Quality sleep is an essential part of your health. If you aren’t getting good sleep, a potential cause can be sleep apnea, which can interfere with your ability to breathe properly while you sleep. To treat this, your doctor may prescribe a CPAP machine.
If you have Medicare, you might be wondering if a CPAP machine and supplies are covered. In this MedicareWire article, we’ll go over exactly how Medicare covers CPAP machines, as well as any replacement parts you need.
Key Takeaways
- A continuous positive airway pressure (CPAP) machine increases air pressure in your airways to treat sleep apnea.
- Sleep apnea is a condition where you are unable to get beneficial sleep due to difficulty breathing properly while resting.
- Medicare will provide coverage for a CPAP machine for 3-month periods if your doctor orders it for your sleep apnea treatment.
- Medicare will also cover replacement parts for the CPAP machine every one to six months, depending on the part.
- The average CPAP machine will cost about $500 to $800 before Medicare pays its share.
- Medicare Advantage plans will also provide coverage for CPAP machines, but suppliers will be limited to in-network providers.
- Medigap can provide additional help with out-of-pocket costs for Medicare-approved CPAP machines and parts.
What Is A CPAP Machine?
A continuous positive airway pressure (CPAP) machine is a medical device that delivers air pressure into your airway passages (mouth and nose) to prevent them from collapsing while you sleep. The CPAP device delivers the air pressure through a tube and a mask that you strap over your nose and/or mouth, depending on the mask you need. CPAP equipment is used to treat severe snoring and sleep apnea disorders.1Mayoclinic.org, “Continuous positive airway pressure (CPAP)“, Accessed December 4, 2021
Sleep Apnea
If you are suffering from consistently poor sleep and you snore loudly, you may have a sleep disorder called sleep apnea. Sleep apnea is when your airway passages are obstructed during sleep, caused by the muscles surrounding them relaxing too much as you rest. This can make it impossible to get meaningful rest even when you are exhausted, and can cause symptoms such as:2Mayoclinic.org, “Sleep apnea“, Accessed December 4, 2021
- Loud snoring
- Inability to breathe while asleep
- Gasping for air while asleep
- Dry mouth
- Headaches
- Insomnia
- Excessive daytime sleepiness
- Concentration issues
- Irritable moods
Will Medicare Cover My CPAP Machine?
Medicare Part B covers Continuous Positive Airway Pressure (CPAP) therapy if you have been diagnosed with obstructive sleep apnea. Medicare typically covers a three-month trial period of CPAP therapy.3Medicare.gov, “Continuous Positive Airway Pressure devices, accessories, & therapy“, Accessed December 4, 2021
Medicare may cover CPAP therapy longer than three months if you meet in person with your doctor, and your doctor documents in your medical record that you meet certain conditions about the use of the device and the CPAP therapy is helping you.3Medicare.gov, “Continuous Positive Airway Pressure devices, accessories, & therapy“, Accessed December 4, 2021
Beneficiaries pay 20% of the Medicare-approved amount for the durable medical equipment (DME) rental and related supplies (like masks and tubing). Medicare pays the rental company for 13 months. After you’ve rented and used the machine for 13 months, without interruption, you own it.3Medicare.gov, “Continuous Positive Airway Pressure devices, accessories, & therapy“, Accessed December 4, 2021
Replacement CPAP Machines and Accessories
If you started using a CPAP machine before you got Medicare, Medicare may cover the cost for a replacement CPAP machine rental and/or CPAP accessories. When your CPAP machine requires specific accessories to be replaced, Medicare will cover the following items:4oig.hhs.gov, “REPLACEMENT SCHEDULES FOR MEDICARE CONTINUOUS POSITIVE AIRWAY PRESSURE SUPPLIES“, Accessed December 4, 2021
- CPAP Tubing With Heating Element: 1 per 3 months
- Combination Oral/Nasal CPAP Mask: 1 per 3 months
- Replacement Oral Cushion for Oral/Nasal Mask: 2 per 1 month
- Replacement Nasal Pillows for Oral/Nasal Mask, One Pair: 2 per 1 month
- Full Face Mask: 1 per 3 months
- Full Face Mask Interface: 1 per 1 month
- Cushion for Nasal Mask Interface: 2 per 1 month
- Nasal Pillows: 2 per 1 month
- Nasal Interface: 1 per 3 months
- Headgear: 1 per 6 months
- Chinstrap: 1 per 6 months
- Tubing: 1 per 3 months
- Disposable Filter: 2 per 1 month
- Nondisposable Filter: 1 per 6 months
- Humidifier Water Chamber: 1 per 6 months
How Much Does A CPAP Machine Cost?
The cost of most CPAP machines varies between $500 to $800, although some higher-end products can cost over $1,000. Costs for CPAP supplies can vary even more depending on their accessory type:5Sleepfoundation.org, “How Much Do CPAP Machines Cost?“, Accessed December 4, 2021
- Air filters: $5 to $30
- Headgear and mask sets: $100 or more
- Mask cushions and similarly small parts: $20 to $100
These cost estimates are without any coverage. With Original Medicare coverage, you will only need to pay 20 percent of these listed costs.3Medicare.gov, “Continuous Positive Airway Pressure devices, accessories, & therapy“, Accessed December 4, 2021
Do Medicare Advantage Plans Cover CPAP Machines?
Medicare Advantage plans are required to provide coverage for CPAP machines, as well as any other service covered by Medicare Part A and Part B (Original Medicare). The difference is that Medicare Advantage plans may require their members to use in-network providers and equipment suppliers. Plus, out-of-pocket costs vary from plan to plan and may not be the same as Original Medicare.6Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed December 4, 2021
Summary
Being unable to sleep properly, even if you get a full night’s rest, is a terrible condition to deal with. It makes everything in your daily life more difficult and puts you at risk for other medical conditions when your body cannot restore itself. Fortunately, if your sleep problems are caused by sleep apnea, Medicare will pay their share for a CPAP machine for your treatment.
Talk to your doctor about your sleep quality. If someone notices you snore rather loudly or if you frequently wake up while trying to sleep, your doctor may suggest you take an active approach to treat your condition with a CPAP machine.
Citations
- 1Mayoclinic.org, “Continuous positive airway pressure (CPAP)“, Accessed December 4, 2021
- 2Mayoclinic.org, “Sleep apnea“, Accessed December 4, 2021
- 3Medicare.gov, “Continuous Positive Airway Pressure devices, accessories, & therapy“, Accessed December 4, 2021
- 4oig.hhs.gov, “REPLACEMENT SCHEDULES FOR MEDICARE CONTINUOUS POSITIVE AIRWAY PRESSURE SUPPLIES“, Accessed December 4, 2021
- 5Sleepfoundation.org, “How Much Do CPAP Machines Cost?“, Accessed December 4, 2021
- 6Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed December 4, 2021