How Long Will Medicare Pay for CPAP Supplies?

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Does Medicare Cover CPAP Supplies?

Medicare covers CPAP supplies for people who have been diagnosed with sleep apnea and prescribed CPAP therapy by a physician. CPAP machines and necessary components are considered durable medical equipment (DME) and are covered under Medicare Part B, which is the portion of Medicare that covers outpatient visits, preventative care, and supplies. Trusted Source Centers for Medicare and MedicaidView Source

Rather than covering machines and supplies outright, though, Medicare requires that you undergo a 12-week CPAP machine trial, then a 13-month CPAP machine rental, after which you own the CPAP machine. During the trial, Medicare covers the cost of the machine and supplies. Most CPAP machines store your sleep data, including usage and breathing interruptions. If your physician determines that therapy is helping, you’ll be able to move to a machine rental. This data confirms both effectiveness and proper use

During the 13-month rental, Medicare covers 80% of the cost of your CPAP machine and supplies. You’re responsible for your deductible and the remaining 20%. If you adhere to CPAP therapy during the rental (defined as at least 4 hours a night on 70% of nights), Trusted Source Centers for Medicare and MedicaidView Source you’ll own the machine outright once the rental is complete. 

Medicare covers CPAP supplies on a regular replacement schedule with the same 80% coverage. After meeting your Part B deductible, you’ll pay 20% of supply costs. Routine replacement keeps therapy effective and comfortable.

How Long Will Medicare Pay for CPAP Supplies?

Medicare will pay for CPAP supplies as long as your physician says therapy is helpful. CPAP therapy eases the symptoms of OSA, but it doesn’t cure the disorder. So if you’ve been diagnosed with OSA and prescribed CPAP as treatment, you’ll use a CPAP machine for as long as it helps. To continue getting Medicare coverage, you’ll need to adhere to CPAP therapy and meet Medicare’s minimum usage requirements.

During the trial period, Medicare pays for your CPAP machine and necessary accessories. While you’re renting the machine, Medicare covers 80% of the associated costs, and you cover the remaining 20%. After you own the machine, Medicare continues to cover qualifying accessories and components at 80% of the total cost. This coverage continues indefinitely if therapy remains effective.

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Medicare CPAP Supplies Replacement Schedule

Medicare has clear guidelines illustrating how often you can get coverage for CPAP supplies. Trusted Source U.S. Department of Health and Human ServicesView Source Optional accessories aren’t typically covered. You’ll have to pay out-of-pocket for things like mask liners, cleaning supplies, or CPAP pillows. These items may improve comfort but are not medically required.

How to Get Medicare to Cover Your CPAP Supplies

Getting Medicare coverage for CPAP supplies isn’t difficult, but there are specific steps and requirements. First, you’ll need a sleep apnea diagnosis. If you suspect that you have sleep apnea but haven’t done a sleep study, Medicare covers sleep studies for people who have one ordered by a doctor.

If your sleep test indicates that you have sleep apnea, your physician may prescribe CPAP therapy. While there are other treatments for OSA, CPAP remains the most popular and it’s generally quite effective when adhered to properly. Trusted Source Journal of Clinical Sleep Medicine (JCSM)JCSM is the official, peer-reviewed journal of the American Academy of Sleep Medicine.View Source  

Once prescribed, Medicare will cover the cost of the initial 12-week trial, including the device and supplies. If the trial shows that CPAP therapy improved your OSA symptoms and you are compliant you can move on to the 13-month rental.

During the rental, Medicare Part B covers 80% of the device rental costs as well as 80% of the supplies, though you’ll have to meet your deductible first. If you use your CPAP machine correctly and meet the adherence guidelines, you’ll own your CPAP machine. After 5 years, Medicare will cover 80% of a new machine’s cost.

Once you own your CPAP machine, Medicare will continue to cover 80% of your CPAP supply costs. There is a replacement schedule with generous timelines allowing you to get new masks, cushions, headgear, filters, humidifiers, and other supplies regularly. Many DME suppliers offer subscription options that automatically send you new supplies when it’s time to swap. To get medicare coverage for CPAP supplies, check that your DME supplier works with Medicare directly. Otherwise, you can apply for reimbursement. 

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