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.
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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.
Even if Medicare covers your CPAP machine, there are some out-of-pocket costs you should expect to pay, which may include:
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 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 benefits not covered by Original Medicare.
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.
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Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.