Short answer: yes, Medicare covers CPAP machines—but the coverage comes with strings attached, and those strings have a name: the compliance requirement. Miss it, and Medicare stops paying. Know it going in, and you avoid a frustrating surprise midway through treatment. Obstructive sleep apnea affects an estimated 30 million Americans, with older adults disproportionately impacted. CPAP therapy is the first-line treatment, and a basic machine without insurance runs $500–$900. Medicare's coverage can reduce your out-of-pocket costs to a fraction of that—if you navigate the process correctly. Here's everything you need to know, without the runaround. ## How Medicare Covers CPAP: The Rent-to-Own Model Medicare Part B covers CPAP machines as durable medical equipment (DME) under a **rent-to-own structure**. Here's how it works: - **Months 1–3:** Medicare pays for a 3-month trial rental. This is your compliance window (more on that below). - **Months 4–13:** If you pass the compliance check and your doctor documents that therapy is working, Medicare continues covering the rental for another 10 months. - **After month 13:** Ownership transfers to you automatically. Medicare no longer pays rental fees, but continues covering supplies if you remain compliant. After you meet your 2026 Part B deductible of **$283**, Medicare covers 80% of the Medicare-approved rental amount. You're responsible for the remaining 20% coinsurance. If you have a Medigap (supplemental) plan, that 20% may be covered depending on your plan type. No prior authorization is required under Original Medicare for CPAP therapy. But both your prescribing provider and your DME supplier must be enrolled in Medicare—otherwise, Medicare won't pay. ## Qualifying for Coverage: What You Need Before You Start ### 1. A Medicare-Approved Sleep Study You need a formal diagnosis of obstructive sleep apnea confirmed by a sleep test. Medicare accepts several types: a Type I facility-based polysomnogram (PSG), a Type II home-based PSG, a Type III home sleep apnea test with at least four channels, or certain other qualifying home tests. The test must be ordered by your treating physician and performed by a Medicare-enrolled provider. The sleep study results must meet Medicare's AHI/RDI thresholds under **LCD L33718** (the coverage policy for positive airway pressure devices): - An AHI or RDI of **15 or more events per hour**, or - An AHI or RDI between **5 and 14 events per hour** combined with documented symptoms such as excessive daytime sleepiness, impaired cognition, insomnia, hypertension, ischemic heart disease, or a history of stroke ### 2. A Face-to-Face Evaluation Before the CPAP is dispensed, your treating physician must conduct an in-person evaluation documenting that you have OSA and are an appropriate candidate for CPAP therapy. This visit also establishes the Standard Written Order (SWO)—the prescription your DME supplier needs before they can bill Medicare. ### 3. A Medicare-Enrolled DME Supplier This is where many people get tripped up. If you rent your CPAP from a supplier that isn't enrolled in Medicare, you'll pay out of pocket. Always confirm enrollment before signing anything. **→ [Search for Medicare-enrolled CPAP suppliers near you on DMEHelper](https://dmehelper.com/sleep-apnea)** ## The 3-Month Trial: Medicare's Compliance Window This is the part that matters most. During the first 3 months of CPAP therapy, Medicare requires two things: 1. **Objective proof of use:** You must use the CPAP for **at least 4 hours per night on 70% of nights** during any consecutive 30-day period within that window. That works out to roughly 21 out of 30 nights. Your machine tracks this automatically—modern CPAPs record every session and transmit compliance data via cellular or SD card. Medicare does not accept self-reporting. 2. **A clinical re-evaluation:** Between day 31 and day 91 of therapy, your doctor must see you in person and document that CPAP is helping—meaning your OSA symptoms (daytime sleepiness, disrupted sleep, morning headaches) are improving. If both criteria are met, Medicare extends coverage through month 13. If they're not, coverage stops. You won't necessarily lose the machine, but you'll be responsible for the remaining rental payments yourself. One thing worth knowing: if you fail the initial trial, you're not permanently disqualified. You can re-qualify, but it requires repeating portions of the evaluation process—including a titration sleep study showing your AHI was reduced to under 10 events per hour. Getting it right the first time is easier. ## What Medicare Covers—and What It Doesn't ### Covered Medicare Part B covers your CPAP machine (HCPCS code E0601) and all medically necessary accessories once coverage criteria are met. The replacement schedule under LCD L33718 includes: - **Full-face or nasal mask:** 1 per 3 months - **Full-face cushion or nasal cushion:** 2 per month - **Disposable filters:** 2 per month - **Tubing:** 1 per 3 months - **Headgear:** 1 per 6 months - **Chin strap:** 1 per 6 months - **Humidifier chamber:** 1 per 6 months Requesting replacements beyond these quantities will typically be denied unless you provide documentation of medical necessity—for example, a mask that wore out faster