Does Medicare cover sleep apnea equipment?
If you're diagnosed with sleep apnea, Medicare will cover your use of a CPAP machine for a 3-month trial or longer, if deemed medically necessary.
Medicare does cover CPAP machine therapy if you are diagnosed with sleep apnea.
You may be eligible for sleep apnea treatment options if you are enrolled in Medicare Part B and have been diagnosed with obstructive sleep apnea.
If you have been formally diagnosed with sleep apnea, you are likely eligible for a 3-month trial of CPAP therapy. If the therapy is successful, your doctor can extend the treatment and Medicare will cover it.
What Is Sleep Apnea?
Sleep apnea is a medical disorder that causes one or more pauses in breathing or shallow breaths during sleep.
Breathing pauses from sleep apnea can last from several seconds to minutes and can occur over 30 times per hour.
Sleep apnea is a chronic condition that disrupts your sleep and can lead to daytime sleepiness and more serious health conditions.
What are the Treatment Options for Sleep Apnea?
There are several recognized treatments for sleep apnea including lifestyle changes, mouthpieces, machines and surgery.
A continuous positive airway pressure (CPAP) machine is the most common treatment for moderate to severe sleep apnea. The machine is equipped with a mask that blows air into your throat while you are sleeping to keep your airway open.
Although Medicare-approved CPAP machines are the most common treatment, Medicare may cover other available treatments.
Please check with your doctor before receiving new equipment to confirm it is a covered sleep apnea treatment.
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Medicare covers the sleep apnea equipment for a specific period of time.
If you are diagnosed with sleep apnea and are enrolled in Original Medicare (Parts A and B), the majority of the CPAP machine rental costs will be covered for a 3-month trial period.
If your doctor determines that the machine is beneficial, Medicare may cover the rental costs for longer than 3 months.
Current Medicare rules dictate that if you rent a CPAP machine for 13 months, you own it.
How Does Medicare Pay for CPAP Machines?
After you are approved for therapy, your doctor will give you a medical prescription for the CPAP machine.
You can take this to any medical equipment supplier that accepts Medicare payments. If they accept Medicare, the supplier will bill Medicare directly for your Medicare-covered CPAP supplies. If not, you could be responsible for all of the costs.
Please note that your doctor may recommend more extensive sleep apnea treatments and CPAP therapy than the Medicare program will cover. Check with your doctor and Medicare before receiving any treatment to confirm coverage and any uncovered costs.
How Much Does a CPAP Machine Cost With Medicare?
Medicare will cover the CPAP machine and other accessories in the same way that it covers other qualified durable medical equipment (DME).
After you pay the $240 yearly Part B deductible (in 2024), Medicare will cover 80% of the Medicare-approved rental costs of the CPAP machine for 3 months, including the costs of filters, hoses and other parts. You are responsible for paying for the remaining 20% Part B coinsurance.
How Long Will Medicare Pay for CPAP Supplies?
Depending on the Medicare Supplement insurance plan you choose, you could get full coverage for your CPAP Machine for up to 13 months.
Does Insurance Cover CPAP Machines?
More traditional insurance such as employer-sponsored insurance and plans purchased on the Marketplace will typically cover CPAP machines in the same fashion as Medicare under many of the same circumstances.
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