Continuous Positive Airway Pressure (CPAP) therapy
Medicare Part B (Medical Insurance) may cover CPAP therapy if you meet certain conditions
Description
CPAP therapy is an in-home treatment for people with sleep apnea.
Coverage details
Medicare may cover a 12-week trial of CPAP therapy (including devices and accessories) if you’ve been diagnosed with obstructive sleep apnea. After the trial period, Medicare may continue to cover CPAP therapy if you meet with your doctor or other health care provider in person, and they document in your medical record that you meet certain conditions and the therapy is helping you.
If you had a CPAP machine before you got Medicare and you meet certain requirements, Medicare may cover a rental or replacement CPAP machine and/or CPAP accessories.
Medicare covers different kinds of durable medical equipment (DME) in different ways. Depending on the type of equipment:
- You may need to rent the equipment.
- You may need to buy the equipment.
- You may be able to choose whether to rent or buy the equipment.
- Some items become your property after you’ve made a certain number of rental payments.
Who's eligible
Part B covers medically necessary DME if your provider prescribes it for use in your home.
Provider requirements
Make sure your doctors and DME suppliers are enrolled in Medicare. It’s also important to ask your suppliers if they participate in Medicare or will accept assignment of your claims before you get DME.
Costs
- After you meet the Part B deductible , you pay 20% of the Medicare-approved amount (if your supplier accepts assignment) for the machine rental and related supplies (like masks and tubing).
- Medicare pays the supplier to rent a CPAP machine for 13 months as long as you’ve been using it without interruption. After Medicare makes rental payments for 13 continuous months, you’ll own the machine.
- If suppliers are participating in Medicare, they must accept assignment (which means, they can charge you only the coinsurance and Part B deductible for the Medicare-approved amount). A non-participating provider doesn't have to accept assignment of your claims, but may choose to do so in your case. If DME suppliers aren't participating suppliers or won't accept assignment of your claims, you may be charged more. For rented DME, make sure the supplier is willing to accept assignment of your claims for all rental months. If the claim isn't assigned, you must pay for the full cost upfront. If this happens, Medicare will pay you later for the amount it covers after your claims have been processed.