Does Medicare Cover CPAP Machines? Key Insights & Grants

Does Medicare Cover CPAP Machines – Overview

A continuous positive airway pressure (CPAP) machine is a medical device that provides a steady air pressure to keep the airways open.

For people with obstructive sleep apnea (OSA), the CPAP machine pushes oxygen into the lungs to help overcome breathing pauses or obstructions because these are things that come with the condition.

Now, you are probably wondering whether Medicare covers the cost of CPAP machines. Well, the good news is that Medicare does cover these machines, but beneficiaries have to meet specific criteria.

Medicare CPAP Machines Coverage

As we have just mentioned, Medicare will cover your CPAP machine if you are a Medicare beneficiary diagnosed with Obstructive Sleep Apnea.

Your supplies, such as masks and filters, will also be covered if you use them properly. Medicare covers oral appliances for sleep apnea only when CPAP therapy has been tried and failed or is contraindicated.

What Coverage Does Medicare Provide for CPAP Machines

CPAP machines, a standard treatment for obstructive sleep apnea, are covered by Original Medicare (Part B) as durable medical equipment.

Still, you must sign up for Part B, pay your premiums, and meet your annual deductible. Once you’ve done so, you’re responsible for 20% of the Medicare-approved amount for your CPAP.

What if I have a Medicare Advantage plan

Medicare Advantage (Part C) plans are private insurance products that combine the services offered by original Medicare with some extras, depending on the plan.

For instance, these plans may provide additional coverage for medical equipment and services that are covered under Medicare Part B.

The amount you’ll pay for these devices will depend on your chosen plan and your ability to afford the monthly premiums for the added coverage.

How do I Qualify for Coverage?

Because sleep apnea can be a severe and chronic condition, Medicare covers CPAP machines to treat sleep apnea. Medicare also helps pay for sleep studies needed to diagnose this disorder.

Medicare covers a 3-month trial period for CPAP therapy if you have been diagnosed with obstructive sleep apnea through a Medicare-covered sleep study.

If your doctor documents that this therapy is helping your condition and orders continued CPAP therapy, Medicare will keep covering it.

Does Medicare Cover CPAP Supplies

In addition to CPAP machines, Medicare Part B’s durable medical equipment benefit also covers supplies related to CPAP machines, such as face masks, tubing, and filters.

Medicare Part B covers 80 percent of the Medicare-approved amount for CPAP supplies, with beneficiaries responsible for the remaining 20 percent as coinsurance.

Your Medicare supplement plan may deliver your coinsurance, or you may be subject to different out-of-pocket expenses if you have a Medicare Advantage plan.

Replacement Supplies

According to the Department of Health and Human Services, Medicare pays a set amount yearly to offset the cost of CPAP supplies.

After the 13-month rental period, you own the CPAP machine, but Medicare continues to cover replacement supplies according to established schedules.

If your CPAP machine needs replacement due to damage or wear and tear, Medicare may cover the replacement if it meets certain conditions, such as the machine being no longer repairable.

Medicare covers replacement supplies for CPAP machines according to specific replacement schedules (e.g., masks every 3 months, tubing every 3 months, filters monthly).

How Much Does a CPAP Machine Cost with Medicare

Medicare Part B covers 80 percent of the Medicare-approved amount for a CPAP machine after the deductible is met, and the beneficiary is responsible for the remaining 20 percent of coinsurance. A doctor must prescribe a CPAP machine after a Medicare-covered sleep study confirms obstructive sleep apnea, and the prescription must come from the treating physician.

In addition, you will pay a coinsurance payment based on a Medicare-approved amount, and you get rental prices for at least 13 months as long as you use it without interruption.

After 13 months, you own the machine. Your Medicare Advantage plan should provide the same coverage as Part B but may set its terms for paying benefits.

The Takeaway

People with sleep apnea can improve their condition with various treatment options. For example, those who require a CPAP machine should first have a sleep study.

Medicare covers sleep studies and CPAP machines when they are medically necessary, ordered by your doctor, and provided by Medicare-enrolled suppliers who accept assignment.

With Original Medicare, you pay 20% of the Medicare-approved amount for the CPAP machine rental and supplies after meeting your Part B deductible; costs may differ with Medicare Advantage plans.

Grants for Medical

Does Medicare Cover CPAP Machines