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Written byErin Gobler
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Más de 5 años de experiencia en redacción financiera
Certificado de planificación financiera por la Universidad de Boston
Erin es escritora y periodista especializada en finanzas personales. Sus artículos exploran inversiones, tarjetas de crédito, hipotecas, seguros y mucho más.
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Edited byKatie Powers
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Licensed auto and home insurance agent
3+ years experience in insurance and personal finance editing
Katie uses her knowledge and expertise as a licensed property and casualty agent in Massachusetts to help readers understand the complexities of insurance shopping.
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Updated June 26, 2024
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Table of contents
Table of contents
A continuous positive airway pressure (CPAP) machine is a breathing device used to treat sleep apnea and other sleep breathing disorders. CPAP machines are common in the U.S. — about 33 million Americans, or about 10% of the population, use one.[1]
Like other medical devices, CPAP machines often come with large price tags. Original Medicare Part B covers the rental cost of CPAP machines as well as necessary supplies like face masks and tubing. But you must meet specific requirements, including a sleep test, an initial trial period, and compliance with your CPAP machine.
Here’s what you need to know about Medicare coverage for CPAP machines.
What are CPAP machines?
A CPAP machine helps you breathe more easily during sleep by using air pressure to keep breathing airways open.
Typically, people with breathing disorders like sleep apnea use this machine as a treatment. It can help improve sleep and reduce the risk of long-term health risks such as high blood pressure, stroke, and more.
A CPAP machine is an at-home medical device that users generally must wear any time they sleep, including at night and during naps. The machine consists of several pieces, including a mask, tubing, and a motor to blow air through the tube.[2]
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Learn More: When Does Medicare Coverage Start?
Does Medicare cover CPAP machines and supplies?
CPAP devices fall under the definition of durable medical equipment (DME), which refers to any equipment that meets the following criteria:[3]
Durable (meaning you can use it repeatedly)
Used for a medical reason
Primarily useful to someone who’s sick or injured
Used in your home
Has an expected lifespan of at least three years
Medicare covers CPAP machines and other pieces of DME if you have an obstructive sleep apnea (OSA) diagnosis and meet other qualifications.[4] The coverage specifics — and how much you owe — depend on the type of Medicare you have and how long you’ve used a CPAP machine.
Assuming you continue meeting the qualifications, Medicare pays for CPAP equipment rental for 13 continuous months. If you’ve used the machine without interruption for that period, you’ll own the machine and won’t need to make any more payments.
Learn more below about what Medicare covers and what you may owe if you get a CPAP machine.[5]
Medicare Type ▲▼ | Deductible Amount ▲▼ | Copay Amount ▲▼ | Does it Cover CPAP Machines? ▲▼ |
|---|---|---|---|
| Part A (Original Medicare) | $240 | 20% of Medicare-approved amount | Yes, primarily during hospital stays |
| Part B (Original Medicare) | $1,632 | 20% of Medicare-approved amount | Yes, for in-home use |
| Medicare Advantage | Varies by private insurance company but adheres to Medicare rules | Varies by private insurance company | Yes |
When Medicare doesn’t cover CPAP machines
Though Medicare generally covers CPAP machines and other DMEs, Medicare could deny your claim in some cases. If you have your claim denied, you either won’t be able to get CPAP therapy or you’ll have to cover the costs out of pocket.
Here are some situations where Medicare may not cover CPAP therapy in the following situations:[5]
You don’t have a prescription from a Medicare-enrolled doctor.
You don’t meet the medical requirements for CPAP therapy.
You don’t have an OSA diagnosis based on results from a sleep study.
You didn’t get your machine from a Medicare-enrolled supplier.
How much does CPAP therapy cost out of pocket?
The average cost of a CPAP device ranges from $650–$1,000, according to the National Council on Aging. But depending on the type of machine, the cost can reach thousands of dollars.
More advanced positive airway pressure machines, including bilevel positive airway pressure (BiPAP) and automatic positive airway pressure (APAP) machines, are often more expensive than CPAP machines.
The cost of a CPAP machine depends on several factors, including the age and model of the machine. Generally speaking, newer machines are more expensive than older ones due to improvements in technology.[6]
In addition to the up-front cost of buying a CPAP machine, you have to consider ongoing costs. For example, you’ll eventually have to pay for replacement parts, such as filters, tubing, and masks, which have a combined cost of $60–$270.
Good to Know
You can also rent a CPAP machine instead of purchasing one. A CPAP rental costs $30–$120 per month and may require an up-front deposit. Though renting is more affordable up front, it results in higher long-term costs.