due to heavy use or a skin condition requiring more frequent changes. ### Not Covered **CPAP cleaners and sanitizers**—including SoClean and Lumin UV sanitizers—are explicitly not covered by Medicare. They're classified as comfort or convenience items, not DME. You can purchase them out-of-pocket or through an HSA/FSA account. **Travel CPAP machines** are generally not covered. Medicare views them as supplemental devices, not medically necessary replacements for your primary equipment. **Mask liners** used inside CPAP masks are also non-covered and must be billed as noncovered items (code A9270) by your supplier. If a supplier tries to bill Medicare for these, that's a red flag. ## How Much Will You Pay? Here's a realistic picture of out-of-pocket costs under Original Medicare in 2026: - **Part B deductible:** $283 (once per calendar year, shared across all Part B services) - **Coinsurance:** 20% of the Medicare-approved monthly rental amount - **Monthly rental (approximate):** Medicare-approved amounts vary by competitive bidding area, but typical supplier rates run $50–$80/month. Your 20% share: roughly $10–$16/month - **Total over 13 months:** Approximately $130–$208 in coinsurance, plus any unmet deductible Compare that to purchasing a CPAP outright at $500–$900 with no insurance. Medicare's coverage is substantial, especially when you factor in ongoing supply replacements over the years. If you have a Medigap Plan G, your 20% coinsurance is covered after you pay the deductible. Plan N covers coinsurance with minor exceptions. If you're enrolled in Medicare Advantage, your cost-sharing will depend on your specific plan. ## Medicare Advantage and CPAP Medicare Advantage (Part C) plans must cover everything Original Medicare covers—CPAP included. But the supplier network and cost terms are set by the plan, not CMS. Before ordering through a Medicare Advantage plan, confirm two things: (1) the supplier is in-network for your specific plan, and (2) your plan's cost-sharing for DME. Some Advantage plans offer lower coinsurance for CPAP than Original Medicare does; others require higher cost-sharing in exchange for premium savings elsewhere. The compliance and documentation rules are the same under Advantage plans as under Original Medicare—those come from CMS policy, not the plan. ## Already Have a CPAP? What Happens When You First Enroll in Medicare If you were already using a CPAP before becoming Medicare-eligible, you may qualify for coverage of a replacement machine or accessories under Medicare—without going through a new trial period. What you do need: - Documentation of a prior sleep study that meets Medicare's AHI/RDI criteria - An in-person evaluation with a Medicare-enrolled physician confirming you still have OSA and continue to use the device After five years (the reasonable useful lifetime under Medicare), a replacement CPAP requires a new in-person evaluation—but no new sleep study. ## Find a Medicare-Enrolled CPAP Supplier Near You The single most common reason Medicare CPAP claims are denied is using a supplier that isn't properly enrolled or that skips required documentation steps. Working with an experienced, Medicare-enrolled DME provider from the start prevents most of these problems. **→ [Use DMEHelper to find Medicare-enrolled CPAP suppliers in your city](https://dmehelper.com/sleep-apnea)**. Search by ZIP code or city, compare provider listings, and find one that accepts Medicare assignment—meaning they've agreed to bill Medicare directly and can't charge you more than the Medicare-approved amount. --- ## FAQ ### Does Medicare cover CPAP machines? Yes. Medicare Part B covers CPAP machines as durable medical equipment for people diagnosed with obstructive sleep apnea. Coverage follows a rent-to-own model: Medicare pays toward a 13-month rental, after which you own the device. After meeting the 2026 Part B deductible of $283, you pay 20% coinsurance on rental and supply costs. ### What is the CPAP compliance requirement for Medicare? Medicare requires you to use your CPAP for at least 4 hours per night on 70% of nights during any consecutive 30-day period within the first 3 months of therapy. Your machine records usage data automatically—self-reporting is not accepted. Miss this threshold, and Medicare stops covering the rental. ### What sleep study do I need to qualify for Medicare CPAP coverage? You need a Medicare-approved, FDA-cleared sleep study ordered by your treating physician showing an AHI or RDI of 15 or more events per hour, or between 5 and 14 with qualifying symptoms like excessive daytime sleepiness or hypertension. Both your doctor and your DME supplier must be enrolled in Medicare. ### Does Medicare cover CPAP accessories like masks and tubing? Yes. Medicare covers masks, cushions, tubing, filters, headgear, humidifier chambers, and chin straps on a defined replacement schedule. Masks: every 3 months. Cushions and disposable filters: 2 per month. Tubing: every 3 months. Headgear and humidifier chambers: every 6 months. ### Does Medicare cover CPAP cleaners and sanitizers? No. CPAP cleaners like SoClean are classified as convenience items and are not covered by Medicare. You can purchase them out-of-pocket or use HSA/FSA funds to cover the cost.