Your Medicare Coverage
Is my test, item, or service covered?
Sleep apnea & Continuous Positive Airway Pressure (CPAP) therapy
How often is it covered?
Medicare covers CPAP therapy when medically necessary .
People with Medicare who’ve been diagnosed with obstructive sleep apnea are eligible to get a 3-month trial of CPAP therapy. If your doctor says that the machine has helped you, Medicare may cover it longer.
If you had a CPAP machine before you got Medicare, Medicare may cover rental or a replacement CPAP machine and/or CPAP accessories if you meet certain qualifications.
Your costs in Original Medicare
Medicare pays the supplier to rent the machine for the 13 months if you’ve been using it without interruption.
Under current Medicare rules, you own these types of equipment after renting for 13 months. When you switch to a Medicare-contract supplier instead of using a "grandfathered" supplier or other non-contract supplier, your 13-month rental period will start over, so you won't own the equipment until after the new rental period ends. This will extend your rental period and result in additional months of coinsurance. However, the amount you pay will be lower because the amount you'll pay will be based on the new payment rates under the new program.
- Once you own the equipment, you must get replacement supplies and accessories for the equipment from a contract supplier in order for Medicare to help you pay for these items. You may get repairs for the equipment you own from any Medicare-approved supplier (even a non-contract supplier), including replacement parts needed for the repair.
- If you already own your equipment, you must use a Medicare-contract supplier for your replacement supplies and accessories (like masks used with the CPAP device).
Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs.
Suppliers that don’t get Medicare contracts can decide to become "grandfathered" suppliers. This means a supplier may continue to rent equipment to you if you were renting the equipment when the program started. This rule applies to oxygen, oxygen equipment, and certain rented equipment. You may continue using the “grandfathered” supplier until the rental period for your equipment ends.
If you start renting additional equipment from a “grandfathered” supplier after the program starts, Medicare won’t pay for the new equipment.
If you’re renting equipment that’s eligible for grandfathering, your supplier will let you know in writing 30 business days before the program begins whether it will or won’t become a “grandfathered” supplier.
If your supplier doesn’t choose to grandfather, you’ll need to use a new contract supplier for Medicare to help pay for your equipment.