How to qualify for CPAP therapy under Medicare
If you think you may need CPAP therapy, it’s important to go through the appropriate process to make sure Medicare covers your claim. Here’s a step-by-step guide to qualifying for Medicare coverage, from your initial sleep evaluation to your final approval.
1. Set up a sleep evaluation
If you have a sleep concern and think you may need CPAP therapy, your first step should be scheduling a sleep evaluation. Based on the results of your sleep evaluation, your doctor may complete a physical exam and recommend that you undergo a sleep test.
Make sure this evaluation is with a Medicare-approved healthcare provider so your medical insurance covers it.
2. Complete a sleep test
In order to have your CPAP machine covered, Medicare requires you to go through a sleep test ordered by your treating doctor and done under physician supervision. You can go through multiple types of sleep tests, including a nocturnal polysomnography and a home sleep test.
Based on your sleep test, your doctor must diagnose you with OSA to qualify for CPAP therapy covered by Medicare.
3. Get a prescription for a CPAP machine
If your doctor enrolled in Medicare diagnoses you with OSA, you can get a prescription for a CPAP machine through a supplier enrolled in Medicare. If your doctor or supplier isn’t enrolled, Medicare won’t cover your treatment unless your doctor and CPAP machine supplier have both enrolled in Medicare.
4. Submit the required documentation
When approving your CPAP expenses, Medicare may require supporting documents, including your medical records, the results of your sleep study, and your CPAP prescription.
5. Prove compliance after three months
When Medicare initially approves your CPAP therapy, it’ll only approve a 12-week trial that covers your device and accessories. You’ll have to prove your compliance throughout the three-month period, so it’s important to use your CPAP machine consistently.
6. Complete a follow-up visit after three months
After your initial three-month trial of CPAP therapy, you’ll meet with your doctor in person to determine whether it’s an effective treatment. If your doctor provides a medical record that confirms the therapy is working, Medicare will continue to cover it after your trial period.
Medicare and CPAP machines FAQs
Medicare covers CPAP machines, but it’s important to understand the proper steps to have your therapy covered. Here’s some additional information about Medicare and CPAP machines.
How much will Medicare pay for a CPAP machine?
It depends on your Medicare plan. The deductible for Medicare Part A is $1,632, and the Part B deductible is $240. With Medicare Parts A and B, your plan will pay for 80% of your approved CPAP costs for your machine rental and related supplies once you pay your deductible.
Medicare will pay for your CPAP rental for 13 months, after which you’ll own your machine.
Can you claim CPAP machines on Medicare?
Yes. You can claim your CPAP machine for Medicare insurance coverage. But Medicare will only cover your CPAP therapy expenses if you meet the medical documentation requirements and work with both a doctor and a CPAP supplier enrolled in Medicare.
What are the CPAP compliance requirements for Medicare?
Medicare requires that you use your CPAP machine for at least four hours per night for at least 70% of nights.
The compliance requirements don’t apply until after 31 days of usage, but they apply for the remaining two months of your trial. So, for nights 32 through 90 of your trial, you must use your CPAP machine for at least four hours on more than 41 nights.[7]
How do you qualify for a CPAP machine?
To qualify for a CPAP machine under Medicare, you must go through a sleep study, receive a diagnosis of obstructive sleep apnea, and get a CPAP machine prescription from a Medicare-enrolled doctor. You’ll have to go through a three-month trial period using the CPAP machine before Medicare will continue to cover your CPAP therapy.
Sources
- National Council on Aging. "Sleep Apnea Statistics and Facts You Should Know."
- National Heart, Lung, and Blood Institute. "CPAP."
- Medicare.gov. "Durable medical equipment (DME) coverage."
- Medicare.gov. "Continuous Positive Airway Pressure (CPAP) devices, accessories, & therapy."
- National Council on Aging. "A Guide to Medicare Coverage of CPAP Machines and Supplies in 2024."
- National Council on Aging. "How Much Does a CPAP Machine Cost?."
- University of Michigan Health. "Medicare and CPAP Compliance."
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Erin Gobler
Erin Gobler is a personal finance writer and journalist based in Madison, Wisconsin. With more than five years of experience, Erin has covered topics such as investing, credit cards, mortgages, insurance, and more. Her work has been featured in major publications like Business Insider, Fox Business, and Time. Erin received her bachelor’s degree from the University of Wisconsin-Oshkosh in 2013, studying journalism and political science. She also received a certificate of financial planning from Boston University in 2022.
Licensed auto and home insurance agent
3+ years experience in insurance and personal finance editing
Katie uses her knowledge and expertise as a licensed property and casualty agent in Massachusetts to help readers understand the complexities of insurance shopping.
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