Does Medicare Cover CPAP Machines

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 will also pay to treat the condition another way, such as oral appliances or a mouthguard.

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.

If you have been newly diagnosed with sleep apnea, Medicare will cover a 3-month trial period of CPAP therapy.

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 equipment without additional cost coverage implications.

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.

The reimbursement for CPAP supplies does not depend on annual cost record submissions but on the regular coverage and co-insurance terms under Medicare Part B.

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 sleep study confirms a diagnosis of sleep apnea; the requirement is not limited to doctors who have treated an apnea episode.

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 as long as your doctor and supplier participate in Medicare.

You must share some of the costs associated with Medicare Part B or Medicare Advantage plans.

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Does Medicare Cover CPAP Machines