A Guide To Medicare Coverage for CPAP

If you or a loved one has sleep apnea, understanding Medicare coverage for CPAP can save you money and speed up treatment.

The right device and supplies can dramatically improve sleep quality, daytime alertness, and long-term health.

What a CPAP machine does—and why it matters

Continuous positive airway pressure (CPAP) gently keeps your upper airway open while you sleep. For obstructive sleep apnea (OSA), that steady airflow helps prevent the pauses in breathing that cause loud snoring, oxygen drops, and frequent awakenings.

Better-treated OSA is linked to improved daytime energy, fewer morning headaches, lower blood pressure, and reduced risks related to drowsy driving and heart strain. In many patients, using CPAP at least 4 hours per night on most nights leads to meaningful symptom relief and measurable health gains.

Modern machines offer features like auto-adjusting pressure (APAP), heated humidification, ramp-to-sleep, and quiet motors. Masks come in several styles—nasal pillows, nasal masks, and full-face masks—so you and your clinician can find a comfortable fit that supports consistent use.

Does Medicare cover CPAP?

Yes. Original Medicare (Part B) covers CPAP as durable medical equipment (DME) when medical criteria are met. Coverage generally begins with a 12-week (90-day) trial. If your doctor documents improvement and adequate use during this period, Medicare continues to cover the machine—typically as a monthly rental—up to 13 months, after which you own it.

After the annual Part B deductible, you usually pay 20% of the Medicare-approved amount; Medicare pays 80%.
Use a Medicare-enrolled DME supplier, ideally one that accepts assignment to avoid extra charges.
Coverage applies whether your diagnosis comes from an in-lab polysomnogram or an approved home sleep apnea test ordered by your clinician.
Supplies like masks, tubing, and filters are also covered at set replacement intervals when medically necessary.

For authoritative details, see Medicare’s page on CPAP therapy coverage.

Who’s eligible for Medicare CPAP coverage?

Medical criteria

Medicare covers CPAP for beneficiaries diagnosed with obstructive sleep apnea based on an approved sleep study and typical severity thresholds (commonly, an apnea-hypopnea index or respiratory disturbance index of ≥15, or 5–14 with symptoms/comorbidities such as daytime sleepiness or hypertension). Your clinician must determine medical necessity and write a prescription.

Medicare recognizes both in-lab sleep tests and many home sleep apnea tests when properly ordered and interpreted. Learn more about diagnosing OSA from the American Academy of Sleep Medicine.

Documentation requirements

A face-to-face evaluation with your treating practitioner to assess signs and symptoms of OSA and order testing.
A valid prescription that includes device type (CPAP/APAP), pressure settings (or auto range), and needed supplies.
Evidence from the sleep study supporting the diagnosis.

Local Medicare Administrative Contractors issue detailed policies, often titled “Positive Airway Pressure (PAP) Devices for OSA.” You can review one example policy family through the CMS Coverage Database (search for PAP LCDs and articles).

Continued coverage after the 12-week trial

Adherence: Generally, use the device at least 4 hours per night on 70% of nights during a consecutive 30-day period within the first 90 days.
Follow-up visit: A re-evaluation between day 31 and day 91 that documents symptom improvement and benefit from therapy.
If you don’t meet criteria, talk to your clinician—many patients can reattempt after addressing issues like mask fit, humidity, or pressure settings.

Step-by-step: How to get your CPAP covered

Start with your doctor: Share symptoms such as loud snoring, witnessed apneas, morning headaches, or daytime sleepiness. Ask about a sleep evaluation.
Complete an approved sleep study: In-lab or at home, as ordered. Ensure results are sent to your doctor.
Get a prescription: It should specify the device (CPAP or APAP), pressure settings, and necessary supplies.
Choose a Medicare-enrolled supplier: Use the supplier directory and confirm the supplier accepts assignment.
Arrange setup and education: Your supplier should fit your mask, show cleaning and maintenance, and enable wireless compliance monitoring.
Use the device nightly: Aim for at least 4 hours per night, most nights. Work quickly with your team to fix comfort issues.
Attend the 31–91 day follow-up: Your clinician will review your usage report and document improvement to extend coverage.
Reorder supplies as needed: Medicare covers replacements on a schedule when medically necessary—ask your supplier to set reminders.

What will it cost under Medicare?

Part B coverage: After you meet your annual Part B deductible, you’re responsible for 20% coinsurance of the Medicare-approved amount; Medicare pays 80%.
Rental-to-own: Machines are usually rented monthly. After up to 13 months of continuous use and ongoing medical need, ownership typically transfers to you.
Medigap (Medicare Supplement): Many plans help pay the 20% coinsurance.
Medicare Advantage (Part C): Plans must cover at least what Original Medicare covers but may use networks, prior authorization, and different copays. Check your plan’s DME rules.
Accepting assignment matters: Using a supplier that accepts assignment limits your costs to the Medicare-allowed amount.

For a refresher on DME basics and costs, see Medicare’s guide to durable medical equipment.

Supplies Medicare typically covers (and when to replace)

Replacement schedules help maintain hygiene and performance. Exact allowances can vary by policy and medical need, but these are common benchmarks:

Mask (complete): every 3 months
Nasal cushions/pillows: 2 per month
Headgear/chin strap: every 6 months
Tubing: every 3 months
Disposable filters: 2 per month
Non-disposable filter: every 6 months
Water chamber (humidifier): every 6 months

Your supplier can confirm what your plan allows and when you’ll next be eligible. Medicare also outlines typical DME supply coverage on its CPAP coverage page.

Tips to stay comfortable—and compliant

Prioritize mask fit: Small adjustments, different cushion sizes, or switching styles can eliminate leaks and pressure marks.
Use humidity and ramp: Heated humidification and a gentle pressure ramp reduce dryness and ease you into sleep.
Clean regularly: Follow your supplier’s instructions for daily/weekly cleaning to prevent odors and prolong equipment life.
Address side effects early: Talk to your clinician about nasal sprays, liners, or pressure tweaks instead of powering through discomfort.
Travel smart: CPAPs are allowed on planes as medical devices; carry them on and bring a copy of your prescription. Check your airline’s medical device policy.

Common pitfalls—and how to avoid them

Using a non-enrolled supplier: Could lead to higher bills or no coverage. Verify enrollment and assignment acceptance.
Missing the 31–91 day follow-up: Without this visit and a usage report, ongoing coverage can be denied.
Poor initial adherence: If comfort is an issue, ask for a different mask, adjust humidity, or explore an auto-adjusting device.
Assuming all devices are the same: CPAP, APAP, and bilevel (BiPAP) are different; your clinician will match therapy to your needs.
Overlooking prior authorization (MA plans): Many Medicare Advantage plans require approval before setup—confirm first.

Helpful resources

Bottom line: Medicare coverage for CPAP is within reach if you follow the steps: get a proper diagnosis, use a Medicare-enrolled supplier, meet the trial-period usage goals, and keep your follow-up appointment. With the right support, better sleep—and better health—can start tonight.