Does Medicare Cover CPAP Machines? 

Restful sleep is one of the most important aspects of maintaining overall health. Unfortunately, some people experience difficulty breathing during sleep, and this condition, known as sleep apnea, can lead to more serious health concerns. In fact, sleep apnea may even lead to cardiovascular disease and the potential for fatal outcomes.

The symptoms of sleep apnea

Sleep apnea is a medical condition that causes your body to temporarily stop breathing during sleep. While the major symptom of sleep apnea is a low blood oxygen level, you may also find that you feel fatigued during the day. Additionally, sleep apnea can cause an increased risk for heart attacks and strokes as well as high blood pressure and atrial fibrillation.

How is sleep apnea treated?

Sleep apnea is sometimes treated by making lifestyle adjustments. Changing your diet and exercising regularly to maintain a healthy weight are two things recommended often by doctors to prevent sleep apnea. In situations where these steps are not enough, the use of a CPAP machine may be required.

What is a CPAP machine?

A continuous positive airway pressure (CPAP) machine is a medical device that is worn while sleeping to keep your airway open. It works by supplying a steady stream of air through a hose that is directed into a mask worn overnight. The air pressure produced by the CPAP machine prevents airway closure which can be caused by sleep apnea or other health concerns that affect nighttime breathing.

Do Medicare benefits cover CPAP machines?

Medicare recipients who are enrolled in Medicare Part B, the outpatient portion of the program, can receive coverage for CPAP machine usage under certain conditions. First, your Part B premium must be current, and you must have also met your deductible for the year before benefits begin applying toward CPAP costs.

Medicare coverage for CPAP is also supplied on a trial basis for three months. What this means is that your doctor must prescribe the use of a CPAP machine for at least three months. During this time, Original Medicare will cover the cost of the machine under Part B. After your three-month trial, you must follow up with your physician to have your prescription extended. As long as your doctor notes that your continued use of a CPAP machine is medically necessary, Medicare will continue to provide coverage for your CPAP device.

It should be noted that there are several different types of sleep apnea, but Medicare benefits will generally only cover a CPAP machine in situations where the diagnosis is obstructive sleep apnea. If you have a different type of sleep apnea, a CPAP machine may not benefit you at all, but you should discuss this with your doctor and with your Medicare plan manager for more details.

Rental vs ownership

Coverage for a CPAP machine also gets split between renting and owning. Original Medicare benefits will cover the rental of a CPAP machine for 13 months. If you have used the machine continuously for those 13 months, you will then take ownership of it.

It should also be noted that during the rental period, Medicare will cover the cost of accessories that include masks and hoses. Your cost will be 20% with Medicare coverage picking up the remaining 80%. This is the standard coinsurance split for Medicare Part B benefits.

Does Medicare cover sleep studies?

Many people who suffer from sleep apnea also benefit from having a sleep study performed. These are medical tests during which a patient’s vital signs are monitored while the patient sleeps. A sleep study can help to identify health concerns that are affecting sleep, and these tests are often ordered for individuals suspected of suffering from sleep apnea.

If your physician believes that a sleep study will help to determine whether apnea is a problem or whether a CPAP device would be helpful in your situation, Medicare should cover your sleep study. Covered studies include type I, II, III and IV, but coverage for a type I study is only available if the study is conducted in a lab.