Will Medicare cover a CPAP machine?

Medicare covers CPAP machines used to treat sleep apnea under the durable medical equipment benefit. To qualify for CPAP coverage, you must meet the following requirements:

• Complete a sleep test in a laboratory setting or by using an approved at-home test
• Be diagnosed with obstructive sleep apnea based on sleep test results
• Have a prescription for a CPAP machine from your doctor
• Get the CPAP machine from a participating Medicare supplier

Since CPAP treatment doesn’t work for everyone, Medicare first covers the machine for a three-month trial period. After three months, your doctor will check how the treatment is working for you. Medicare may cover CPAP therapy long term if your doctor verifies in your medical record that you are using the machine and that it’s helping you.

You will pay a 20 percent coinsurance based on the Medicare-approved amount for a CPAP machine. Medicare Part B covers the other 80 percent of the cost. The Part B deductible applies.

Medicare helps pay to rent your CPAP machine for a total of 13 months, but only if you continue to use it without interruption. After 13 months of rental, you own the CPAP machine.

If you have a Medicare supplement plan (Medigap), the plan may cover your CPAP coinsurance payment for the rental period. If you have a Medicare Advantage plan (Part C), you need to check with the plan for details about what a CPAP machine would cost. Medicare Advantage plans must provide at least the same coverage as Part B, but each plan sets its own cost terms.

In addition to CPAP machines, Medicare Part B’s durable medical equipment benefit also covers CPAP supplies, such as face masks, tubing and filters. Medicare Part B pays 80 percent of the Medicare-approved amount, while you pay 20 percent as coinsurance. Your coinsurance may be paid by your Medicare supplement plan, or your cost may be different if you have a Medicare Advantage plan.

Since CPAP supplies can get dirty and lose effectiveness with use, Medicare covers replacement supplies on a regular schedule. Depending on the item, you may need replacements every two weeks to every six months. Talk with your doctor or supplier about scheduling replacement supplies.