Does medicare cover a cpap machine

If you’ve been diagnosed with obstructive sleep apnea (OSA), you might be wondering: Will Medicare help pay for a CPAP machine? In many cases, yes — but you must meet certain medical and usage requirements. Medicare provides coverage under its durable medical equipment (DME) benefit, though costs and conditions apply.

Quick Definition

Medicare Part B may cover CPAP devices and supplies as long as they are medically necessary, you follow a trial period, and you get the equipment from a Medicare-approved supplier.

How Medicare Covers CPAP Therapy

1. Diagnosis Requirement
   To qualify, a doctor must diagnose OSA, typically through a sleep study. Once diagnosed, your doctor can prescribe CPAP therapy for use at home. 

2. Three-Month Trial Period
   Medicare generally covers a 12-week (three-month) trial rental of a CPAP machine. 

3. Compliance Is Crucial
   During the trial, you must use the machine regularly. Medicare tracks “adherence” (usually at least four hours per night for at least 70% of nights). Long-Term Coverage
   If you meet usage and medical criteria after the trial, Medicare continues to rent the device for up to 13 months. After that, you may own it. 

4. Replacing Supplies
   Medicare also covers replacement parts and accessories on a set schedule — for example, masks, tubing, filters, and headgear. 

5. Machine Replacement
   If your CPAP machine needs replacing (due to age or malfunction), Medicare may agree to replace it — as long as your supplier and doctor follow the required steps.

What It Costs You

• Medicare’s Part B deductible applies before coverage begins. 

• After the deductible, you typically pay 20% of the Medicare-approved amount for the machine rental or purchase and related accessories. 

• Your CPAP supplier must be enrolled in Medicare. If they accept assignment, they agree to Medicare’s payment rule; if not, you may pay more. 

What Could Disqualify You

• Not meeting the usage requirement: If your doctor determines you’re not using the device enough, Medicare may refuse ongoing coverage. 

• Supplier issues: If the supplier isn’t enrolled in Medicare, coverage may be denied. 

• Incorrect documentation: Your medical provider must properly document your sleep study, diagnosis, treatment plan, and progress. 

Tips for Getting Covered

• Make sure your sleep study is done through a Medicare-approved provider.

• Confirm that your DME supplier (the one selling or renting the CPAP) is Medicare-enrolled and accepts assignment.

• Use the machine consistently during the trial — track your hours and stay in contact with your doctor.

• Keep up-to-date records: prescriptions, medical notes, and usage data can help when Medicare reviews your case.

• Ask your supplier about the replacement schedule for supplies so you can plan ahead.

FAQ

Q1: What if I already had a CPAP before enrolling in Medicare?
You may still get a replacement or rental machine if Medicare approves your supplier and documents show continuing need. 

Q2: How often does Medicare cover new masks or tubing?
Yes — Medicare has a schedule for replacing supplies like masks, tubing, headgear, and filters. 

Q3: Can I buy the CPAP instead of renting?
Yes, in most cases. After renting for 13 months with continuous use, ownership can transfer to you under Medicare rules. 

Q4: Will Medicare cover advanced machines like auto-adjusting CPAP or BiPAP?
It depends. Medicare covers certain types of durable medical equipment, but your doctor must prescribe the specific type, and the supplier must accept Medicare. 

Q5: Do Medicare Advantage plans cover CPAP machines differently?
Possibly. They must cover at least what Original Medicare does, but details (like cost and eligibility) can vary by plan. 

Final Summary

Yes, Medicare Part B can cover a CPAP machine and its supplies — but only if you’re diagnosed with sleep apnea, use the device regularly, and get it from a Medicare-approved supplier. You’ll likely rent it initially, pay your Part B deductible, and then 20% of the approved cost. If you follow the rules and show consistent use, you may eventually own the device.

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