At a Glance
Medicare will cover most CPAP supplies as long as you have a documented need for CPAP therapy and get your medical care and supplies from providers enrolled in Medicare.
Many people with obstructive sleep apnea (OSA) use a CPAP device every night for years or decades. With use, parts such as the CPAP mask, filters, and tubing can get dirty or worn out, and replacing them is essential to using the CPAP machine safely and effectively.
Understanding the ins and outs of Medicare coverage can be complicated. We’ll try to make it clearer by explaining how long Medicare pays for CPAP supplies, how often they cover replacement parts, and what steps you need to maintain Medicare coverage when using a CPAP machine.
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Does Medicare Cover CPAP Supplies?
Medicare covers CPAP supplies and accessories under certain conditions, including:
- You have a medical need: You need a written prescription for CPAP therapy that's been signed by your doctor within the last year, and your doctor has to verify that you regularly use the device and benefit from using it. To determine this, your doctor will review data from your CPAP device. Medicare requires that you use your device at least 4 hours per night on 70% of nights. This is known as compliance and is especially important in the first 90 days of use.
- The supplies are deemed necessary: Medicare only covers CPAP accessories and supplies that are needed to properly use your device as prescribed by your doctor. Optional add-ons or nice-to-haves like travel CPAPs, CPAP pillows, and cleaning supplies aren’t covered.
- Your doctor and supplier are enrolled in Medicare: Coverage requires working with providers who are enrolled in Medicare and accept assignment of medical claims under Medicare.
- Get documentation before supplies are ordered: If a durable medical equipment (DME) supplier processes an order for you before your medical documentation is in place, you won’t get coverage from Medicare.
- You’ve met your Medicare deductible: Once you’ve met your yearly deductible, Medicare will pay 80% of the cost of CPAP supplies on an ongoing basis, as long as you continue to need and benefit from CPAP therapy. Supplemental insurance may cover the difference.
For CPAP supplies, the same rules for Original Medicare (including Medicare part B) apply to Medicare Advantage plans. However, the suppliers and pricing may be different if you have Medicare Advantage.
How Long Will Medicare Pay for CPAP Supplies?
Medicare will pay for CPAP supplies for as long as you meet the requirements for coverage. Your doctor must occasionally renew your order for CPAP therapy and its related supplies. Generally, this must be updated each year with a face-to-face visit with your doctor. You also have to keep following all of the other criteria, such as having providers who are enrolled in Medicare and submitting documentation before your supplies are shipped.
As long as you meet all the conditions, Medicare will provide indefinite, ongoing coverage for replacement CPAP supplies. However, Medicare has a strict policy that specifies how often you can receive different types of CPAP supplies. Private insurance usually follows the same rules.
Medicare CPAP Supplies Replacement Schedule
Medicare’s replacement schedule for CPAP supplies places a limit on how frequently Medicare will pay for different CPAP accessories. If you need any supplies more frequently, you’ll have to pay for them out of pocket and will not be able to purchase them from your usual DME supplier.
Each individual type of CPAP accessory is covered separately by Medicare based on what Medicare has deemed to be “reasonable and necessary.” The following table shows how often Medicare will replace different kinds of CPAP supplies if you meet all the criteria for ongoing coverage.
In addition to CPAP supplies, Medicare will cover a replacement CPAP machine once every 5 years.
| CPAP Part or Accessory | Medicare Will Replace Every |
|---|---|
| Nasal cushions or pillows | 2 weeks (2 per month) |
| Full-face mask cushion | Month |
| Disposable CPAP machine filters | 2 weeks (2 per month) |
| Reusable CPAP machine filters | 6 months |
| CPAP mask frame | 3 months |
| Hoses and tubing | 3 months |
| Headgear | 6 months |
| Chin strap | 6 months |
| Humidifier water chamber | 6 months |
How to Get Medicare to Cover Your CPAP Supplies
Medicare won’t automatically provide coverage for your CPAP supplies. You have to follow certain steps to make sure that Medicare pays for your CPAP machine and ongoing replacement CPAP supplies.
Verify Your Medical Need
First, you need to ensure that your doctor is enrolled in Medicare. Then, your doctor will need to confirm a sleep apnea diagnosis through testing and that you benefit from regular use of a CPAP machine.
Even if you’ve already been using a CPAP machine, if you’re just getting started with Medicare, your Medicare-enrolled doctor will need to document that you had a prior test or sleep study showing that you have OSA that meets Medicare criteria for CPAP device coverage. Medicare may follow different scoring rules with the interpretation of the test results and the doctor will ensure the proper interpretation is in place.
You’ll also need to have an appointment with your doctor so that they can confirm that you still have a medical need for a CPAP device and are still using it regularly.
Find a CPAP Equipment Supplier
If you want Medicare to pay for replacement masks, filters, and other CPAP supplies, it’s critical that you only order from a supplier that is enrolled in Medicare. You should ask the supplier directly about whether they are enrolled in Medicare and accept assignment of your Medicare claims. If not, your supplies may not be covered, or you may have to pay more out of pocket.
Initial Trial Period
If you haven’t had a CPAP device before, Medicare will cover a three-month trial of CPAP therapy, after which your doctor will assess whether it is helping to treat your sleep apnea. If the trial is successful with the usage as defined above, Medicare will pay for another 10 months as a CPAP machine rental. Once Medicare has paid for a total of 13 months, the rental period is over, and the device becomes yours. Medicare will provide continuing coverage for necessary CPAP supplies.
Order Replacement CPAP Supplies
For ongoing replacement of CPAP supplies, you’ll need a valid order from your doctor about the need for CPAP therapy, which your DME supplier can keep on file. If needed, your doctor can access usage data from your device to give Medicare the verification it needs to keep covering your CPAP supplies.
You need to have your documentation in place before any order of CPAP supplies is processed or shipped to you. For this reason, you should never set up CPAP supply orders that auto-ship or auto-renew. If this lapses, you may fall out of coverage. To be covered, Medicare also requires that you first give confirmation that you need the supplies. To help you maintain coverage, many medical supply companies will proactively ask for your authorization before processing any CPAP supply orders.
Track Your Replacement Schedule
Medicare has a strict schedule for how often it will replace different CPAP supplies and accessories. If you order a replacement too early, it won’t be covered, and you’ll have to pay for the entire cost yourself. Set up a resupply calendar and keep careful records about when you’ve placed orders for each type of CPAP accessory.
Keep Using Your CPAP Machine
If you want Medicare to keep paying for CPAP supplies, you have to keep using your device. Your doctor may want to look at the data from your CPAP machine, which shows how much you have used it. To maintain Medicare coverage, you may need to use the device for a minimum of four hours per night on at least 70% of nights per month.
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Written by
Eric Suni, Contributing WriterEric Suni has over a decade of experience as a science writer and was previously an information specialist for the National Cancer Institute.
Reviewed by
Brandon R. Peters, MD, FAASM, Medical ReviewerBrandon R. Peters, MD, FAASM, is a double board-certified neurologist and sleep medicine specialist and fellow of the American Academy of Sleep Medicine who currently practices at Virginia Mason Franciscan Health in Seattle. He is a leading voice in sleep medicine who works at the cutting edge of medicine and technology to advance the field.
