Does Medicare Cover CPAP Machines and Supplies?

Yes, Medicare covers Continuous Positive Airway Pressure (CPAP) machines and related supplies under Part B, provided you meet specific medical requirements. If you've been diagnosed with obstructive sleep apnea, Medicare considers a CPAP machine durable medical equipment (DME) and will help pay for it.

But they don't just hand you a machine and walk away. Medicare requires a trial period to prove the therapy is actually working for you before they commit to long-term coverage.

Here is exactly how the coverage works, what you'll pay, and the hoops you need to jump through to get your equipment covered.

The Initial 12-Week Trial

When you are first prescribed a CPAP machine, Medicare covers it for a 12-week trial period. To qualify for this initial coverage, you must have a face-to-face consultation with your doctor and a sleep test that confirms you have obstructive sleep apnea.

During this trial, Medicare pays the supplier to rent the machine for you. You do not own it yet.

Proving It Works

To keep your coverage after the 12-week trial, your doctor must document that you are actually using the machine and that it's helping your condition. Specifically, you must use the CPAP machine for at least 4 hours a night on 70% of nights during a consecutive 30-day period within the trial.

If you meet this usage requirement and your doctor confirms the therapy is effective, Medicare will continue to cover the rental.

Renting to Own

Medicare doesn't buy the machine outright. Instead, they pay for a 13-month rental. After you've rented the machine for 13 continuous months, you own it. During this time, Medicare also covers the necessary supplies, like masks, tubing, and filters.

This is where the rubber meets the road. The system is designed to make sure your tax dollars aren't paying for equipment that just sits in a closet gathering dust. It's a fair standard, but it means you have to stay on top of your usage and your doctor's appointments. We believe in straight answers, no surprises - so know going in that you have to prove you're using the machine.

What You Pay

Under Traditional Medicare, CPAP machines and supplies fall under Part B. Once you meet your annual Part B deductible, Medicare pays 80% of the Medicare-approved amount for the machine rental and supplies. You are responsible for the remaining 20% coinsurance.

If you have a Medicare Supplement (Medigap) plan, it will help cover that 20% gap. For example, if you have Plan G, it covers the entire 20% coinsurance after you've met the Part B deductible.

The Two Paths: Traditional vs. Advantage

Remember, the Medicare system offers two distinct paths, not two products.

If you stay on the Traditional Medicare path (Part A and Part B), you can use any DME supplier in the country that accepts Medicare assignment. Your coverage is standardized nationwide.

If you choose the Medicare Advantage path (Part C), your plan must provide at least the same level of coverage as Traditional Medicare. However, you will likely have to use a CPAP supplier within the plan's specific network, and your out-of-pocket costs (copays or coinsurance) will depend on your specific plan's rules, not the standard 80/20 split.

Replacement Supplies

CPAP supplies wear out and need to be replaced regularly to prevent infection and ensure the machine works correctly. Medicare covers replacement supplies on a specific schedule:

• Full face mask: 1 every 3 months
• Nasal mask: 1 every 3 months
• Headgear: 1 every 6 months
• Tubing: 1 every 3 months
• Disposable filters: 2 every month
• Non-disposable filters: 2 every 6 months

You must ask your supplier for these replacements; they cannot automatically ship them to you without your explicit request each time.

Navigating Medicare's rules for medical equipment shouldn't keep you up at night. If you're trying to figure out how your current coverage handles CPAP supplies, or if you're looking to switch to a plan that better fits your needs, we can help. We're licensed in all 50 states and we're on your side of the table.