Does Medicare Cover CPAP Machines?
Key Takeaways
- If you’re on Medicare and prescribed a CPAP machine, your coverage will pay to rent the machine for 13 months — as long as you use it without interruption.
- Medicare first covers the CPAP machine for a three-month trial period. After three months, your doctor will check how the treatment is working for you.
- Medicare typically covers the standard supplies you’ll need to operate your CPAP machine.
Medicare may cover a CPAP machine as part of your care. Medicare Part B provides this benefit. Since Medicare Advantage (Part C) coverage is in line with Original Medicare’s Parts A and B, it also offers the same CPAP benefits.
Coverage for your Medicare CPAP supplies (including the machine) may begin with a 3-month trial; if your doctor determines after an in-person meeting that you meet certain conditions, Medicare can cover it longer.
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How Do I Get a CPAP Machine Through Medicare?
There are several ways to get a CPAP machine through Medicare. CPAP machines and CPAP supplies are Durable Medicare Equipment, so they’ll count toward your deductible. Once you meet your deductible, you’ll pay 20% of the Medicare-approved cost for these items. Medicare will cover the other 80%.
New to Medicare and already have a CPAP machine? If you meet certain requirements, Medicare may cover your rental or replacement CPAP machine.
If you’re on Medicare and prescribed a CPAP machine, your coverage will pay to rent the machine for 13 months — as long as you use it without interruption. If you’re eligible, you’ll own the CPAP machine after those 13 months. [i]
How Do I Find Medicare-Approved Durable Medical Equipment Suppliers Near Me?
Once you’ve had a sleep test and approved for CPAP therapy, you’ll need to choose a CPAP machine through a Medicare-approved supplier. You can ask your doctor for recommendations or search for a nearby supplier online. Make sure your CPAP machine is Medicare-approved. If not, you may be stuck paying the total price for a device that won’t work.
What are Medicare Guidelines for CPAP?
You have a three-month trial period covered by Medicare. After three months, your doctor will check how the treatment is working for you. Medicare may cover CPAP therapy long-term if your doctor verifies in your medical record that:
- You are using the machine
- The therapy is helping you.
How Much Does Medicare Cover for a CPAP Machine?
Whether you have Part B through Original Medicare or enrolled in Medicare Advantage, Medicare will cover your CPAP machine similarly to other benefits. First, you’ll pay your deductible. Then, Medicare will pay its portion. You’ll pay the remainder or coinsurance.
- How much does Medicare pay for CPAP machines? 80% of the Medicare-approved amount.
- How much will you have to pay for a CPAP machine? The remaining 20%.
If you have Original Medicare, you may be able to sign up for Medicare Supplement Insurance (Medigap). Many states offer Medigap plans that can help cover your CPAP coinsurance during your rental period.
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Does Medicare Part B Cover CPAP Supplies?
Yes, Medicare Part B covers CPAP supplies. Medicare covers your CPAP supplies at 80% after you meet your deductible, much like CPAP machines. CPAP supplies can include tubing, filters and face masks. As with the coinsurance on CPAP machines, Medigap may help cover your out-of-pocket costs if you have Original Medicare.
Although Medicare Advantage offers the same coverage and benefits as Parts A and B, your plan may charge a different amount for Medicare CPAP supplies. To find out what you’ll pay, call your health insurance company.
How Do I Get CPAP Supplies Through Medicare?
Medicare typically covers the standard supplies you’ll need to operate your CPAP machine. Some items, like disposable filters, usually need to be replaced more often than face masks and tubing. Talk to your doctor about how often you should expect to replace these items and how best to schedule your replacement Medicare CPAP supplies.
Does Medicare Pay for a New CPAP Machine?
Yes, but there are stipulations. Medicare will usually help cover the cost of renting a CPAP machine for 13 months. If you use it without interruption throughout that time, you’ll own it at the end of the term. Talk to your doctor if your CPAP machine breaks or you need a new one. If it’s old enough or meets other guidelines, Medicare may pay for a new CPAP machine.
Do Medicare Advantage Plans Cover CPAP Machines?
Yes. Remember, Medicare Advantage plans must prove at least the same coverage as you’d get from Parts A and B with Original Medicare. The most significant difference may be in what you pay out of pocket. To find out exactly what your coverage options are with your Medicare Advantage plan, contact your insurance carrier. You can also call GoHealth. Our licensed insurance agents will go through your benefits and help you understand what’s covered and how. Breathe easier knowing GoHealth can help you get the CPAP machine and supplies you need.
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Sources
- CPAP Coverage. medicare.gov.
- Sleep Study Coverage. medicare.gov.
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