Continuous Positive Airway Pressure devices, accessories, & therapy

Continuous Positive Airway Pressure devices, accessories, & therapy

Medicare may cover Continuous Positive Airway Pressure (CPAP) therapy if you’ve been diagnosed with obstructive sleep apnea. Medicare may cover a 3-month trial of CPAP therapy. Medicare may cover it longer if you meet in person with your doctor, and your doctor documents in your medical record that you meet certain conditions about the use of the device and the CPAP therapy is helping you.

Note

If you had a CPAP machine before you got Medicare, Medicare may cover CPAP machine cost for replacement CPAP machine rental and/or CPAP accessories if you meet certain requirements.

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 [glossary]

 applies. Medicare pays the 

Supplier

 to rent the machine for the 13 months if you’ve been using it without interruption. After you’ve rented the machine for 13 months, you own it.

Medicare will only cover your durable medical equipment (DME) if your doctor or supplier is enrolled in Medicare. If a DME supplier doesn't accept assignment, Medicare doesn't limit how much the supplier can charge you. You may also have to pay the entire bill (your share and Medicare's share) at the time you get the DME.

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

  • Other insurance you may have
  • How much your doctor charges
  • Whether your doctor accepts assignment
  • The type of facility
  • Where you get your test, item, or service

Note

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. Ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.

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