 percent of the Medicare-approved rental amount each month (after you have met your Part B deductible for the year). After 13 months of rental payments, you own the machine outright and do not pay further rental fees.

If you choose to buy the machine outright instead of renting, Medicare pays a one-time amount toward the purchase price. You pay 20 percent of the Medicare-approved purchase price after your deductible. The Medicare-approved amount for purchase is usually less than the total cost of 13 months of rental, so buying makes financial sense if you plan to use the machine for more than a year.

Some suppliers offer lease-to-own arrangements. Make sure any arrangement you choose goes through a Medicare-approved supplier, or Medicare will not pay any part of the cost.

Finding a Medicare-approved CPAP supplier

You must obtain your CPAP machine from a supplier that is enrolled with Medicare. Your doctor can recommend one, or you can search the Medicare Supplier Directory on the Medicare website. Enter your ZIP code and select "CPAP" as the equipment type to see which suppliers near you accept Medicare.

Once you have identified a supplier, call them and tell them you have a prescription for a CPAP machine and want to use Medicare. The supplier will verify your Medicare coverage and explain what you will owe out of pocket. Do not assume all suppliers charge the same amount — Medicare-approved suppliers can charge different prices, and you are responsible for any amount above the Medicare-approved fee.

What Medicare covers and what you pay

Medicare Part B covers the CPAP machine, the mask, the tubing, and replacement supplies like filters and cushions. Replacement masks and supplies are covered on an ongoing basis as long as you continue to use the machine under a doctor's care.

You pay 20 percent of the Medicare-approved amount for the machine and supplies after you meet your annual Part B deductible (which is $240 in 2024, though this amount may change each year). If your supplier charges more than the Medicare-approved amount, you pay the full difference on top of your 20 percent coinsurance.

Medicare does not cover CPAP machines or supplies if you do not have a current prescription or if you stop using the machine. Your doctor may ask you to check in periodically to confirm the machine is helping and that you are using it regularly.

Medigap and Medicare Advantage coverage for CPAP

If you have a Medigap (supplemental insurance) plan, it may pay some or all of your 20 percent coinsurance for the CPAP machine and supplies. The exact coverage depends on which Medigap plan you have. Call your Medigap insurer to ask whether they cover durable medical equipment coinsurance.

If you have a Medicare Advantage plan (Part C), your coverage for CPAP machines works differently. Medicare Advantage plans must cover at least what Original Medicare covers, but they may have different copays, deductibles, or supplier networks. Check your plan's coverage details or call the plan directly to learn what you will owe for a CPAP machine.

What happens if you need a new machine or mask

If your current CPAP machine breaks or stops working, your doctor can prescribe a replacement. Medicare will cover a new machine under the same rental or purchase rules as the original. If you rented for 13 months and now own the machine, you can rent a replacement and start the 13-month rental period over, or you can buy a new one outright.

Masks and other supplies wear out and need replacement. Medicare covers replacement masks, tubing, filters, and cushions as medically necessary items. Your supplier can order these for you, and Medicare will pay its share. You will pay 20 percent of the Medicare-approved amount for each replacement item.

Frequently Asked Questions

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

Yes. Even if you were diagnosed with sleep apnea years ago, Medicare requires a sleep study on record to cover a CPAP machine. If your old study is more than a few years old, your doctor may order a new one. Ask your doctor whether your existing diagnosis is recent enough for Medicare purposes.

What if my doctor prescribes a CPAP but I buy it from an online retailer instead of a Medicare-approved supplier?

Medicare will not pay for a CPAP machine purchased from a non-approved seller. You would pay the full cost out of pocket. Always confirm the supplier is Medicare-approved before you buy or rent.

Can I switch from renting to buying after a few months?

Yes. If you rent for a few months and then decide to buy, you can stop renting and purchase the machine. Medicare will credit the rental payments you have already made toward the purchase price. Talk to your supplier about how the credit works before you make the switch.

Does Medicare cover CPAP machines for central sleep apnea or mixed sleep apnea?

Medicare covers CPAP for obstructive sleep apnea. For central sleep apnea or mixed apnea, your doctor may prescribe a different type of device, such as a BiPAP or APAP machine. Medicare covers these devices under the same rules as CPAP if your doctor prescribes them and a sleep study supports the diagnosis.

What if I cannot afford the 20 percent coinsurance?

Talk to your doctor or the CPAP supplier about your cost concerns. Some suppliers offer payment plans. If you have limited income, you may be able to get help through a local aging services agency or community health center. Your local Area Agency on Aging can point you toward resources in your area.