Yes, Medicare covers CPAP machines for adults diagnosed with obstructive sleep apnea, but coverage comes with specific diagnostic thresholds, a trial period, and usage requirements you need to meet. The machine is classified as durable medical equipment under Part B, which means it follows a rental-to-own model over 13 months rather than a single purchase.
Who Qualifies for Coverage
Medicare uses a scoring system based on your sleep study results. The key number is your apnea-hypopnea index (AHI) or respiratory disturbance index (RDI), which counts how many times per hour your breathing stops or becomes abnormally shallow while you sleep. You qualify if your score falls into one of two categories:
- 15 or more events per hour: You qualify based on the sleep study alone, with a minimum of 30 total recorded events.
- 5 to 14 events per hour: You qualify if you also have documented symptoms or related health conditions. Qualifying symptoms include excessive daytime sleepiness, impaired thinking, mood disorders, or insomnia. Qualifying health conditions include high blood pressure, ischemic heart disease, or a history of stroke. You need a minimum of 10 total recorded events.
Your doctor must order the sleep study. Medicare covers both in-lab sleep tests (called Type I polysomnography, which must be done at a sleep lab facility) and certain home sleep tests. The sleep study establishes the diagnosis that triggers coverage for the machine itself.
How the 13-Month Rental Works
Medicare doesn’t buy you a CPAP machine outright. Instead, it pays a supplier to rent one for you on a month-to-month basis. After 13 continuous months of rental payments, you own the machine. The key word is “continuous.” If your rental is interrupted for any reason, the clock can reset.
During the rental period, your supplier is responsible for maintaining the equipment. Once you own it after month 13, repairs and maintenance become your responsibility, though Medicare may still cover replacement supplies.
The Initial Trial Period
Coverage begins with an initial 12-week trial. During this window, Medicare wants evidence that CPAP therapy is actually working for you. This means two things need to happen: you need to use the machine consistently, and your treating doctor needs to document that the therapy is benefiting you.
The usage bar is typically set at a minimum of 4 hours per night. If you can’t tolerate the machine or aren’t using it enough during this trial, Medicare can stop covering it. A face-to-face clinical re-evaluation during this period confirms that treatment should continue. If you pass the trial, coverage continues through the full 13-month rental period and beyond for supplies.
What You Pay Out of Pocket
CPAP coverage falls under Medicare Part B, so the standard cost-sharing structure applies. You pay your annual Part B deductible first, then 20% of the Medicare-approved amount for the equipment rental each month. Medicare picks up the remaining 80%. If you have a Medigap (supplemental) policy, it may cover some or all of that 20% coinsurance, depending on your plan. Medicare Advantage plans must cover at least what Original Medicare covers, though the specific copay amounts and supplier networks may differ.
Supplies and Replacement Schedules
The machine itself is only part of the ongoing cost. CPAP requires regular replacement of masks, cushions, tubing, and filters. Medicare covers these supplies on a set schedule, and understanding the timing helps you avoid paying out of pocket for replacements you could get covered.
- Full face mask or nasal mask: 1 every 3 months
- Nasal pillows or cushions: 2 per month
- Replacement oral cushion (for combination masks): 2 per month
- Standard tubing: 1 every 3 months
- Heated tubing: 1 every 3 months
- Disposable filters: 2 per month
- Nondisposable filters: 1 every 6 months
These are maximums. You can replace items less frequently if they’re still in good shape, but Medicare won’t pay for replacements faster than this schedule allows. Many CPAP supply companies will contact you automatically when you’re eligible for new supplies, which is convenient but worth double-checking against your actual needs. Some suppliers push replacements you may not need yet.
Getting a Replacement Machine
Medicare considers the “reasonable useful lifetime” of a CPAP machine to be five years. After five years, you can qualify for a new machine if your current one is no longer functioning properly. You’ll generally need a new prescription from your doctor, though you won’t necessarily need to repeat a sleep study if your diagnosis hasn’t changed. Before the five-year mark, Medicare will only cover a replacement if your machine is lost, stolen, or damaged beyond repair.
Choosing a Supplier
You can’t get your CPAP from just any retailer and expect Medicare to pay. The supplier must be enrolled in Medicare as a durable medical equipment supplier. In many parts of the country, Medicare uses a competitive bidding program that contracts with specific suppliers in your area, and using a non-contracted supplier can mean higher out-of-pocket costs or no coverage at all. Before committing to a supplier, confirm they accept Medicare assignment in your region. The simplest way to check is through Medicare’s supplier directory at Medicare.gov or by calling 1-800-MEDICARE.
If you buy a CPAP machine on your own from an online retailer without going through a Medicare-enrolled supplier, you will not be reimbursed. The rental arrangement must go through proper channels from the start.
What Happens if You Don’t Meet Compliance
If you fail the initial 12-week trial because you aren’t using the machine enough or your doctor can’t document clinical improvement, Medicare stops paying for the rental. This doesn’t permanently disqualify you, but restarting the process typically means a new evaluation from your doctor and potentially a new sleep study to re-establish medical necessity. Some people struggle with their first mask type or pressure setting and do much better after adjustments, so working closely with your sleep specialist during that initial trial is worth the effort. Losing coverage and having to restart is a much bigger hassle than troubleshooting comfort issues early on.