Does Medicare Cover CPAP Machines? (2025)

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CPAP machine therapy is a common treatment for OSA, a condition in which a person’s breathing pauses and restarts continuously during sleep due to narrowed or blocked airways.

“CPAP machines are one of the first-line therapies for people with obstructive sleep apnea because there’s clear evidence to show they’re effective,” says Harley Greenberg, M.D., a sleep medicine expert at Northwell Health in Long Island, New York.

By pumping pressured air into the upper airway, CPAP machines prevent airway collapse that blocks breathing and causes breathing pauses for those with OSA.

Typically, a CPAP machine consists of:

• A motor that pressurizes the air
• A mask that fits over the nose or nose and mouth (although some CPAP machines use nasal prongs that fit inside the nose or a tube that goes through the nose and stops at the top of the throat)
• Straps to position the mask
• A tube that connects the mask to the CPAP machine motor, which blows air into the tube

Some machines also include a heated humidifier, which may make the CPAP machine more comfortable for those with dry nasal passages or skin.

Who Needs a CPAP Machine?

“Somebody who has significant sleep apnea symptoms, such as daytime sleepiness, heavy snoring and gasping for air, may benefit from a CPAP machine,” explains Dr. Greenberg. Usually, he recommends a CPAP device when a person can use it every night because CPAP therapy is as effective as their user’s adherence to them.

To increase effectiveness, an individual should be fitted for the device properly, the treatment should be overseen by a sleep medicine expert and the person must use it every day, says Dr. Greenberg. If all three of these factors can’t be met, other treatments should also be explored.

Dr. Greenberg points out that oral therapy, upper airway surgery and newer neurostimulation therapies may also be effective for those with obstructive sleep apnea.

The price of a CPAP machine typically ranges from $500 to $1,000, depending on the model and features. CPAP machines with more advanced features are generally more expensive than basic models. According to one online retailer, the average cost of a fixed pressure CPAP or auto-adjusting CPAP is $850. Another states the average cost is around $800.

However, these averages don’t include accessories, such as a CPAP mask. A mask costs around $40 to $200 and is necessary to use the device.

When choosing a CPAP mask, consumers can select a nasal or full-face mask. A provider should help an individual make the decision between the two. Often, a nasal mask leads to better adherence and more effective treatment, but a full-face mask can be effective for those who breathe through their mouth.

Those with health insurance often pay less for CPAP masks and machines. Cost, however, depends on an individual’s insurance plan’s medical equipment benefits and coverage. Some plans reimburse almost the entire cost of a CPAP machine and accessories while others cover only a small percentage.

The CPAP machine supplier can affect costs, too, says David Luna, a licensed Medicare agent and co-founder of Connie Health. “Before buying [a CPAP machine], ensure your durable medical equipment (DME) supplier accepts your insurance to avoid the CPAP machine and supplies being charged to you without coverage,” he advises.

CPAP machine suppliers often don’t accept insurance upfront. Instead, the consumer purchases the machine and is reimbursed by their insurance company. Check with your insurance provider and supplier to see what your plan covers and how coverage works.

CPAP machines are covered as durable medical equipment under Medicare. However, the Medicare beneficiary must first meet Medicare’s CPAP machine coverage requirements.

“Most Medicare plans are known to cover CPAP machines when a person has obstructive sleep apnea,” says Luna. If a person receives an OSA diagnosis, Medicare may cover an initial trial period of three months, including the CPAP device and any accessories. Should a health care provider recommend a humidifier, Medicare covers that cost as well.

After the three-month trial, the individual must meet with a doctor in person to assess adherence and effectiveness of therapy. If the doctor confirms that they met the minimum usage threshold and the treatment is effective, Medicare continues covering treatment as long as the doctors and suppliers accept Medicare.

Medicare’s minimum usage threshold for CPAP machines is at least four hours a night for 70% of nights, explains Dr. Greenberg. For the device to be effective, a person should exceed this minimum, he adds.

What Medicare Covers for CPAP Therapy

Before Medicare covers CPAP costs, the beneficiary must meet their annual Part B deductible, after which point Medicare pays 80% of a Medicare-approved amount for the machine rental and purchase of related supplies, such as masks and tubing. The Medicare beneficiary then pays the remaining 20%.

As part of this 80% coverage, Medicare makes rental payments on the CPAP machine for 13 months, providing documentation of effectiveness from a physician. After 13 months of rental payments, the beneficiary owns the device.

Luna recommends those enrolled in Medicare ensure their supplier accepts Medicare before they purchase a CPAP machine. For Medicare to cover the cost, both the prescription and the CPAP machine must come from a health care provider and medical supplier that accepts Medicare.

Once covered, a person should continue to meet with a doctor about their treatment. “Long-term adherence is key both for better outcomes and Medicare coverage,” concludes Dr. Greenberg. “Being able to use it for the entire night every night is needed for optimal outcomes.”

Footnotes

• Posadas T, Oscullo G, Zaldívar E, et al. Treatment with CPAP in Elderly Patients with Obstructive Sleep Apnoea. Journal of Clinical Medicine. 2020;9(2).

References

• Sleep apnea treatment. National Heart, Lung and Blood Institute. Accessed 11/1/2023.
• Akbarian S, Ghahjaverestan N, Yadollahi A, Taati B. Distinguishing Obstructive Versus Central Apneas in Infrared Video of Sleep Using Deep Learning: Validation Study. Journal of Internet Medical Research. 2020;22(5).
• Positive airway pressure treatment. MedlinePlus. Accessed 10/24/2023.
• Obstructive sleep apnea – adults. MedlinePlus. Accessed 11/1/2023.
• CPAP. National Heart, Lung and Blood Institute. Accessed 11/1/2023.
• CPAP Machines. The CPAP Shop. Accessed 11/1/2023.
• CPAP Machines. Sleep Doctor. Accessed 111/1/2023.
• CPAP Coverage. Centers for Medicare and Medicaid Services. Accessed 11/1/2023.
• Humidifier Coverage. Centers for Medicare and Medicaid Services. Accessed 11/1/2023.