Does Medicare Cover CPAP? The Rules, the Rental, and What You Pay
Medicare covers a 12-week CPAP trial, then rents the machine for 13 months before you own it. Here is what qualifies you and what it costs.
CPAP is covered under Medicare Part B as durable medical equipment. The structure catches people out, though, because it isn’t a purchase — it’s a trial, then a rental, then eventually ownership.
The 12-week trial
Medicare “may cover a 12-week trial of CPAP therapy (including devices and accessories)” if your doctor documents “in your medical record that you meet certain conditions and the therapy is helping you”1 .
Two conditions there, and both matter. Meeting the diagnostic criteria gets you started. Documented benefit is what keeps it going.
What qualifies you
The clinical thresholds come from Medicare’s coverage determination. You qualify if your sleep study shows either:
- AHI or RDI of 15 or more events per hour, with a minimum of 30 recorded events; or
- AHI or RDI of 5 to 14 events per hour, with a minimum of 10 events, plus a documented related condition — excessive daytime sleepiness, cognitive impairment, mood disorder, insomnia, hypertension, ischemic heart disease, or a history of stroke2 .
That second pathway is the one people don’t know about. Mild apnea on paper plus documented hypertension is a covered situation. Whether it gets documented is up to your clinician, which is a good reason to describe your daytime symptoms specifically rather than saying you’re “a bit tired.”
More on what these numbers mean in what is a good AHI.
The rental structure
This is the part that surprises everyone.
“Medicare pays the supplier to rent a CPAP machine for 13 months, as long as you’re using it continuously. After Medicare makes rental payments for 13 continuous months, you’ll own the machine.”1
So for the first 13 months the machine isn’t yours. It belongs to the DME supplier, Medicare pays them monthly, and if you stop using it, the rental — and the payments — can stop. After 13 continuous months of rental payments, ownership transfers to you.
Supplies like masks, cushions, tubing, and filters are covered separately and on an ongoing basis.
What you pay
“you pay 20% of the Medicare-approved amount (if your supplier accepts assignment) for the machine rental and related supplies (like masks and tubing)”1
The Part B deductible applies. Two practical notes:
“Accepts assignment” matters. A supplier who accepts assignment agrees to the Medicare-approved amount as full payment. One who doesn’t can charge you more. Ask before you choose a supplier — it’s a question people don’t think to ask and it directly changes what you pay.
Medigap and Medicare Advantage change the picture. Supplemental coverage may pick up the 20%. Advantage plans must cover at least what Original Medicare does but run their own networks and prior authorisation rules, so check with the plan directly.
Staying covered
Coverage continues only if you meet the adherence standard and attend the follow-up. Medicare defines adherence as “use of PAP ≥4 hours per night on 70% of nights during a consecutive thirty (30) day period anytime during the first three (3) months of initial usage”2 .
And separately: “no sooner than the 31st day but no later than the 91st day after initiating therapy, the treating practitioner must conduct a clinical re-evaluation and document that the beneficiary is benefiting from PAP therapy”2 . Medicare’s patient guidance emphasises this has to be in person1 .
Full detail in CPAP compliance rules.
Replacement supplies
Medicare covers replacement masks, cushions, tubing, filters, and chambers on a defined schedule, and most people claim fewer than they’re entitled to — usually because nobody explained the schedule. A worn cushion is a leaking cushion, and leaks are the main reason people quit therapy, so this isn’t a trivial saving.
If you’re denied
Denials happen, often for documentation reasons rather than clinical ones — a missing note, a study scored under criteria the payer doesn’t accept, a re-evaluation outside the window. You have appeal rights, and the first step is usually getting the specific reason in writing.
Your sleep clinic and DME supplier deal with this constantly and are the fastest route to fixing a paperwork denial. Ask them what’s missing before you assume the answer is no.
Common questions
How much does a CPAP machine cost with Medicare?
Do you ever own the CPAP machine under Medicare?
Does Medicare cover CPAP masks and supplies?
What AHI does Medicare require for CPAP?
Does Medicare Advantage cover CPAP?
References
Every clinical claim above links to one of these. Where the evidence is mixed or thin, we say so in the text rather than picking the source that sounds most confident.