Does Medicare Pay for CPAP Machines for Sleep Apnea?
Medicare covers 80% of the cost for a CPAP machine and supplies if you have a specific type of sleep apnea.
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To get coverage for a CPAP machine, you have to show that you have sleep apnea through a sleep test or an approved at-home sleep monitoring device. If you meet certain criteria and your doctor agrees you should try a CPAP machine, Medicare will cover a three-month trial. If the machine helps you, Medicare will continue to cover the cost to buy a CPAP machine and supplies like a mask and tubing.
Does Medicare cover CPAP machines?
Medicare covers CPAP machines and supplies if you've been diagnosed with what's called obstructive sleep apnea.
But your diagnosis has to meet certain requirements. You have to do a sleep test or use an approved at-home sleep monitoring device, and the results have to show specific issues with your sleep.
Then, your doctor has to agree that a CPAP device could help your sleep apnea, and you'll start a trial process.
Three-month trial: At first, you'll only have coverage to get a CPAP machine for three months. This is to make sure that a CPAP machine is helping to keep your airway open while you sleep.
13-month rental: As long as you continue seeing your doctor and they agree that the CPAP is helping you, Medicare will cover most of the cost to rent a CPAP machine for you for 13 months.
Ongoing care: After 13 months of renting the CPAP machine, you'll own it. Medicare will continue to cover the CPAP supplies, like the mask, tubing and air filter, as long as your doctor says the CPAP machine is helping you.
The coverage for CPAP machines comes from Medicare Part B. Specifically, CPAP machines are considered what's called "durable medical equipment" or DME. Part B covers medical equipment that your doctor says you need to treat your medical conditions.
Does Medicare pay for CPAP supplies?
Medicare Part B covers CPAP supplies like tubing and masks.
The CPAP machine doesn't work without the supplies, so the supplies are part of the trial period and rental period. But unlike the CPAP machine, the supplies have to be replaced more often. For example, CPAP masks and hoses should be replaced every three months.
How long will Medicare pay for CPAP supplies?
Medicare will pay for CPAP supplies for as long as your doctor says you need them. You have to keep seeing your doctor for your sleep apnea and meet other medical requirements. But as long as your doctor confirms that your CPAP machine helps you, Medicare will pay for the supplies when they need to be replaced.
However, Medicare might not pay for CPAP supplies that aren't considered "necessary." You might want to get a CPAP pillow, for example, which is designed with cutouts that allow you to sleep on your side without the mask digging into your face. Because a pillow isn't medically needed to treat sleep apnea, you'll probably have to pay for it yourself.
How much does a CPAP machine cost with Medicare?
If you have Original Medicare, you'll pay for one-fifth of the cost for a CPAP machine, which is usually between $100 and $600.
Medicare Part B covers 80% of the cost for medical care, including supplies like a CPAP machine. CPAP machines usually cost between $500 and $3,000. That means you'll usually pay between $100 and $600 for a CPAP after Medicare pays its share. You'll also need to buy some supplies for your CPAP, which range in price from less than $1 to $40, on average, after Medicare pays.
Costs for a CPAP machine and supplies with Medicare
Full cost | Cost after Medicare | |
|---|---|---|
| Air filters | $5 or less | $1 or less |
| Tubing/hoses | $5-$35 | $1-$7 |
| Headgear | $15-$40 | $3-$8 |
| Mask cushions | $20-$60 | $4-$12 |
| Nasal masks | $50-$175 | $10-$35 |
Source: SleepApnea.org
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But you have to get your CPAP machine from a supplier that takes Medicare. If you don't, you have to pay the full cost.
Costs with Medicare Advantage
Medicare Advantage plans should cover CPAP machines and supplies because they have to have coverage that is the same or better than Original Medicare. The amount you pay for a CPAP machine will depend on your specific Medicare Advantage plan.
Costs with Medicare Supplement
If you have a Medicare Supplement plan, you might not pay anything for a CPAP machine or supplies. That's because most plans — including Plans G, F and N, which are the most popular — fully cover your Part B coinsurance. That means that your Medigap plan will pay your share of the cost for a CPAP machine and you won't have to pay anything.
Only Plan K and Plan L don't fully pay for the Part B coinsurance, which means you would still have to pay some of the cost for a CPAP machine and supplies.
How long do CPAP machines last?
CPAP machines usually last about five years. But the lifespan can depend on the type of CPAP you get, so be sure to read your manual to know how often you should replace yours.
Medicare will continue to cover CPAP machines as long as your doctor says you still need one. Just make sure you get your CPAP machine from a supplier that takes Medicare. You'll still have to pay for 20% of the cost for the replacement machines. The cost varies if you have a Medicare Advantage plan, but if you have a Medicare Supplement plan, you might not have to pay anything.
Frequently asked questions
Can you get a CPAP machine through Medicare?
Medicare covers CPAP machines if you've been diagnosed with obstructive sleep apnea. You have to meet certain criteria on a sleep test and your doctor has to agree that a CPAP is right for you. The coverage starts with a three-month trial. If the machine helps, Medicare will continue to pay for the cost of the machine for 13 months, until you own it. Medicare also covers CPAP supplies like the mask and tubing.
How much will Medicare pay for a CPAP machine?
Medicare covers 80% of the cost for a CPAP machine and supplies, which means you have to pay for 20% of the cost. If you have a Medicare Advantage plan, the amount you pay depends on the specifics of the plan. If you have a Medicare Supplement plan, you might not have to pay anything, depending on the plan you have.
Does Medicare cover Inspire for sleep apnea?
Medicare covers the cost for Inspire if your doctor agrees that it is medically necessary and you meet other criteria. For example, you have to be at least 22 years old and have a body fat percentage under a certain level. Inspire is an implantable device that can help treat obstructive sleep apnea.
Sources
Sources for this article include the Centers for Medicare & Medicaid Services coverage database, Mayo Clinic, Medicare.gov and SleepApnea.org.
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