Summary

Medicare Part B helps pay for CPAP (continuous positive airway pressure) therapy for obstructive sleep apnea, but you’ll need a qualifying sleep test, a doctor’s prescription, and a successful 3-month trial period. Ongoing coverage requires documented use and renting the device from a Medicare-approved durable medical equipment supplier. You’ll still pay the Part B deductible ($257 in 2025) and typically 20% coinsurance for the machine and replacement supplies; Medigap may cover your share, while Medicare Advantage coverage varies by plan.

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😴 How Medicare Covers CPAP

Medicare Part B covers CPAP therapy for obstructive sleep apnea in two stages: a physician-prescribed 3-month trial followed, if successful, by a rental period of up to 13 months. After the rental period, you own the machine. To qualify, you must obtain the device from a Medicare-approved durable medical equipment supplier and continue using it consistently; usage is monitored to maintain coverage. Before starting, a sleep test is required to confirm obstructive sleep apnea. This test can be performed at home (if available locally) or in a sleep lab. Altogether, these steps ensure that CPAP is clinically appropriate and effective for you while Medicare shares the cost.

Takeaways:

• Coverage begins with a doctor-ordered 3-month CPAP trial to prove benefit.

• If successful, Medicare covers rental for up to 13 months; then you own the device.

• You must use a Medicare-approved supplier and maintain consistent usage.

• A qualifying sleep test (home or lab) is required before coverage starts.

Key Terms

• CPAP (Continuous Positive Airway Pressure): A device that uses pressurized air via a mask to keep the airway open during sleep.

• Trial Period: The initial 3 months during which you must use CPAP as prescribed to demonstrate benefit.

• Durable Medical Equipment (DME) Supplier: A Medicare-approved vendor that rents and provides covered medical equipment.

• Usage Monitoring: Technology that records whether you’re using CPAP as required to keep coverage active.

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🧪 Eligibility & Sleep Test Requirements

Coverage hinges on documented obstructive sleep apnea based on testing and a physician’s prescription. Your evaluation can include a home sleep test if your local physician or sleep clinic offers the equipment, which can spare you an overnight lab stay. Once your doctor confirms the diagnosis and prescribes CPAP, you begin the trial. Using the machine nightly as instructed is essential—both for your health and to keep Medicare paying. If CPAP isn’t effective for you during the trial, your doctor may revisit your treatment plan.

Takeaways:

• A sleep test confirming obstructive sleep apnea is required for coverage.

• Home sleep testing may be available through local providers.

• A physician’s prescription is necessary to start CPAP and the trial.

Key Terms

• Obstructive Sleep Apnea (OSA): A condition where throat muscles relax and block the airway, fragmenting sleep and straining the body.

• Sleep Study (Polysomnography/Home Test): Diagnostic testing that measures breathing and sleep patterns to identify OSA.

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💸 What You’ll Pay Under Medicare

Because CPAP is considered durable medical equipment, the Medicare Part B deductible applies first—$257 in 2025. After you meet the deductible, you typically pay 20% of the Medicare-approved amount for the machine rental and covered supplies. If you carry a Medigap policy, it generally pays your 20% coinsurance. If you’re enrolled in a Medicare Advantage plan, costs and coverage for CPAP machines and supplies can differ by plan, so review your plan documents or contact your insurer to confirm details and any prior authorization requirements. Always verify that both your physician and your CPAP supplier participate in Medicare; otherwise, you could be billed at higher, non-Medicare rates and lose the 80% Medicare payment.

Takeaways:

• 2025 Part B deductible: $257, then 20% coinsurance on approved amounts.

• Medigap may cover your 20% share.

• Medicare Advantage coverage varies—check your plan.

• Confirm your doctor and supplier are enrolled in Medicare.

Key Terms

• Part B Deductible: The amount you pay each year before Part B cost-sharing applies.

• Coinsurance: Your percentage share (often 20%) of the Medicare-approved cost after the deductible.

• Medicare Advantage (Part C): Private plans that provide Medicare benefits and may have different CPAP rules and costs.

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🧰 Supplies, Replacements & Ongoing Costs

CPAP therapy involves recurring supplies—such as masks, headgear, filters, humidifier water reservoirs, and tubing—that need periodic replacement. Medicare covers many of these items on an approved replacement schedule, but not every accessory is included under Part B. Your DME supplier should help you time replacements to maximize coverage and minimize out-of-pocket costs. Keep in mind that continued Medicare help depends on ongoing, documented CPAP use and obtaining supplies through enrolled providers.

Takeaways:

• Expect recurring costs for masks, filters, headgear, reservoirs, and tubing.

• Medicare covers many supplies on set replacement intervals; some items may not be covered.

• Work with your supplier to optimize replacement timing and maintain coverage.

Key Terms

• Replacement Schedule: Medicare-approved timing for when CPAP supplies can be replaced and covered.

• Covered vs. Non-Covered Supplies: Items Medicare Part B will pay for versus accessories you may need to purchase yourself.

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Conclusion

Medicare Part B can significantly reduce the cost of CPAP therapy if you meet diagnostic criteria, complete a successful 3-month trial, rent from an approved supplier, and keep using the device as prescribed. You’ll still owe the Part B deductible and coinsurance (often covered by Medigap), while Medicare Advantage rules and costs vary. Plan ahead for supply replacements, confirm that your providers are enrolled in Medicare, and stay consistent with your therapy to maintain coverage and improve your sleep and health.