What Medicare Covers for Sleep Apnea Equipment and Testing

Medicare covers sleep apnea testing and equipment, but only after a doctor diagnoses the condition through an overnight sleep study

Yes, Medicare Part B covers the cost of a sleep study to diagnose sleep apnea, and it also covers the equipment you need if you are diagnosed — typically a CPAP (continuous positive airway pressure) machine or similar device. The catch is that Medicare requires a doctor's order and a completed sleep study showing you have the condition before it will pay for any equipment. You cannot buy a machine on your own and ask Medicare to reimburse you later.

The coverage includes the machine itself, the mask, tubing, and filters. Medicare also covers replacement parts and supplies, though there are limits on how often you can get new equipment. The amount Medicare pays depends on whether you rent or buy the machine, and rental payments can eventually count toward purchase if you choose to buy later.

Key Takeaways

Medicare Part B covers an overnight sleep study ordered by your doctor, which is the first step toward getting equipment coverage.
Once a sleep study confirms sleep apnea, Medicare covers CPAP machines, masks, tubing, and replacement supplies at 80 percent of the approved amount after you meet your Part B deductible.
You can rent a CPAP machine for about $50 per month (the amount varies by supplier), and rental payments count toward the purchase price if you decide to buy.
Medicare limits how often you can receive replacement equipment — typically one mask per month and one machine every five years.
You will need a prescription from your doctor and must use a Medicare-approved supplier to get coverage.

How the sleep study works and what it costs

Your primary care doctor or a sleep specialist orders an overnight sleep study, usually called a polysomnography. You spend one night in a sleep lab where technicians attach sensors to monitor your breathing, heart rate, oxygen levels, and sleep stages. The study costs between $1,500 and $3,000 depending on the facility, but Medicare Part B covers 80 percent of the approved amount after you pay your annual deductible (which is $240 in 2024, though this amount changes yearly).

Some people can do a home sleep apnea test instead of going to a lab. This is a simpler test you do at home with a portable device, and it costs less — usually $300 to $800. Medicare covers home tests too, and they work well for people with moderate to severe sleep apnea. If the home test is inconclusive, your doctor may still order an in-lab study.

Once the study shows you have sleep apnea, your doctor writes a prescription for a CPAP machine or another type of device. You cannot get equipment without this prescription and the study results.

CPAP machine rental versus purchase

Medicare lets you rent or buy a CPAP machine. Most people start by renting because it costs less upfront and gives you time to see if the machine works for you. Rental typically costs $50 to $100 per month through a Medicare-approved supplier, and Medicare pays 80 percent of that amount after your deductible. You pay the remaining 20 percent out of pocket.

If you rent for 13 months, the total rental payments usually equal the purchase price, and at that point you own the machine. Some suppliers will let you explore all your rental payments toward a purchase if you decide to buy before 13 months are up. After you own the machine, Medicare still covers replacement masks, tubing, and filters.

If you buy outright, Medicare covers 80 percent of the approved purchase price (usually $500 to $800 for the machine itself). You pay 20 percent plus any amount above Medicare's approved price. Buying makes sense if you know you will use the machine long-term and want to avoid monthly payments.

Masks, tubing, and replacement supplies

Medicare covers the mask that comes with your machine, plus replacement masks, tubing, and filters. The mask is the part that sits on your face and delivers air from the machine, and different styles exist — some cover your nose only, others cover your nose and mouth, and some sit in your nostrils. Your doctor or the supplier helps you find the right fit.

Medicare limits how often you can get new supplies. You can receive one replacement mask per month, and tubing and filters are covered as medically necessary. If you need a different mask style because the first one does not work for you, Medicare usually covers that switch. Replacement parts are covered at 80 percent of the approved amount after your deductible, just like the machine itself.

Equipment replacement and upgrade rules

If your machine breaks or stops working, Medicare covers a replacement. You will need a new prescription from your doctor and documentation of the problem from your supplier. Replacement machines are covered at the same 80 percent rate as the original.

Medicare covers a new machine every five years if you are still using CPAP therapy. If your doctor prescribes a different type of device — such as a BiPAP (bilevel positive airway pressure) machine, which adjusts pressure as you breathe in and out — Medicare covers that too, but usually only if your doctor documents that you tried CPAP first and it did not work for you.

Using a Medicare-approved supplier

You must order your equipment from a Medicare-approved durable medical equipment (DME) supplier. These are companies that specialize in medical equipment and have a contract with Medicare. Your doctor's office usually has a list of approved suppliers in your area, or you can search the Medicare supplier directory on the Medicare website.

Approved suppliers handle the paperwork with Medicare, bill your insurance, and deliver the equipment to your home. They also provide training on how to use the machine and clean it. If you order from a non-approved supplier or buy online without a prescription, Medicare will not pay, and you will owe the full cost.

When you contact a supplier, ask whether they accept Medicare assignment, which means they accept Medicare's approved amount as full payment (except for your 20 percent coinsurance). This protects you from surprise bills.

What happens if you have a Medigap or Medicare Advantage plan

If you have a Medigap (supplemental insurance) plan, it may cover some or all of your 20 percent coinsurance for CPAP equipment and supplies. Check your plan documents or call your Medigap insurer to see what is covered.

If you have a Medicare Advantage plan (Part C), coverage for sleep apnea equipment works differently. Your plan must cover at least what Original Medicare covers, but the copays, coinsurance, and deductibles may be different. Some Advantage plans cover CPAP equipment with little or no out-of-pocket cost. Call your plan to find out your specific costs before you order equipment.

Frequently Asked Questions

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

Yes. Medicare requires a sleep study result to be on file before it will pay for equipment, even if you were diagnosed years ago. If you do not have recent test results, your doctor will order a new study. Some people can use a home test instead of an in-lab study, which is faster and less expensive.

What if my doctor prescribes a machine but I have not met my deductible yet?

You will pay the full cost of the sleep study and equipment until you reach your annual Part B deductible ($240 in 2024). After that, Medicare pays 80 percent and you pay 20 percent. If you have a Medigap plan, it may cover your deductible.

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

Medicare will not pay to replace supplies or parts for a machine you bought before you were covered by Medicare. If you want Medicare to cover your equipment and supplies going forward, you will need a current sleep study and a new prescription from your doctor, and you will need to get the machine through a Medicare-approved supplier.

How much will I pay out of pocket for a CPAP machine?

Costs vary by supplier and whether you rent or buy. If you rent, you typically pay 20 percent of the monthly rental cost (usually $10 to $20 per month) after your deductible. If you buy, you pay 20 percent of the approved purchase price, usually $100 to $160. Costs are lower if you have a Medigap plan that covers coinsurance.

What if I try CPAP and it does not work for me?

Tell your doctor. They may prescribe a different mask style, a different machine type like BiPAP, or a different therapy altogether. Medicare covers these alternatives if your doctor documents that you tried CPAP first. You will need a new prescription and may need another sleep study to confirm the new device is right for you.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.