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Does Medicare cover sleep apnea equipment?

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.

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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.

Medicare & Medigap coverage for CPAP devices

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 $185 yearly Part B deductible (for 2019), 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.

Medicare Supplement Plans Can Cover Your Out-of-Pocket CPAP Machine Costs

Depending on the Medicare Supplement insurance plan you choose, you could get full coverage for both the Part B deductible and the 20% Part B coinsurance cost.

You can use the comparison chart below to see the benefits that are offered by each type of standardized Medigap plan sold in most states.

Medicare Supplement Benefits A B C D F1 G K2 L3 M N4
Part A co-insurance and hospital costs
Part B co-insurance or co-payment 50% 75%
First 3 pints of blood 50% 75%
Part A hospice care co-insurance or co-payment 50% 75%
Co-insurance for skilled nursing facility     50% 75%
Medicare Part A deductible   50% 75% 50%
MedicarePart B deductible              
Medicare Part B excess charges              
Foreign travel emergency     80% 80% 80% 80%     80% 80%
1. Plan F offers a high-deductible plan. This plan requires you to pay a $2,300 deductible in 2019 before it covers anything.
2. Plan K has an out-of-pocket yearly limit of $5,560 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
3. Plan L has an out-of-pocket yearly limit of $2,780 in 2019. After you pay the out-of-pocket yearly limit and yearly Part B deductible, it pays 100% of covered services for the rest of the calendar year.
4. Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.

A licensed insurance agent can help you compare the costs and coverage of Medicare Supplement Insurance plans that are available where you live.

 

Compare Medigap plan costs in your area.

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