Medicare Part B covers CPAP machines, but only after a sleep study shows you have obstructive sleep apnea
Yes, Medicare Part B will pay for a CPAP machine if a doctor orders one based on a sleep study result. Medicare covers the machine itself, the mask, tubing, and filters. However, you must have a documented diagnosis of obstructive sleep apnea from a sleep study — Medicare will not pay based on symptoms alone or a doctor's clinical judgment without test results.
The coverage works this way: Medicare pays 80% of the approved amount after you meet your Part B deductible. You pay the remaining 20%, which is called coinsurance. If you have a Medigap or Medicare Advantage plan, that plan may cover some or all of your coinsurance, depending on your specific policy.
The machine itself is covered as durable medical equipment (DME), which means Medicare treats it like other long-term medical devices. You do not own it outright at first — you rent it from a Medicare-approved DME supplier for the first 13 months. After 13 months of rental payments, you own the machine. Supplies like masks and filters are covered separately and continue to be covered as long as your doctor says you need them.
Key Takeaways
- You must have a sleep study showing obstructive sleep apnea before Medicare will cover a CPAP machine.
- Medicare Part B covers the machine, mask, tubing, and filters, paying 80% of the approved amount after your deductible.
- You rent the machine from a Medicare-approved supplier for 13 months, then own it; replacement masks and supplies remain covered.
- Your doctor must write an order for the CPAP machine, and the DME supplier must confirm Medicare approval before you receive it.
- If you have a Medigap or Medicare Advantage plan, check your policy to see what coinsurance costs you will owe.
What the sleep study must show
Medicare requires a polysomnography test (an overnight sleep study) or a home sleep apnea test ordered by your doctor. The test must document that you have obstructive sleep apnea — meaning your airway closes repeatedly during sleep, lowering your oxygen levels. The test results must show a specific severity level: 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.
Your primary care doctor or a sleep specialist can order this test. Many primary care doctors refer patients to a sleep medicine clinic, where a sleep specialist reviews the results and decides whether CPAP is the right treatment. If the test shows you have sleep apnea, the sleep specialist or your doctor writes an order for the CPAP machine and sends it to a Medicare-approved DME supplier.
Medicare will not cover a CPAP machine based on a doctor saying you probably have sleep apnea or that your symptoms sound like it. The test result is the requirement — without it, the DME supplier cannot bill Medicare, and you would have to pay the full cost yourself.
How to get a CPAP machine through Medicare
The process has several steps, and timing matters because Medicare requires specific documentation at each stage.
- Get a sleep study. Your doctor orders a polysomnography test or home sleep test. This usually takes one to four weeks to schedule and complete.
- Receive a CPAP order from your doctor. After the test results come back, your doctor or sleep specialist writes a prescription for a CPAP machine. This order must include your diagnosis, the pressure settings the machine should use, and how many hours per night you should use it.
- Choose a Medicare-approved DME supplier. You can search for suppliers on the Medicare website or ask your doctor for a referral. Call the supplier and give them your Medicare number and the doctor's order.
- The supplier confirms coverage with Medicare. The DME supplier submits your information to Medicare to confirm you meet the coverage rules. This step usually takes three to five business days. If Medicare approves it, the supplier will tell you what you owe (your deductible and coinsurance).
- Receive the machine and mask. Once approved, the supplier delivers the CPAP machine and mask to your home or office. They will show you how to use it and how to clean the mask and tubing.
- Start paying rental fees. You pay your coinsurance amount each month for 13 months. After 13 months, you own the machine.
The entire process from sleep study to receiving your machine typically takes four to eight weeks. If your doctor's order is incomplete or the supplier submits it incorrectly, the approval can take longer. Ask the DME supplier to give you a timeline and to contact you if Medicare needs more information.
What you pay out of pocket
Your costs depend on whether you have met your Part B deductible for the year and what your Medigap or Medicare Advantage plan covers.
If you have not met your Part B deductible (which is $226 in 2024, though this amount changes yearly), you pay the full cost of the CPAP machine and supplies until you reach that amount. After you meet the deductible, Medicare pays 80% and you pay 20% coinsurance on the approved amount.
The approved amount is what Medicare decides the machine is worth — not necessarily what the supplier charges. For example, if Medicare's approved amount for a CPAP machine is $1,000, and you have met your deductible, you pay $200 (20%) and Medicare pays $800 (80%). If the supplier charges $1,200, you do not pay the extra $200 — the supplier must accept Medicare's approved amount as payment in full.
