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.
Who's eligible?
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
You pay 20% of the Medicare-approved amount for rental of the machine and purchase of related supplies (like masks and tubing). The Part B deductible applies.
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 obtain 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).
If you’re already renting certain equipment that's paid on a monthly basis when the program starts, you may be able to stay with your current supplier. Suppliers that aren't Medicare-contract suppliers can decide to become "grandfathered" suppliers for certain rented items and supplies, like CPAP devices, oxygen, and oxygen supplies.
If a "grandfathered" supplier rented the equipment to you at the time the program started, Medicare will pay for the supplier to continue to rent to you. You may continue using that supplier until the rental period for your equipment ends.
If you start renting additional equipment from a "grandfathered" supplier after the program started in your area, 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.
Related resources
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