Does Medicare Cover CPAP Machines?

Sleep apnea is a potentially serious disorder in which your breathing repeatedly stops and starts during sleep. Apnea occurs when your airflow stops for at least 10 seconds.

According to the Mayo Clinic, if you snore loudly and feel tired the next day even after a full night’s sleep, you may have sleep apnea.

Research has found OSA to be much more common than CSA. When people use the generic term “sleep apnea,” they’re usually referring to OSA.

Sleep apnea is most common in people who are overweight, use alcohol or sedatives, smoke or suffer from certain medical conditions such as congestive heart failure.

The condition is also more common in men than women.

The most common treatment for moderate to severe sleep apnea is a breathing device, such as a Continuous Positive Airway Pressure, or CPAP, machine.

CPAP therapy delivers a flow of pressurized air from a machine through a mask that fits over your mouth or nose. This helps keep your airway open and breathe more easily while you sleep.

CPAP machines also include tubing that connects the machine to the face mask. It may also have a humidifier attachment.

A bilevel positive airway pressure, or BiPAP, machine is another device used to treat sleep apnea. It’s like a CPAP machine but provides more air pressure when you inhale and less pressure when you exhale.

Generally, Medicare covers 80% of costs related to sleep apnea machines. The Part B deductible applies.

You may pay less or owe nothing if you have Medicaid as your secondary payer.

Medicare Advantage plans also generally cover CPAP machines and therapy because these plans must offer at least the same coverage as Original Medicare.

Many Medicare Advantage plans require doctors to submit a prior authorization request before the insurer will pay for a sleep study or CPAP machine.

Because CPAP treatment doesn’t work for everyone, Medicare initially covers the machine for a three-month trial period after you are diagnosed with sleep apnea.

Medicare may extend coverage if your doctor determines that the therapy is helping your condition.

After this three-month trial, you will owe 20% of the Medicare-approved cost to rent the machine as durable medical equipment.

The equipment supplier will provide you with instructions on how to use the CPAP machine.

Medicare pays its share to the supplier to rent the machine for 13 months. After that, you own the machine outright.

You must rent your device from a supplier enrolled in Medicare, and the doctor who orders your sleep apnea machine must also accept Medicare.

Medicare will usually cover the cost of a new CPAP machine every five years.

If you had a machine before enrolling in Medicare, Medicare may cover some of the costs for a replacement CPAP machine rental and accessories if you meet certain requirements.

In addition to CPAP machines, Medicare Part B covers other treatments and supplies related to sleep apnea.

Your doctor will need to run tests and order a sleep study to formally diagnose you with sleep apnea.

Your doctor may either order an at-home sleep apnea test or require you to undergo a formal lab sleep study at an overnight clinic.

Medicare generally pays 80% of the approved cost for sleep studies, and the Part B deductible applies.

Medicare will also cover 80% of the cost of replacement CPAP supplies on a regular schedule.

That’s because CPAP supplies can get dirty or worn out over time. For example, the face mask material tends to absorb oil from your skin and may become stiff.

Original Medicare typically doesn’t pay for items or services that exceed this replacement schedule.

If you have a Medicare Advantage plan, check with your insurance company to see how often they will pay for replacement supplies.

Manufacturers, suppliers and sleep physicians all recommend that patients regularly clean their CPAP machines and supplies.

However, there are certain CPAP supplies Medicare won’t cover.

Medicare typically doesn’t pay for cleaning supplies, power solutions or certain comfort accessories.

These items may be expensive without insurance. The SoClean device, for example, can average around $400.

In June 2021, millions of CPAP and BiPAP machines were recalled by Philips Respironics due to the degrading of sound abatement foam inside the machines, which can break down and lead to serious health issues like inflammation in the respiratory system, cancer and other dangerous effects.

The recall was classified by the U.S. Food and Drug Administration (FDA) as a Class I recall due to the toxic effects from the machines as capable of causing severe injury or death.

People using a Philips CPAP can check their medical device recall notification page or call 877-907-7508.