Does Medicare Cover CPAP Machines and Sleep Apnea Treatment?

Getting a Diagnosis Comes First

CPAP stands for continuous positive airway pressure. The machine delivers a steady stream of air through a mask to keep the airway open during sleep. Medicare covers it for obstructive sleep apnea, which means breathing that repeatedly pauses or becomes shallow because the airway collapses, not because of a signaling problem in the brain.

Medicare will not pay for a CPAP based on a hunch or a partner’s report of loud snoring. According to the Centers for Medicare & Medicaid Services (CMS) and the Medicare coverage policy for CPAP (local coverage determination L33718), the sequence has these building blocks:

• An in-person clinical evaluation by your treating practitioner before the sleep test, to assess you for obstructive sleep apnea.
• A sleep test that meets Medicare’s requirements, whether performed in a sleep lab or with an approved home testing device.
• Test results that meet Medicare’s severity criteria, which are measured by how many breathing interruptions you have per hour of sleep.

The coverage policy describes two ways to meet the severity threshold. One is at least 15 breathing events per hour, with a minimum of 30 events, on the test. The other is 5 to 14 events per hour, with a minimum of 10 events, combined with documented symptoms (excessive daytime sleepiness, impaired cognition, mood disorders or insomnia) or documented hypertension, ischemic heart disease or a history of stroke. Your sleep specialist will know how your results line up. The point for you is that the report itself is what the supplier and Medicare will look at.

The sleep test itself is generally a covered diagnostic service under Part B when it is medically necessary and ordered by your provider. After you meet the Part B deductible, which is $283, you would typically owe 20% of the Medicare-approved amount, and what you pay in total can vary with the type of facility and where the test is done. If a home test is appropriate for you, it may cost less than an overnight lab study, but whether it is appropriate is a clinical decision for you and your doctor.

The 12-Week Trial

Once you are diagnosed and your doctor prescribes CPAP for home use, Medicare.gov says Medicare may cover a 12-week trial period that includes the device and its accessories. This trial is where many people run into trouble, so it deserves a close look.

The steps below summarize what Medicare looks for at each stage.

Stage	What Medicare looks for
Before the sleep test	In-person evaluation by your treating practitioner
Sleep test	Lab or approved home test that meets severity criteria
12-week trial	Device and accessories covered while you start therapy
Follow-up visit	In-person reassessment between day 31 and day 91, documenting use and symptom improvement
After approval	13 months of rental, then you own the machine

The reason for the trial is straightforward. Medicare wants evidence that the therapy works for you before it keeps paying. To continue coverage past the trial, Medicare.gov says you need to meet with your doctor or another provider in person, and they have to document in your medical record that you meet certain conditions and that the therapy is helping you.

CMS describes the requirement as practitioner reassessment, along with documentation of how consistently you are using the therapy and whether your symptoms are improving. Under Medicare’s coverage policy for these devices, consistent use is defined as at least four hours per night on at least 70% of nights during a consecutive 30-day period at any point in the first three months. Many suppliers and sleep clinics use a modem or a data card in the machine to record that usage, so the numbers are often available without any effort from you.

The in-person follow-up has timing rules too. Medicare’s coverage policy says the reassessment has to happen no sooner than the 31st day and no later than the 91st day after therapy begins. If you don’t hear from your doctor’s office about scheduling it, call and ask. If the criteria are not met, Medicare’s policy says continued coverage of the device and accessories will be denied. If the reassessment happens after day 91 but does show benefit, the policy says coverage resumes starting on the date of that visit rather than going back to the start, so a late visit can leave a gap. A missed visit is one of the most common reasons coverage stalls.

Rent First, Then Own

CPAP is typically handled as a rental. Medicare.gov says Medicare pays the supplier to rent the machine for 13 months, as long as you use it continuously. After Medicare makes rental payments for 13 continuous months, you own the machine.

During that period, the rental payment covers the machine itself, and the related supplies, such as masks and tubing, are covered too. Because you are paying 20% of the Medicare-approved amount after the deductible, your cost is spread across the months rather than front-loaded.

The word “continuously” matters. If you stop using the device, break the rental, or switch suppliers in a way that interrupts the payment sequence, the 13-month count can be disrupted. If you plan to change suppliers, ask both the old and the new supplier how the rental period will be treated before you make the move.

Masks, Tubing and Other Supplies

CPAP is more than a box. The mask cushion wears out, tubing cracks, and filters clog. Medicare covers replacement supplies for people who continue to qualify, on a schedule set by Medicare’s coverage policy rather than whenever you feel like it. Supplies are billed in the same way as the machine, with you owing 20% after the deductible.

Two practical points follow from that. First, suppliers can’t ship you more than the schedule allows, so if your mask is falling apart weeks before it is eligible for replacement, ask the supplier what options exist, such as documented medical need. Second, a poor mask fit is one of the main reasons people quit therapy, and quitting can threaten your coverage, so it is worth asking the supplier or your sleep specialist about refitting rather than simply giving up.

If you owned a CPAP before you had Medicare, Medicare.gov notes that you may qualify for rental or replacement coverage if you meet specific requirements. Bring your sleep study and records with you if you have them.

