The first time I had to figure out if Medicare would cover my CPAP (the machine that keeps your airway open while you sleep) machine, I spent two hours on the phone with two different people who gave me different answers. One said yes, and the other one put me on hold for 30 minutes before the call dropped.
If you're newly diagnosed with sleep apnea and trying to understand Medicare coverage, you're probably feeling the same frustration. The good news? Medicare does cover CPAP machines. But there are some specific rules you need to know about.
Does Medicare Part B Cover CPAP Machines?
Yes. Medicare Part B covers CPAP machines as durable medical equipment (DME). That means medical equipment you use at home long-term.
But here's the catch: Medicare only covers your CPAP if you meet specific requirements. You can't just ask your doctor for one and have Medicare pay for it.
Here's what you need:
- A face-to-face visit with your doctor
- A sleep study showing you have obstructive sleep apnea
- A prescription from your doctor specifically for a CPAP machine
- A Medicare-approved supplier
Without all four of these, Medicare won't cover anything.
What Does Medicare Actually Pay For?
Medicare Part B covers 80% of the Medicare-approved amount for your CPAP equipment. You pay the other 20% plus your Part B deductible.
Here's what that looks like in real numbers:
If your CPAP machine costs $800 and Medicare approves $800:
- Medicare pays: $640 (80%)
- You pay: $160 (20%) plus your yearly deductible if you haven't met it yet
Medicare covers:
- The CPAP machine itself
- The mask
- Tubing and filters
- Humidifier (if medically necessary)
- Replacement supplies on a regular schedule
The replacement schedule matters. Medicare will only pay for new supplies at specific intervals. You can't just order new masks whenever you want and expect Medicare to cover them.
The 30-Day Trial Period You Need to Know About
Here's something most people don't know until it's too late: Medicare treats your first three months with a CPAP machine as a trial period.
During those first 90 days, Medicare rents the machine. They don't buy it for you yet. You're essentially test-driving it.
Why does this matter? Because if you don't use the machine enough during those three months, Medicare can decide you don't need it and stop covering it. They can also refuse to pay for the machine at all.
"Enough" means you need to use your CPAP for at least 4 hours per night on 70% of nights during a 30-day period within those first 90 days.
Your CPAP machine tracks this automatically. Your supplier will check your usage data and report it to Medicare. If you don't hit those numbers, Medicare won't pay.
After you pass the trial period, Medicare buys the machine for you over the next 10 months. Once those 13 months are up, the machine is yours and you own it.
How to Find a Medicare-Approved Supplier
This is crucial: Medicare will only pay if you use a Medicare-approved CPAP supplier. If you go to a supplier that's not approved, Medicare won't cover a single dollar.
Every supplier who wants to bill Medicare has to be certified as a DMEPOS supplier. That's a certification that means they meet Medicare's quality and safety standards.
You can find Medicare-approved suppliers in your area using our directory. Every supplier listed on CPAPLocator.com is Medicare certified.
Don't assume your local medical equipment store is approved just because they sell CPAP machines. Always verify before you commit to anything.
What About Medigap or Medicare Advantage?
If you have a Medigap plan (also called Medicare Supplement Insurance), it may cover some or all of your 20% coinsurance. That's the 20% of the cost Medicare doesn't cover.
If you have Medicare Advantage instead of Original Medicare, your coverage works differently. Medicare Advantage plans have to cover at least what Original Medicare covers, but they can add extra rules.
Some Medicare Advantage plans require prior authorization before they'll cover your CPAP. That means your doctor has to get permission from your insurance company before ordering the equipment.
Check with your specific plan to understand what they require.
Common Medicare CPAP Coverage Mistakes to Avoid
These are the mistakes I see people make most often:
Buying a CPAP machine online before talking to Medicare. Medicare won't cover equipment you already bought. You have to go through an approved supplier who bills Medicare directly.
Not using the machine during the trial period. If you struggle with your CPAP in the first month, call your supplier immediately. They can adjust your mask, change your pressure settings, or help troubleshoot. Don't just stop using it.
Going to a supplier that's not Medicare-approved. Always verify first. It takes 30 seconds and can save you thousands of dollars.
Not getting a prescription. Even if your doctor told you that you need a CPAP after your sleep study, you still need an actual written prescription. Medicare requires it.
Your Next Step
If you've been diagnosed with sleep apnea and have Medicare, here's exactly what to do next:
1. Make sure you have a written prescription from your doctor for a CPAP machine
2. Find a Medicare-approved supplier near you using our search tool
3. Call the supplier and tell them you have Medicare Part B
4. Ask them to verify your coverage before you commit to anything
5. Ask about your expected out-of-pocket cost
The supplier can check your coverage in about five minutes and tell you exactly what you'll pay. Don't leave that appointment without a clear number.
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Once you find a Medicare-approved supplier, read What to Expect at Your First CPAP Setup Appointment so you walk in prepared. And bookmark How to Get CPAP Supplies Covered by Insurance for when your first supply order comes due.
Frequently Asked Questions
What happens if I don't use my CPAP enough during the 90-day trial period?
Medicare can stop covering your equipment. They require at least 4 hours of use per night on 70% of nights during a 30-day window within those first 90 days. If you're struggling to hit those numbers, call your supplier immediately. Don't wait. They can help troubleshoot whatever is keeping you from using it.
Does Medicare cover a travel-sized CPAP machine?
Standard Medicare covers your primary CPAP machine. Travel machines are generally not covered as a second machine. Some Medicare Advantage plans handle this differently. Check with your specific plan. Most people buy travel machines out of pocket.
After the 13-month rental period ends, do I keep the machine?
Yes. Once Medicare finishes the 13-month rental, the machine is yours. Medicare continues to cover your supplies on the regular schedule, but you own the equipment outright after that point.
My Medicare Advantage plan requires prior authorization. Is that normal?
Yes. Medicare Advantage plans can add requirements that original Medicare doesn't have. Prior authorization (your insurance company's approval before they'll pay) is common with Advantage plans. Your doctor and supplier handle most of this paperwork. Ask them what they need from you.
Can Medicare deny CPAP coverage after it's already been approved?
Medicare can stop covering your CPAP if your usage data shows you're not using it enough, or if your doctor stops certifying it as medically necessary. As long as you use the machine regularly and keep up with doctor follow-ups, this shouldn't be an issue.
*CPAPLocator.com is a directory service only. We are not a medical provider. Content is for informational purposes only. Always consult your healthcare provider.*