Does Medicare Cover CPAP Machines? – Overview
A continuous positive airway pressure (CPAP) machine is a medical device that provides extra oxygen with a bit of force.
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.
Does Medicare Cover CPAP Machines?
As we have just mentioned, Medicare will cover your CPAP machine if you are a Medicare beneficiary and have been diagnosed with Obstructive Sleep Apnea.
All of your supplies will also be covered if you use them properly, such as masks and filters. 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 which are a standard treatment for obstructive sleep apnea, are covered by Original Medicare (Part B) as durable medical equipment.
Still, you have to 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 fall under Medicare Part B coverage.
The amount you’ll pay for these devices will depend on the plan you choose and how much you can afford to pay in 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, which are 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 writes an order for 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 the use of CPAP machines, such as face masks, tubing, and filters.
Medicare Part B covers the Medicare-approved for up to 80 percent amount for covered items, with beneficiaries responsible for paying 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.
According to the Department of Health and Human Services, Medicare has a set amount of money it will pay every year to help offset the cost of CPAP supplies.
The government will only cover 90% of these costs after you have owned your equipment for 13 months.
If you break your machine or it becomes damaged somehow, Medicare will not cover its replacement.
The cost of your supplies is reimbursable on an annual basis if you keep records proving the costs incurred.
How Much Does a CPAP Machine Cost with Medicare?
Medicare Part B will help pay 80 percent of the cost of a CPAP machine to treat obstructive sleep apnea. The machine can only be prescribed by a doctor who has treated you for 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 get to own the machine. Your Medicare Advantage plan should provide the same coverage as Part B but may set its terms for paying out benefits.
People with sleep apnea can improve their condition with a range of treatment options. For example, those who require a CPAP machine should have a sleep study first.
Medicare covers sleep studies and CPAP machines as long as your doctor and supplier participate in Medicare.
You will have to share some of the costs associated with Medicare Part B or Medicare Advantage plans.