* CPAP machines and other supplies fall under Medicare Part B.
** Deductible for the 2023 year (deductible changes annually starting Jan. 1, or whenever your plan year begins). For Part A, the deductible is for each inpatient period, not the year.
When does Medicare cover CPAP machines?
Original Medicare Part B will only cover your CPAP therapy devices and accessories if, after a diagnostic sleep study, your prescribing doctor and the CPAP equipment supplier are enrolled in Medicare.5 Doctors and supplies enrolled with Medicare agree to accept the Medicare-approved amount for the service or product provided. This is called “accepting assignment.”
At times, the Medicare-approved amount may be less than the amount the provider would normally charge, but the provider agrees to accept the set amount as full payment for services. If your doctor or supplier doesn’t agree to be paid by Medicare directly, you’ll be responsible for the total cost of your CPAP supplies at the time of purchase.
If you have Medicare Advantage, coverage of DME varies by plan. Your plan may have specific rules about getting approval, selecting a brand, and choosing a supplier that you must follow to get coverage. Reach out to your plan for more information before ordering your CPAP supplies.
How does Medicare coverage work for CPAP machines?
After you’ve confirmed that your doctor and the supplier are enrolled and you’ve paid the $226 deductible, Medicare Part B will cover a three-month trial of CPAP therapy. This includes the machine and accessories, like tubing, filters, and masks.
To qualify for the three-month CPAP therapy trial, you must:
- Use a doctor and supplier enrolled with Medicare (accept Medicare as payment)
- Be diagnosed with OSA after clinical evaluation in a sleep lab or by an at-home sleep test using a qualifying sleep monitoring device (Type II, III, or IV home sleep device)6
- Have an apnea-hypopnea index (AHI) or respiratory disturbance index (RDI) of at least 15 events per hour or between five and 14 events per hour, along with other documented symptoms (like excessive daytime sleepiness, hypertension, or heart disease)
After the three-month trial period, Medicare pays 80% of the Medicare-approved amount to rent the machine for 13 months. You pay the remaining 20% as coinsurance. Medigap plans and other supplemental health insurance plans often cover the 20% copay. Following the 13-month CPAP machine rental, you’ll own it.
To qualify for the 13-month CPAP equipment rental (and ultimate purchase), you must:
- Complete the three-month trial and provide documentation
- Meet with your doctor in person, and your doctor must document in your medical record that CPAP therapy is helping you and you were compliant (sometime after day 31 of usage but no later than day 91)
You’ll need to use the CPAP machine without interruption throughout the 13-month rental period for Medicare to continue paying each month. If at any point you stop using the machine on a regular basis, Medicare can stop paying the rental, and you’ll need to return the machine to the supplier or pay the remaining balance in full.