Medicare Coverage for Sleep Apnea Treatment: CPAP and More

Medicare Coverage for Sleep Apnea Treatment: CPAP and More is one of the most common questions we get from readers. In this guide, we break down everything you need to know to make an informed decision.

Medicare covers CPAP therapy for obstructive sleep apnea — but the coverage requirements are specific, and many beneficiaries don't know what documentation is needed to get approved. Here's a complete breakdown of what Medicare pays for, what you pay, and how to navigate the system.

Medicare Part B: CPAP Coverage Requirements

Medicare Part B (Medical Insurance) covers CPAP machines as Durable Medical Equipment (DME) under specific conditions:

• You must have a diagnosis of obstructive sleep apnea confirmed by a sleep study
• The sleep study must show an Apnea-Hypopnea Index (AHI) or Respiratory Disturbance Index (RDI) of ≥15 events per hour, OR ≥5 with documented symptoms (excessive daytime sleepiness, impaired cognition, insomnia, or associated hypertension/cardiac conditions)
• The study can be either an in-lab polysomnography or a qualified home sleep test
• A physician must order the CPAP and document medical necessity

The Initial CPAP Trial Period

Medicare initially covers CPAP as a 13-week rental. After that initial period, continued coverage requires documented compliance:

• You must use CPAP ≥4 hours per night on ≥70% of nights during any consecutive 30-day period in the first 90 days
• A face-to-face follow-up with your physician must confirm benefit from treatment
• If compliance is demonstrated, coverage continues and converts to purchase after 13 months of rental
• If compliance fails, Medicare stops coverage — but can restart with documented renewed adherence

What Medicare Pays vs. What You Pay

Under Medicare Part B (after meeting the annual deductible of $240 in 2024):

• Medicare pays: 80% of the approved amount for CPAP rental/purchase and supplies
• You pay: 20% coinsurance after deductible
• Medigap/Supplement: May cover your 20% coinsurance depending on plan letter
• Medicare Advantage: CPAP coverage is included but cost-sharing varies by plan — check your Evidence of Coverage document

CPAP Supplies Covered by Medicare

Medicare covers replacement supplies on a set schedule:

• Full face mask or nasal mask: 1 every 3 months
• Mask cushions/pillows: 2 per month (full face), 4 per month (nasal pillows)
• Headgear and chin straps: 1 every 6 months
• Filters: 2 disposable per month, 1 non-disposable every 6 months
• Tubing: 1 every 3 months
• Humidifier chamber: 1 every 6 months

BiPAP and ASV Coverage

Medicare also covers BiPAP (bilevel positive airway pressure) when CPAP is inadequate, and Adaptive Servo-Ventilation (ASV) for complex sleep apnea — though ASV has additional restrictions for patients with heart failure and reduced ejection fraction following the 2015 SERVE-HF trial findings.

Positional Therapy and Adjustable Beds

For positional obstructive sleep apnea (more events when sleeping supine), head-of-bed elevation is a clinician-recommended adjunct. Our guide to adjustable bed Medicare coverage details when and how adjustable bases may be covered as DME. Understanding sleep apnea in older adults provides additional context for Medicare beneficiaries, as does our insurance coverage guide for sleep studies.

Frequently Asked Questions