Does Medicare Cover CPAP Machines? 5 Things We Found Out

Greg Wilson

Updated on:

Does Medicare Cover CPAP Machines?

    A large number of the adult population have sleep apnea and require CPAP assistance. Get the scoop here and find out does Medicare covers CPAP machines.

    Did you know that 56% of Americans over 64 are at risk for obstructive sleep apnea (OSA)? The most common treatment for OSA is a continuous positive airway pressure (CPAP) machine.

    If you're diagnosed with sleep apnea, you may wonder, “Does Medicare cover CPAP machines”? Get the information you need here and find the answer to this question.

    Types of Sleep Apnea

    OSA describes repeated relaxation of the throat muscles, causing a collapse during sleep. The brain sends incorrect signals to the respiratory muscles with central sleep apnea. Some individuals combine the complex sleep apnea syndrome, which results in repeated periods where you stop breathing for 10 seconds or longer. Symptoms include loud snoring and feeling tired after a whole night's sleep.

    What Are CPAP Machines?

    CPAP machines keep positive pressure in your throat to prevent muscle collapse, decrease snoring and help you feel more rested.

    There are several styles of machines. In general, the base machine holds water to provide humidification. It also has a filter and tube connecting to the mask or headgear you wear.

    The headgear may include a full face mask, mouth/nose mask, or nasal option. The filter keeps dust and other particles out of the machine and tubing.

    Overview of Medicare Coverage

    Medicare Part A and B are often called “Original Medicare.” Most people over the age of 64 qualify for this Medicare. People under 65 and receiving Social Security disability for two years are eligible, extending to those diagnosed with ALS or end-stage renal disease.

    Part A is free if you have paid into Medicare and Social Security for at least ten years. There is a monthly premium for Part B. Varying based on your income.

    After enrolling in Original Medicare, you may buy Medicare Advantage. Medicare Advantage includes Part A, B, and D coverage.

    You may enroll in Original Medicare and buy Part D to cover prescription medications. You can also choose a Medigap plan to pay for charges not covered by your other insurance.

    Does Medicare Cover CPAP Machines?

    The answer to “Does Medicare pay for CPAP?” is yes, if you have a diagnosis of sleep apnea. You're eligible for a 3-month CPAP therapy trial under Medicare Part B. If the treatment proves successful, Medicare will extend your coverage.

    Medicare may continue coverage if you've used CPAP before beginning Medicare. However, it may cover the cost of machine replacement, rental, and accessories.

    You'll generally pay 20% of Medicare-approved machine rental and supplies charges. You will need to meet the Part B deductible. Once you've rented the machine for 13 months, you own it.

    Medicare pays for durable medical equipment (DME), such as CPAPs. A Medicare-approved doctor must order the equipment, and you get the equipment from a Medicare-approved supplier.

    There's no limit from Medicare on how much a supplier may charge you. So be prepared to pay the entire bill when you first get the DME.

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    You now have the answer to the question, “Does Medicare cover CPAP machines?” So it's important always to ask questions and explore your options. Make sure you check with reputable sources.

    Senior Affair provides reliable, high-level information about the Medicare program. We want seniors and their caretakers to feel confident about their Medicare decisions. 

    If you qualify for Medicare but don't know where to start, we have licensed insurance agents ready to answer your questions and help you enroll in Medicare Advantage, Medicare Supplement Insurance, and Prescription Part D plans.

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