Medicare covers CPAP machines and most supplies through Part B, but only after a doctor diagnoses sleep apnea and writes an order for the equipment.

Medicare will pay for a CPAP machine, mask, hose, and filters if you have a sleep apnea diagnosis documented by a sleep study. Part B covers 80 percent of the approved amount after you meet your annual deductible. You pay the remaining 20 percent, plus any difference between what Medicare approves and what the supplier charges — unless your supplier is in-network and accepts assignment.

The process starts with your doctor ordering the equipment. Medicare then requires a 30-day trial period during which you use the machine at least four hours per night on at least 70 percent of those nights. After 30 days, your doctor must confirm you are using it and that it is helping. Only then does Medicare move from a rental arrangement to covering ongoing supplies.

Key Takeaways

  • Medicare Part B covers CPAP machines and supplies after a sleep apnea diagnosis and a 30-day trial showing you use the equipment regularly.
  • You pay 20 percent of the Medicare-approved amount after your deductible, plus any charges above what Medicare approves if your supplier does not accept assignment.
  • Replacement masks, hose, and filters are covered as ongoing supplies once the initial trial period ends, but coverage limits explore to how often you can get new parts.
  • Your doctor's order must specify the type of CPAP machine and settings; Medicare will not cover equipment ordered without a physician's written prescription.
  • Suppliers must be Medicare-enrolled and accept Medicare assignment to avoid surprise bills for the difference between their charge and Medicare's approved amount.

What Medicare Covers Under Part B

Medicare Part B covers the CPAP machine itself, the mask, tubing, filters, and humidifier chamber if your machine has one. The machine is considered durable medical equipment (DME), which means Medicare treats it as a rental for the first three months, then transitions to a purchase model where you own the equipment after that period.

Replacement supplies — new masks, tubing, and filters — are covered as long as your doctor continues to document that you are using the machine and it remains medically necessary. The frequency of replacement coverage varies: masks are typically covered once every three months, tubing once every six months, and filters once every three months. Your supplier will track these dates and know when you are due for replacements.

Humidifier chambers and heated tubing are covered if your doctor's order specifically includes them. If your machine has a heated humidifier built in, Medicare covers the water chamber as part of the equipment. Distilled water for the humidifier is not covered.

The 30-Day Trial Period and Documentation Requirements

Before Medicare will pay for ongoing CPAP use, you must complete a 30-day trial period. During this time, your supplier rents the machine to you, and Medicare covers 80 percent of the rental cost. You are responsible for 20 percent of the approved amount.

The trial has specific requirements: you must use the machine at least four hours per night on at least 70 percent of the nights in that 30-day window. Your machine tracks this data automatically. After 30 days, your doctor reviews the data and confirms that you are meeting the usage threshold and that the treatment is working. If you do not meet the four-hour, 70-percent standard, Medicare will not cover the equipment beyond the trial period.

Your doctor must submit a statement to Medicare confirming compliance with the usage requirements. This is usually done by the supplier on your behalf, but you should ask your supplier to confirm they have sent this documentation. Without it, your coverage will not continue past the trial.

What You Pay Out of Pocket

Your costs depend on whether your supplier accepts Medicare assignment. If they do, you pay 20 percent of the Medicare-approved amount for the machine and supplies, after you have met your Part B deductible for the year. The deductible is the same across all Part B services and resets each January.

If your supplier does not accept assignment, they can charge you more than Medicare approves. You would then owe 20 percent of the approved amount plus the full difference between the approved amount and the supplier's actual charge. This can add hundreds of dollars to your bill. Always ask your supplier whether they accept Medicare assignment before you begin treatment.

Once you own the machine (after the three-month rental period), you do not pay a monthly fee for the equipment itself. You only pay for replacement supplies as they become due. If you need a new machine because yours breaks or becomes obsolete, Medicare will cover a replacement under the same 80/20 split, but only once every five years under current policy.

