Does Medicare Cover CPAP Machines?

Medicare typically does cover CPAP machines that are deemed medically necessary by a doctor. Medicare Part B is typically responsible for coverage of a CPAP machine if you’ve been diagnosed with obstructive sleep apnea.

Medicare Advantage (Part C) plans can also cover a CPAP machine when it’s medically necessary. Medicare Advantage plans also include an annual out-of-pocket spending limit, which Original Medicare (Part A and Part B) doesn’t include.

This spending limit can potentially save you money in Medicare costs for your CPAP machine.

How often can you get a new CPAP machine under Medicare?

CPAP machines are used to deliver constant, steady air pressure to patients with obstructive sleep apnea while they are sleeping. Sleep apnea is a medical condition that causes pauses in breathing during sleep.

Medicare does cover CPAP machines if you are diagnosed with sleep apnea. Medicare Part B (medical insurance) may cover a 3-month trial of CPAP therapy.

If the CPAP therapy is successful, your doctor may be able to extend the treatment and Medicare will cover it. If you rent a CPAP machine for 13 months, you own it.

Medicare Part B is usually responsible for covering durable medical equipment (DME) like CPAP machines.

How much does Medicare pay for CPAP machines?

Even if Medicare covers your CPAP machine, there are some out-of-pocket costs you should expect to pay, which may include:

• Part B deductible
  The Medicare Part B deductible is $185 per year in 2019. You must meet your deductible before your Part B coverage will kick in.
  
  
• Part B coinsurance or copayment
  You are typically responsible for 20 percent of the Medicare-approved amount for the CPAP machine cost, including filters, hoses and other parts.

There is no annual limit on how much you could pay for the Part B coinsurance in a given year.

If you get your CPAP machine from a medical equipment supplier who doesn’t accept Medicare assignment (which means they don’t accept Medicare reimbursement as payment in full), there’s no limit to how much they can charge you for the machine.

Speak with your doctor and your DME supplier for specific cost and coverage information.

Medicare Advantage plans may provide additional benefits that Medicare doesn’t cover

Medicare Advantage plans are sold by private insurance companies as an alternative to Original Medicare. Medicare Advantage plans cover everything that Part A and Part B cover, and some plans include extra benefits not covered by Original Medicare.

These additional benefits may include coverage for services like:

• Prescription drugs
• Dental care
• Vision care
• Hearing care
• Health and wellness program benefits, such as free gym memberships

If your CPAP machine is covered by Original Medicare, it will also be covered by a Medicare Advantage plan.

If you’re eligible to enroll, a licensed insurance agent can help you compare Medicare Advantage plans in your area so that you can find a plan that fits your coverage and budget needs.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent.