Does Medicare Cover CPAP Machines for Sleep Apnea?

The great news is that Medicare Part B covers CPAP therapy. Medicare classifies CPAP machines and the supplies needed as Durable Medical Equipment (DME).

1. The Cost Breakdown

Medicare treats CPAP machines as Durable Medical Equipment (DME). They don’t buy the machine for you immediately; they follow a 13-month rent-to-own model.
  • Medicare Pays: 80% of the approved rental amount.
  • You Pay: 20% coinsurance after meeting your annual Part B deductible .
  • Medicare Supplement (Medigap) – Your Medicare Supplement should “pick up” the 20% cost.
  • Medicare Advantage (Part C) – If you are on an Advantage plan, your costs may be different. Check to see if your supplier is “in-network”. 

  • The Goal: After 13 months of continuous rental, you own the machine.

2. How to Qualify

Before Medicare cuts a check, you must meet specific clinical milestones:
  • A Professional Diagnosis: You need a sleep study (either in-lab or an approved home test).
  • The Numbers: Your Apnea-Hypopnea Index (AHI) must be 15 or higher. If it’s between 5 and 14, you can still qualify if you have comorbidities like heart disease, hypertension, or documented daytime sleepiness.

  • The Prescription: A doctor must write a formal order for the machine and specific pressure settings.

3. The “Compliance” Trial – The First 90 Days!

Medicare will only keep paying for your machine if you prove it’s working. During your first 90 days:
  • The 4-Hour Rule: You must use the machine for at least 4 hours per night.
  • The 70% Rule: You must hit that 4-hour goal on at least 70% of nights during a consecutive 30-day window.

  • The Follow-Up: You must see your doctor for a face-to-face visit between day 31 and day 90 of your trial to confirm the therapy is helping.

4. Supply Replacement Schedule

To keep your therapy hygienic, Medicare covers replacement supplies on a regular basis:

5. CPAP Equipment and Supplies

Depending on where you live, you will most likely have several options of places to purchase your CPAP equipment and supplies.  The link below will allow you to search for suppliers in your area.

CPAP Supplies SEARCH

 

Bottom Line: Jump through the compliance hoops in the first 90 days, and Medicare will handle the bulk of the cost for the long haul. Keep that mask on—your heart will thank you!