Masks, filters, and tubing are covered separately. Medicare covers one mask per month and supplies like tubing and filters as medically necessary. You pay 20% coinsurance on these items as well, after your deductible.
If you have a Medigap plan, it may cover your 20% coinsurance, reducing what you pay to zero or a small copay. If you have a Medicare Advantage plan, your out-of-pocket costs depend on your plan's rules — some cover CPAP supplies with a copay, others with coinsurance. Check your plan documents or call your plan to find out.
Renting versus owning the machine
Medicare's rental-to-own model means you do not buy the machine upfront. Instead, you rent it for 13 months, paying a monthly rental fee (your coinsurance share). The monthly cost is roughly one-thirteenth of the machine's approved amount. After 13 months of payments, you own the machine outright and no longer pay rental fees.
Once you own the machine, Medicare continues to cover replacement masks, filters, and tubing for as long as your doctor says you need them. You still pay 20% coinsurance on these supplies.
If you stop using the CPAP machine before 13 months, you can return it to the supplier and stop paying rental fees. However, you do not get a refund for the months you already paid. If you own the machine (after 13 months) and no longer need it, you can keep it or return it — Medicare does not require you to return it.
Finding a Medicare-approved DME supplier
Not all medical supply companies are Medicare-approved. You must use a supplier that Medicare has enrolled and that is in your area. You can search for suppliers on the Medicare website by entering your ZIP code. You can also call 1-800-MEDICARE and ask for a list of approved suppliers near you.
When you call a supplier, ask whether they are Medicare-approved and whether they serve your area. Ask what your out-of-pocket cost will be based on your deductible status. Some suppliers are more experienced with CPAP machines than others — it is fair to ask how long they have been supplying CPAP equipment and whether they offer training on how to use the machine.
You have the right to choose which Medicare-approved supplier you use. Your doctor does not have to use a specific supplier, and you do not have to use the one your doctor recommends. However, if your doctor has a preferred supplier, ask why — they may have had good experiences with that company's service or training.
What happens if Medicare denies your claim
Medicare may deny coverage if the sleep study does not show sleep apnea, if the AHI score is below the threshold, or if the doctor's order is incomplete. The DME supplier will tell you if Medicare denies the claim and will explain the reason.
If you disagree with the denial, you have the right to appeal. The supplier can help you file an appeal, or you can contact Medicare directly. An appeal usually takes 30 to 60 days. During the appeal, you can ask your doctor to provide additional information or clarification about your diagnosis or the need for the machine.
If the denial is because your sleep study did not meet Medicare's criteria, your doctor may recommend a second sleep study or a different type of test. Some patients need to repeat the test to get a clearer result.
Frequently Asked Questions
Does Medicare Part D cover CPAP machines?
No. Part D covers prescription drugs, not equipment. CPAP machines are covered only under Part B as durable medical equipment. If you have a Medicare Advantage plan that includes Part D, the CPAP machine is still covered under the Part B portion of your plan, not the drug portion.
What if I already own a CPAP machine and want Medicare to cover it?
Medicare will not reimburse you for a machine you already bought. Medicare covers CPAP machines only when ordered through the rental-to-own process with a Medicare-approved supplier. If you bought a machine before getting Medicare or before being diagnosed with sleep apnea, Medicare will not pay you back.
Can I get a replacement machine if mine breaks?
If your machine breaks during the 13-month rental period, contact your DME supplier. They are responsible for repairs or replacement at no extra cost to you. If the machine breaks after you own it (after 13 months), Medicare does not cover repairs, but you can buy a new machine out of pocket or ask your doctor for a new order so you can rent another one through Medicare.
How often can Medicare cover a new CPAP machine?
Medicare covers a new CPAP machine every five years if your doctor orders it. If your machine is damaged or lost before five years, you may be able to get a replacement sooner, but you will need your doctor to document the reason and submit a new order to Medicare.
Will Medicare cover a CPAP machine if I have not been diagnosed yet but think I have sleep apnea?
No. You must have a sleep study first and a diagnosis of obstructive sleep apnea documented in the test results. Talk to your doctor about getting a sleep study ordered. The study itself is usually covered by Medicare Part B, though you will pay your deductible and coinsurance.