Why CPAP Machines Matter

Sleep apnea affects millions of Americans—especially older adults. When breathing repeatedly stops during sleep, it can cause loud snoring, poor rest, headaches, daytime fatigue, memory problems, and increased risk of heart disease and stroke. A CPAP machine (Continuous Positive Airway Pressure) helps keep airways open while sleeping, improving oxygen flow and sleep quality.

Because CPAP therapy is medically necessary for many people with sleep apnea, Medicare may help pay for the equipment.

Does Medicare Cover CPAP Machines?

Yes. Medicare Part B covers CPAP machines, supplies, and accessories for people diagnosed with obstructive sleep apnea. Medicare also helps pay for maintenance and replacement supplies as long as the patient continues to use the machine and the treatment is medically necessary.

Medicare typically covers:

• CPAP machines
• Masks and cushions
• Tubing and humidifiers
• Headgear and chin straps
• Filters and replacement parts
• Sleep studies used to diagnose sleep apnea

Once approved, Medicare usually pays 80% of the cost, and the patient pays the remaining 20% after the Part B deductible.

How to Qualify for a CPAP Machine Through Medicare

✅ Step 1: Medical Evaluation

A doctor must evaluate the patient’s symptoms, such as snoring, fatigue, choking during sleep, or breathing pauses.

✅ Step 2: Sleep Study

Medicare requires a sleep study to diagnose sleep apnea. This can be:

• An overnight sleep study at a medical facility
• A home sleep test ordered by a physician

If the sleep study confirms obstructive sleep apnea, Medicare may approve CPAP therapy.

✅ Step 3: Prescription

A doctor must write a prescription for the CPAP machine and document that it is medically necessary.

✅ Step 4: Use a Medicare-Approved Supplier

The machine and supplies must be rented or purchased through a Medicare-enrolled durable medical equipment (DME) supplier.

Rental Rules and Costs

In most cases, Medicare rents the CPAP machine for 13 months. If the patient continues to use it and meets Medicare requirements, they can own the machine after the rental period.

During the rental:

• Medicare pays 80% of the approved rental amount
• The patient pays 20% after deductibles

If a patient has supplemental insurance—like Medigap—out-of-pocket costs may be reduced or eliminated.

Medicare’s 90-Day Compliance Requirement

To continue coverage, Medicare requires proof that the patient is using the machine consistently and that it helps manage sleep apnea.

This means:

• Using the machine an average of 4 hours per night
• Using it at least 21 nights within a 30-day period
• Visiting the doctor to confirm improvement and comfort

If the patient meets compliance rules, coverage continues for the full rental period.

Replacement Supplies and Maintenance

Medicare covers replacement supplies on a regular schedule. Common timelines include:

• Masks: every 3 months
• Cushion or nasal pillows: every month
• Tubing: every 3 months
• Filters: every 2 weeks
• Chin strap or headgear: every 6 months
• Humidifier chamber: every 6 months

Using fresh supplies helps keep the machine working properly and reduces the risk of infections.

When Medicare Will NOT Cover CPAP

Medicare will not pay for a CPAP machine if:

• The sleep study does not show sleep apnea
• The patient does not meet compliance requirements
• The machine is purchased through a non-approved supplier
• The doctor does not certify medical necessity

Conclusion

CPAP machines can dramatically improve sleep quality, energy levels, and long-term health for people with sleep apnea. Medicare Part B can help cover the cost of a CPAP machine, sleep testing, and replacement supplies—as long as patients are diagnosed properly, meet usage requirements, and obtain equipment through Medicare-approved providers.

Understanding the coverage rules and rental process can help beneficiaries receive affordable, high-quality CPAP therapy for better sleep and better health.