Yes, Medicare covers sleep apnea diagnosis and treatment, including sleep studies, CPAP machines, oral appliances, and even surgical implants. But coverage comes with specific rules, especially a compliance requirement during your first three months on a CPAP that catches many people off guard. Here’s how it all works.
What Medicare Covers for Sleep Apnea
Medicare Part B covers the major steps in diagnosing and treating obstructive sleep apnea. That includes sleep studies (both in-lab and at-home tests), CPAP machines and supplies, custom oral appliances, and in certain cases, a surgically implanted nerve stimulator. Each of these has its own eligibility rules, but the starting point is the same: your doctor must document clinical signs and symptoms of sleep apnea and order the appropriate test or treatment.
Sleep Studies and Diagnosis
Medicare covers four types of sleep tests, labeled Type I through Type IV. Type I is the most comprehensive, conducted overnight in a sleep lab with full monitoring. Types II through IV are simpler tests that can be done at home. The key distinction: Medicare only covers Type I tests when they’re performed in a certified sleep lab facility. Home sleep tests use portable devices that track your breathing, oxygen levels, and airflow while you sleep in your own bed.
To qualify for any of these tests, you need to show clinical signs of sleep apnea. Common signs include loud snoring, observed pauses in breathing during sleep, gasping or choking at night, excessive daytime sleepiness, and morning headaches. Your doctor evaluates these symptoms during a face-to-face visit and orders the study based on their clinical judgment.
CPAP Coverage and the 90-Day Trial
If you’re diagnosed with sleep apnea, Medicare covers CPAP machines as durable medical equipment. You’ll pay 20% of the Medicare-approved amount after meeting your Part B deductible, which is $257 in 2025. Medicare rents the CPAP rather than purchasing it outright, and the first three months function as a trial period with strict requirements you need to know about.
During those first 90 days, you must prove you’re actually using the machine. Medicare defines compliance as using your CPAP at least 4 hours per night on 70% of nights during any consecutive 30-day stretch within the trial. That works out to at least 21 nights out of 30. Modern CPAP machines track this data automatically, and your doctor will review it.
You also need a follow-up appointment with your doctor between day 31 and day 91 of therapy. At that visit, your doctor must document that you’re benefiting from the treatment and review the objective usage data from your machine. If you meet the compliance threshold and your doctor confirms clinical benefit, Medicare continues covering the rental and supplies going forward.
If you don’t meet either requirement, Medicare will deny coverage from month four onward, and you’d be responsible for the full cost. If your follow-up appointment happens after day 91 but still shows compliance and benefit, coverage can resume starting from the date of that late evaluation, though you may have a gap in coverage.
Oral Appliances as an Alternative
Medicare also covers custom-fabricated mandibular advancement devices, which are mouthpieces that hold your lower jaw slightly forward to keep your airway open during sleep. These are covered under the durable medical equipment benefit, but only for diagnosed obstructive sleep apnea. Oral appliances used solely for snoring without an apnea diagnosis are not covered.
The device itself must meet specific design requirements to qualify. It needs a fixed mechanical hinge, the ability to advance the jaw in increments of one millimeter or less, and the ability to hold its position during sleep without dislodging. Prefabricated, one-size-fits-all devices and tongue-retaining devices are excluded from coverage.
To get one approved, your doctor must perform a detailed face-to-face evaluation documenting your symptoms, their duration, a focused exam of your upper airway, your neck circumference, and your BMI. Many people pursue oral appliances after finding CPAP therapy uncomfortable, though Medicare doesn’t strictly require a failed CPAP trial before covering one.
Surgical Nerve Stimulation Coverage
For people who genuinely cannot tolerate CPAP, Medicare covers hypoglossal nerve stimulation, a surgically implanted device that stimulates the nerve controlling your tongue to keep your airway open during sleep. This is a more involved treatment with a longer list of requirements.
You must be at least 22 years old with a BMI under 35. A sleep study performed within the previous 24 months must show moderate to severe apnea (15 to 65 breathing interruptions per hour), with the majority of events being obstructive rather than central in nature. You also need documented evidence that CPAP has failed or that you couldn’t tolerate it, defined as either continued apnea despite CPAP use or using it fewer than 4 hours per night on most nights. A sleep specialist must be involved in that determination.
Before implantation, you’ll undergo a procedure called drug-induced sleep endoscopy, where a doctor examines your airway while you’re sedated to confirm the device will work for your specific anatomy. If your airway collapses in a circular pattern at the soft palate, the device is unlikely to help and won’t be approved.
Your Out-of-Pocket Costs
For all Part B-covered sleep apnea services and equipment, the standard cost-sharing applies. You pay your annual Part B deductible of $257 (in 2025), then 20% of the Medicare-approved amount for each service or piece of equipment. If you have a Medigap (Medicare Supplement) plan, it may cover some or all of that 20% coinsurance depending on your policy.
Medicare Advantage plans (Part C) must cover everything Original Medicare covers, but they can structure copays and coinsurance differently, and many require prior authorization for sleep studies or CPAP equipment. Check with your specific plan before scheduling a sleep study to avoid surprises. Some Advantage plans also have preferred DME suppliers, so using an out-of-network supplier could mean higher costs or denied claims.
How to Keep Your Coverage Active
The most common reason people lose Medicare coverage for their CPAP is failing the 90-day compliance check. If you’re struggling to use your machine consistently, address it early. Common fixes include trying a different mask style, adjusting the pressure settings, or using the machine’s ramp feature to start at a lower pressure and gradually increase. Your DME supplier and sleep doctor can help troubleshoot.
After the initial trial, Medicare continues renting the CPAP for up to 13 months. After that period, you own the machine. Replacement supplies like masks, tubing, and filters remain covered on a set schedule, typically every three to six months depending on the item. Keep your follow-up appointments and make sure your usage data stays on file with your doctor, as Medicare can audit compliance at any point during the rental period.