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

Medicare will pay for a CPAP (continuous positive airway pressure) machine if you meet specific medical requirements. You must have a diagnosis of obstructive sleep apnea confirmed by a sleep study, a prescription from your doctor, and you must use the machine as prescribed. Medicare Part B covers 80% of the approved amount after you meet your annual deductible; you pay the remaining 20% as coinsurance.

The machine itself is covered, along with supplies like masks, tubing, and filters for the first year. After that, Medicare covers replacement supplies on an ongoing basis. The exact amount Medicare pays depends on the specific machine and supplier you choose, since prices vary.

Key Takeaways

  • You need a sleep study ordered by your doctor that documents obstructive sleep apnea before Medicare will consider covering a CPAP machine.
  • Medicare Part B pays 80% of the approved amount for the machine and supplies after you meet your deductible; you pay 20%.
  • Your doctor must write a prescription for the CPAP, and you must obtain it from a Medicare-enrolled supplier, not just any medical equipment company.
  • Medicare covers the machine for five years, then you can request a replacement if your doctor says you still need it.
  • You may owe out-of-pocket costs upfront, but Medicare's payment typically arrives within a few weeks of the supplier submitting the claim.

The sleep study requirement: how it works and what it shows

Before Medicare will cover a CPAP, your primary care doctor or a sleep specialist must order a sleep study. This study measures how many times per hour your breathing stops or becomes shallow during sleep — a count called the apnea-hypopnea index, or AHI. Medicare requires an AHI of 15 or higher to cover a CPAP machine, or an AHI of 5 to 14 if you also have symptoms like daytime sleepiness or witnessed breathing pauses.

The sleep study can happen in a lab (where you spend a night hooked to monitors) or at home using a portable device your doctor provides. A home study is often faster and more convenient. Once the results come back and show you meet Medicare's threshold, your doctor can write the CPAP prescription.

Keep the sleep study report and your doctor's prescription — you will need to give both to the CPAP supplier when you order the machine. The supplier uses these documents to submit the claim to Medicare.

How to order a CPAP through Medicare

After your doctor prescribes the CPAP, you must order it from a Medicare-enrolled durable medical equipment (DME) supplier. Not all medical equipment companies are enrolled with Medicare, so calling a random supplier may mean Medicare will not pay. Your doctor's office can usually tell you which suppliers in your area accept Medicare, or you can search the Medicare Supplier Directory online at the Centers for Medicare & Medicaid Services (CMS) website.

When you contact the supplier, give them your Medicare number, your doctor's name, and your sleep study results. The supplier will verify your coverage, tell you what your out-of-pocket cost will be, and arrange delivery. They handle submitting the claim to Medicare on your behalf — you do not submit it yourself.

Ask the supplier upfront what you will owe out of pocket. Prices for CPAP machines vary, but your 20% coinsurance typically ranges from $100 to $400 depending on the machine model. Some suppliers offer payment plans if the upfront cost is difficult.

What Medicare covers and what you pay

Medicare Part B covers the CPAP machine itself, plus supplies for the first year: a mask (or multiple masks if you need different styles), tubing, filters, and a humidifier if your doctor prescribes one. After the first year, Medicare continues to cover replacement supplies — typically a new mask every three months and filters as needed.

You pay 20% coinsurance on all of these items after you meet your Part B deductible (which is $226 in 2024, though this amount changes yearly). If you have a Medigap or Medicare Advantage plan, your supplemental coverage may pay some or all of your coinsurance, so check your plan documents or call your plan's customer service line.

Medicare does not cover the cost of a humidifier if your doctor does not specifically prescribe it as medically necessary. It also does not cover cleaning supplies, carrying cases, or replacement parts beyond the standard mask and tubing.

Timeline: from prescription to delivery

Once your doctor writes the prescription, the process usually takes two to four weeks. The supplier needs time to verify your Medicare coverage (a few days), order the machine (a few days to a week), and arrange delivery. If the supplier has the machine in stock, delivery can happen faster.

Medicare processes the claim after the supplier ships the machine to you. You may receive a bill from the supplier for your coinsurance while Medicare's payment is still being processed — this is normal. Medicare typically pays the supplier within two to four weeks of the claim submission.

If you are waiting for Medicare's payment and the supplier is asking you to pay the full amount upfront, ask the supplier if they will bill Medicare directly and let you pay your coinsurance later. Most enrolled suppliers do this as standard practice.

Replacement machines and long-term coverage

Medicare covers a CPAP machine for five years from the date of delivery. After five years, if your doctor says you still need the machine, you can request a replacement. Your doctor will need to write a new prescription, and you will go through the same process with a Medicare-enrolled supplier.

If your machine breaks or stops working before five years are up, talk to your supplier first. Many suppliers will repair it at no cost or low cost under warranty. If repair is not possible, ask your doctor whether Medicare will cover a replacement early. Medicare may approve an early replacement if the machine is irreparably damaged, but this requires your doctor's documentation.

What to do if Medicare denies coverage

Sometimes Medicare denies a CPAP claim because the sleep study results do not meet their threshold, the prescription is incomplete, or the supplier is not enrolled with Medicare. If this happens, you will receive a notice called an Explanation of Benefits (EOB) that explains the reason for the denial.

Read the EOB carefully. If you disagree with the denial, you have the right to appeal. Contact your supplier first — they can often resubmit the claim with additional information. If the denial is because your AHI score is borderline, ask your doctor whether a second sleep study or additional documentation of symptoms might support coverage.

If the supplier is not Medicare-enrolled, you can either ask them to enroll or switch to a supplier who is already enrolled. If you have already paid out of pocket to a non-enrolled supplier, Medicare will not reimburse you retroactively.

Medicare Advantage plans and CPAP coverage

If you have a Medicare Advantage plan (Part C) instead of Original Medicare, your plan covers CPAP machines under its Part B benefits. However, the specific rules, copays, and approved suppliers may differ from Original Medicare. Some Advantage plans require prior authorization from the plan before you order the machine, meaning your doctor must get the plan's approval first.

Call your Medicare Advantage plan's customer service number (on your insurance card) and ask about their CPAP coverage policy, which suppliers they prefer, and whether you need prior authorization. This step can save you time and prevent claims from being denied.

Frequently Asked Questions

Do I have to do a sleep study in a lab, or can I do one at home?

Medicare covers both in-lab and home sleep studies. A home study is often faster and more convenient — your doctor sends you home with a portable monitor that records your breathing overnight. Both types of results are equally valid for Medicare's coverage decision.

What if my doctor prescribed a CPAP but I haven't had a sleep study yet?

Medicare will not pay without a sleep study that documents obstructive sleep apnea. Your doctor needs to order the study first, get the results, and then write the CPAP prescription based on those results. If you already bought a machine without a study, Medicare will not cover it retroactively.

Can I buy a CPAP machine online and have Medicare pay for it?

No. The supplier must be enrolled with Medicare for Medicare to pay. Online retailers and non-enrolled suppliers cannot bill Medicare, so you would pay the full cost yourself. Always verify the supplier is Medicare-enrolled before ordering.

Will Medicare pay for a different type of machine, like a BiPAP or APAP?

Yes, if your doctor prescribes it. BiPAP and APAP machines are covered under the same rules as CPAP machines. Your doctor decides which type is medically necessary based on your sleep study results and how you respond to treatment.

What happens if I stop using my CPAP machine — do I have to pay Medicare back?

No, you do not have to repay Medicare. However, if you stop using the machine and later want a replacement, your doctor will need to document that you still have obstructive sleep apnea and that you are using the machine as prescribed before Medicare will cover a new one.