How Long a Machine Is Expected to Last, and Replacement

CMS describes a five-year useful lifetime for these devices. If a machine within that period is lost, stolen, or irreparably damaged in a specific incident, replacement can generally happen without a new sleep test, evaluation or trial. After the five-year point, Medicare generally requires an in-person evaluation in which your provider documents that you still use the device and benefit from it, but not a new sleep test or trial.

If you own the machine and it breaks, repairs can be an option, but check with the supplier and Medicare for the current rules, because repair and replacement coverage rely on documentation and on whether you own or rent.

BiPAP and Other Devices

Not everyone with sleep-disordered breathing uses a standard CPAP. A bilevel device, often called BiPAP, delivers different pressures when you inhale and exhale. Medicare can cover these devices under separate criteria that depend on your diagnosis and on whether CPAP has been tried or is not appropriate. Because the rules are different, the order and the documentation have to match the device. Your sleep specialist is the right person to say which device suits your condition.

Other treatment routes for sleep apnea, such as oral appliances made by a dentist or procedures performed by a specialist, can be covered under specific Medicare policies in limited situations. This is an area where eligibility depends on details of your diagnosis and history, so ask your doctor and the provider whether Medicare, or your Medicare Advantage plan, covers the option you are considering before you commit to it.

If You Have Medicare Advantage or a Medigap Plan

With Original Medicare, you can get CPAP from any supplier enrolled in Medicare, and you pay the least with one that accepts assignment. Medicare.gov says participating suppliers can only charge the deductible and 20% coinsurance, while non-participating suppliers may charge more and may ask for payment up front. Our broader guide to Medicare coverage of durable medical equipment explains assignment in more detail.

If you have a Medicare Advantage plan, the plan has to cover what Original Medicare covers, but it can add rules. Expect to use a supplier in the plan’s network, and possibly to get prior authorization. Copays may also replace the 20% coinsurance. Call the plan before ordering and ask three things: which suppliers are in network, whether prior authorization is needed, and how the plan handles the 12-week trial and the compliance data. Our article on how prior authorization works and what to do if you’re denied is useful if you hit a wall.

If you have a Medigap policy, most standardized plans pay the Part B coinsurance, which is the 20% you would otherwise owe on the machine and supplies. Plans differ at the edges, so read the benefit chart for your plan letter. Our Medicare Supplement overview lists how each plan letter handles Part B cost-sharing.

Common Reasons Coverage Gets Interrupted

Most CPAP coverage problems are paperwork or follow-through problems rather than disputes about whether sleep apnea is real. These come up often:

• The pre-test evaluation was not documented before the sleep study.
• The sleep test or its report doesn’t meet Medicare’s requirements.
• The in-person follow-up visit wasn’t scheduled or wasn’t documented.
• Usage data doesn’t show enough nightly use during the trial.
• The supplier is not enrolled in Medicare.
• The rental was interrupted by a supplier change.

CMS reports that insufficient documentation accounts for the large majority of improper payments in this category, which is why suppliers may be strict about their paperwork. If you are asked to sign or return something, it is usually because Medicare requires that record.

What to Do If You Can’t Tolerate the Machine

Some people struggle with CPAP: dry mouth, pressure that feels like too much, claustrophobia from the mask, or trouble sleeping with it. Giving up quietly is the worst outcome, both for your health and for your coverage. If the machine isn’t working for you, talk to your sleep specialist early. Settings can be changed, humidifiers adjusted, and masks swapped. Your provider can also document what has been tried and why, which can matter if a different treatment is considered later. If a trial does fail, Medicare’s policy says you would need a new in-person evaluation to look at why therapy failed and a repeat facility-based sleep test before CPAP could be covered again.

Untreated obstructive sleep apnea is associated with serious health problems, and your doctor is the one to discuss what it means for you. Nothing here is medical advice, and the decision about which treatment fits is between you and your care team.

Frequently Asked Questions

Does Medicare cover a CPAP machine without a sleep study?

Generally no. Medicare requires a diagnosis of obstructive sleep apnea based on a qualifying sleep test, along with a clinical evaluation by your treating practitioner.

How long do I have to rent a CPAP machine under Medicare?

Medicare.gov says Medicare pays to rent the machine for 13 continuous months, and then you own it. Replacement supplies such as masks and tubing continue to be covered if you still qualify.

What happens if I don’t use my CPAP enough during the trial?

Medicare may stop covering the device and supplies. Under Medicare’s coverage policy, consistent use means at least four hours a night on at least 70% of nights in a 30-day period, so talk to your supplier or doctor early if you are struggling.

Does Medicare cover CPAP masks and tubing?

Yes, when you continue to qualify for the therapy. Medicare covers related supplies on a replacement schedule, and you pay 20% of the Medicare-approved amount after the Part B deductible, unless a Medigap plan or other coverage pays it.

Does a Medicare Advantage plan cover CPAP differently?

It must cover what Original Medicare covers, but it may require network suppliers, prior authorization, or charge copays instead of 20% coinsurance. Check with your plan before ordering.