Medicare Part B covers CPAP machines and most supplies, but only after a sleep study confirms sleep apnea and your doctor writes an order
Medicare Part B will pay for a CPAP machine, mask, tubing, and filters if you have been diagnosed with obstructive sleep apnea through an overnight sleep study. The machine itself is covered as durable medical equipment (DME), which means Medicare pays 80 percent of the approved amount after you meet your Part B deductible. You pay the remaining 20 percent. Supplies like masks and tubing are covered separately under the same 80/20 split, though the rules for how often you can get replacements are strict.
The catch is that Medicare will not pay without proof of diagnosis. Your doctor must order the CPAP based on results from a sleep study — either an in-lab study or a home sleep test that your doctor ordered and supervised. A CPAP you bought on your own before diagnosis, or one prescribed without a documented sleep study, will not be covered retroactively.
Key Takeaways
- Medicare Part B covers 80 percent of the cost of a CPAP machine and supplies after you meet your deductible, but only if a sleep study has documented sleep apnea.
- Your doctor must write an order for the CPAP based on sleep study results; Medicare will not cover a machine you purchased without a medical order.
- You can get a new mask every month and new tubing every three months, but getting replacements more often requires documentation that the old equipment is damaged or lost.
- You must use a Medicare-approved DME supplier to have your costs covered; ordering directly from online retailers or non-approved vendors means you pay the full price yourself.
- If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower, but coverage rules vary by plan.
How to get Medicare to cover your CPAP
Start by scheduling a sleep study with your primary care doctor or a sleep specialist. The study can happen in a sleep lab or at home, depending on what your doctor orders. Medicare covers the sleep study itself under Part B, so you will pay 20 percent after your deductible. The study must show that you have obstructive sleep apnea — mild, moderate, or severe — for CPAP to be covered.
Once the study is complete and your doctor decides CPAP is the right treatment, your doctor will write an order. This order is the document Medicare needs to see. Take the order to a Medicare-approved DME supplier — not a general medical supply store, and not an online retailer. The supplier will submit the order to Medicare on your behalf and handle the paperwork. Medicare will then send you an approval letter that tells you how much you will pay.
The supplier will deliver the machine and initial supplies to your home. You will receive an invoice showing the Medicare-approved amount, what Medicare paid, and what you owe. Keep this invoice for your records.
What supplies are covered and how often you can get them
Medicare covers the CPAP machine itself, the mask (nasal, full-face, or nasal pillows), tubing, filters, and a humidifier if your doctor orders one. The machine is covered as a single purchase. Supplies are covered on a replacement schedule:
| Supply | Replacement Frequency |
|---|---|
| Mask | Once per month |
| Tubing | Once every three months |
| Filters | Once per month (disposable) or once every three months (reusable) |
| Humidifier chamber | Once every month |
If you need a replacement before the scheduled date — because the mask broke, tubing tore, or you lost a filter — you will need to contact your DME supplier and explain what happened. Some suppliers will replace it when ready; others will ask you to document the damage with photos or a written statement. Medicare will not pay for a second mask in the same month unless you can show the first one was damaged or lost.
If you switch mask types (from nasal to full-face, for example), your doctor must write a new order explaining why the change is medically necessary. Medicare will then cover the new mask type on the same monthly schedule.
Your out-of-pocket costs under Original Medicare
Under Original Medicare (Part A and Part B), you pay 20 percent of the Medicare-approved amount for the CPAP machine and all supplies, after you meet your Part B deductible. The deductible for 2024 is $240, though this amount changes each year. Once you meet the deductible, you pay 20 percent of whatever the approved amount is.
The approved amount varies by region and by supplier, but a typical CPAP machine costs between $800 and $3,000 before insurance. At 20 percent, your share might be $160 to $600 for the machine alone. Monthly masks usually cost $30 to $100 out of pocket; tubing and filters cost less.
If you have already met your Part B deductible earlier in the year (for example, through doctor visits or other medical equipment), you will start paying 20 percent right away for your CPAP.