Finding a Medicare-Enrolled CPAP Supplier

Your CPAP equipment must come from a supplier enrolled with Medicare. Not all medical supply companies are enrolled, and enrollment status varies by state. Your doctor's office can refer you to an enrolled supplier, or you can search the Medicare Supplier Directory on the Centers for Medicare & Medicaid Services (CMS) website.

When you contact a supplier, ask three questions: Are you enrolled with Medicare? Do you accept Medicare assignment? Can you provide a written estimate of what you will owe after Medicare pays? A supplier who cannot answer these clearly or who seems evasive about assignment is a sign to call another company.

Some suppliers are more responsive than others about tracking your replacement supply dates and reminding you when new masks or filters are due. Since you are responsible for requesting replacements, choosing a supplier with good customer service can save you time and prevent gaps in your treatment.

When Medicare Does Not Cover CPAP Equipment

Medicare will not cover a CPAP machine if you do not have a sleep apnea diagnosis confirmed by a sleep study. A doctor's clinical suspicion is not enough; the sleep study must show that you stop breathing during sleep and that the frequency or severity meets diagnostic criteria for sleep apnea.

If you do not meet the four-hour, 70-percent usage threshold during the trial period, Medicare stops covering the equipment. Some people find CPAP uncomfortable or ineffective and choose not to use it; in those cases, Medicare coverage ends. If this happens to you, talk to your doctor about whether a different mask style or machine type might work better, or whether you have other treatment options.

Equipment ordered without a physician's written prescription is not covered. You cannot buy a CPAP machine over the counter and ask Medicare to reimburse you. The order must come from your doctor and be submitted to Medicare before you receive the equipment.

Supplemental Insurance and CPAP Coverage

If you have a Medigap or Medicare Advantage plan in addition to Original Medicare, your supplemental coverage may reduce your out-of-pocket costs for CPAP supplies. Medigap plans vary in what they cover; some pay part or all of your 20 percent coinsurance, while others do not cover DME at all. Check your plan documents or call your supplemental insurer to confirm.

Medicare Advantage plans (Part C) must cover at least what Original Medicare covers, but they may have different rules about which suppliers you can use or how often you can get replacements. Some Advantage plans require prior authorization before you start CPAP treatment. If you are on a Medicare Advantage plan, contact your plan before your doctor places an order.

Frequently Asked Questions

What happens if I stop using my CPAP machine after Medicare starts paying for supplies?

If you stop using the machine, you can still request replacement supplies as long as your doctor continues to prescribe them and Medicare has not formally ended your coverage. However, if you go more than 12 months without using the machine, Medicare may require a new sleep study or doctor's statement confirming that treatment is still necessary before approving more supplies.

Can Medicare cover a second CPAP machine if I travel or need a backup?

Medicare typically covers only one CPAP machine per person. A second machine would not be covered unless your first machine breaks and cannot be repaired, in which case a replacement would be covered under the five-year replacement cycle. Portable or travel machines are not separately covered.

Does Medicare cover CPAP masks that are not the standard style?

Medicare covers CPAP masks as long as they are compatible with your prescribed machine and your doctor's order includes them. Different mask styles — nasal, full-face, nasal pillow — are all covered if medically necessary. If you need to switch mask types because the original does not fit or work for you, ask your doctor to update the prescription and your supplier to request the new style from Medicare.

What if my CPAP supplier goes out of business?

If your supplier closes, you will need to transfer your care to another Medicare-enrolled supplier. Contact your doctor's office and ask for a referral to a new supplier, or search the Medicare Supplier Directory. Your new supplier can request your machine settings and usage data from your old supplier's records and continue your care without interruption.

Are CPAP accessories like travel cases or extra tubing covered by Medicare?

Medicare covers only the essential equipment and supplies needed for treatment: the machine, mask, tubing, filters, and humidifier chamber. Accessories like carrying cases, travel adapters, or extra tubing beyond the standard replacement schedule are not covered. You would pay for these out of pocket.