Sleep apnea machines and Original Medicare

An estimated 22 million Americans suffer from sleep apnea.1 Let’s explore the basic details about this condition and learn more about how Original Medicare helps pay for treatment.

What is sleep apnea?

Sleep apnea, opens new window is a sleep disorder that causes long pauses in breathing during sleep. There are several types of sleep apnea, including obstructive sleep apnea (OSA), central sleep apnea (CSA) and mixed sleep apnea. Anyone can develop sleep apnea, but it’s more common in older adults and affects men more than women.2

What is a CPAP machine?

If you have OSA, continuous positive airway pressure (CPAP) machines, opens new window are one of the most common treatments. A CPAP machine is a device with a face or nose mask attached to a small pump. The pump pushes pressurized air through a hose, into the mask and into your airway. The steady flow of air keeps the airway open to improve breathing and sleep quality. Some people may require extra CPAP supplies like humidifiers and heating tubes for effective treatment.3

Does Medicare cover sleep apnea machines?

Yes. Original Medicare Part B (medical insurance), which pays for durable medical equipment (DME), helps cover some of the costs of sleep apnea machines if:4

  • Your doctor diagnoses you with OSA after a sleep study, opens new window
  • Your doctor and device provider participate in the Medicare program
  • You’re up-to-date in paying your Part B premiums
  • You’ve met your annual Part B deductible

Once you’ve met your annual Part B deductible, Original Medicare helps pay up to 80% of the Original Medicare-approved amount for covered equipment.5

Does Original Medicare cover CPAP supplies?

Yes. Original Medicare helps pay 80% of the cost of the following equipment after you’ve met your Part B deductible:6

  • CPAP machine rental for a 3-month trial if you’re newly diagnosed
  • CPAP rental for 13 months if you’ve been using it consistently (after 13 months, you’ll own the CPAP machine)
  • Masks or nose pieces you wear when using the machine
  • Tubing to connect the mask or nose piece to the machine

Original Medicare has certain rules for replacing CPAP machine supplies. Contact your doctor or device supplier for more information.

Note: Part B also helps pay up to 80% of the costs of your sleep study if you have clinical signs and symptoms of sleep apnea. Costs covered include Type I, II, III, and IV sleep studies and devices.7

Learn more about Medicare

For more helpful information on Medicare, check out these 10 frequently asked questions about Medicare plans .

Sources

  1. “Sleep Apnea Information for Clinicians,” American Sleep Apnea Association, last accessed March 31, 2021, https://www.sleepapnea.org/learn/sleep-apnea-information-clinicians, opens new window.
  2. “Sleep Apnea,” SleepFoundation.org, last accessed March 31, 2021, https://www.sleepfoundation.org/sleep-apnea, opens new window.
  3. “What’s a CPAP Machine, and How Does It Work,” Healthline, last accessed April 14, 2021, https://www.healthline.com/health/what-is-a-cpap-machine, opens new window.
  4. “Does Medicare Cover CPAP Machines?” Healthline, last accessed March 31, 2021, https://www.healthline.com/health/medicare/does-medicare-cover-cpap-machines, opens new window.
  5. “Does Medicare Cover CPAP Machines?”
  6. “Does Medicare Cover CPAP Machines?”
  7. “Sleep studies,” Medicare.gov, last accessed March 31, 2021, https://www.medicare.gov/coverage/sleep-studies, opens new window.

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