Medicare Advantage and Medigap coverage differences
If you have a Medicare Advantage plan (Part C), CPAP coverage works differently. Most Advantage plans cover CPAP, but the copay, coinsurance, or deductible may be higher or lower than Original Medicare's 20 percent. Some plans cover the full cost after a copay; others charge 20 percent like Original Medicare. You will need to call your plan's customer service number (on your insurance card) to find out your exact out-of-pocket cost before you order.
If you have a Medigap policy, it may cover some or all of the 20 percent you would pay under Original Medicare, depending on which Medigap plan you have. Plans C, D, G, and M cover the Part B coinsurance, which means Medigap would pay your 20 percent share. Plans F and G also cover the Part B deductible. Call your Medigap insurer to confirm what they cover for DME.
Common mistakes that delay or deny coverage
The most common mistake is ordering a CPAP without a sleep study or without a doctor's order. If you buy a machine on your own and then ask Medicare to reimburse you, the answer will be no. Medicare only pays for equipment ordered by a doctor based on documented medical need.
Another mistake is using a non-approved DME supplier. If you order from an online retailer or a store that is not enrolled with Medicare, Medicare will not pay anything, even if you have a valid doctor's order. Always ask the supplier whether they are Medicare-approved before you place an order.
A third mistake is not keeping your sleep study results and doctor's order. If Medicare asks for proof of your diagnosis, you need to be able to provide it. Keep copies of your sleep study report and the CPAP order from your doctor in a safe place.
Finally, some people try to get replacement masks or tubing more often than Medicare allows and are surprised when the claim is denied. If you genuinely need a replacement early, contact your supplier and ask what documentation they need. Do not assume Medicare will pay without asking first.
What to do if Medicare denies your CPAP claim
If your claim is denied, the denial letter will explain the reason. Common reasons include: no sleep study on file, the sleep study did not show sleep apnea, the doctor's order is missing or incomplete, or the supplier is not Medicare-approved.
If the reason is a missing sleep study or incomplete order, ask your doctor's office to submit the missing document to Medicare. Your doctor can resubmit the order or provide a copy of the sleep study results. This usually takes one to two weeks.
If the reason is that the supplier is not approved, you will need to order from a different supplier. Ask your doctor for a referral to a Medicare-approved DME company in your area, or search the Medicare supplier directory at dmepos.cms.gov.
If you disagree with the denial, you have the right to file an appeal. The denial letter will include instructions on how to appeal and a important date (usually 120 days from the date of the letter). You can appeal on your own or ask your doctor to help.
Frequently Asked Questions
Do I need a sleep study if my doctor thinks I have sleep apnea?
Yes. Medicare requires a sleep study — either in a lab or at home — that documents sleep apnea before CPAP is covered. A doctor's clinical judgment alone is not enough. The study must show how many times per hour you stop breathing and how low your oxygen drops.
Can I get a CPAP machine without Medicare paying for it and then ask for reimbursement later?
No. Medicare will not reimburse you for a machine you bought on your own. You must have a valid doctor's order and use a Medicare-approved supplier from the start. If you buy first and ask later, you pay the full cost yourself.
What happens if I lose or damage my mask before the month is up?
Contact your DME supplier and explain what happened. Many suppliers will replace it right away, but some ask for proof (photos or a written statement). Medicare will pay for one replacement per month, so if you lose a mask on day 5 and need another on day 25, you may have to pay out of pocket for the second one unless you can document that both were damaged.
If I switch to a Medicare Advantage plan, will my CPAP still be covered?
Most Medicare Advantage plans cover CPAP, but the cost to you may change. Call your new plan before you switch to confirm they cover CPAP and what your copay or coinsurance will be. Your existing machine and supplies will still work; you just may have different out-of-pocket costs going forward.
Can I get a different mask type if the one I have does not fit well?
Yes, but your doctor must write a new order explaining that the current mask is not working and a different type is medically necessary. Once Medicare approves the new type, you can get it on the same monthly replacement schedule. Do not switch mask types on your own without a doctor's order, or Medicare may not cover the new mask.