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Many people swear by their CPAP machines. And if you suffer from obstructive sleep apnea (OSA) your doctor may recommend one for you.
CPAP, short for continuous positive airway pressure, therapy is one of the leading treatments, along with oral devices, for OSA. But the machines can be a bit pricey.
So a common question many people have is, “Does Medicare cover CPAP?” In this article, we answer that question in clear, plain English. You will also find the average costs of CPAP machines and equipment.
Do Medicare Cover CPAP?
The short answer is yes; Medicare will cover the cost of CPAP treatment. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your CPAP treatment. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for the costs of CPAP treatment.
Medicare Part B covers a CPAP machine’s cost as it is considered Durable Medical Equipment (DME). However, for Medicare to cover CPAP machines, you have to be diagnosed with OSA. Also, your healthcare provider and supplier of DME must be enrolled in Medicare for Medicare to cover a CPAP machine’s cost.
You can find a Medicare-approved supplier and a healthcare provider using the medicare.gov website.
Once approved by Medicare, Part B will cover either:
- Rental of a CPAP machine for a 3-month trial if you are newly diagnosed
- Rental of a CPAP machine for 13 months if you consistently use it; after 13 months, you will then own the device
Suppose you own the CPAP machine after 13 months of using it. In that case, it needs to last several years before Medicare covers another one. Once approved, Medicare Part B will cover 80% of the costs.
Medicare will also provide coverage for certain CPAP supplies, but the amount will be limited per year. Some of these supplies are:
- Humidifier water chamber – 2 per year
- Chinstraps per year – 2 per year
- Non-disposable filters – 2 per year
- Headgear – 2 per year
- CPAP tubing with heating element – 4 per year
- Oral/nasal CPAP mask – 4 per year
- Full CPAP face mask – 4 per year
- Nasal interface – 4 per year
- Tubing – 4 per year
- Full-face mask interface – 4 per year
- Cushions for nasal mask interface – 24 per year
- Disposable filters – 24 per year
- Oral replacement cushion for oral/nasal mask – 24 per year
- Replacement nasal pillows for oral/nasal mask, 24 pairs per year
Aside from that, Medicare Part B also provides coverage for the costs of a sleep study. Suppose the CPAP machine has improved your condition within the 3-month trial, and your doctor orders a continued therapy. In that case, Medicare will not stop covering your CPAP therapy.
Medicare Advantage plans (Medicare Part C) also provides coverage for CPAP treatment as they cover everything Original Medicare covers. However, out-of-pocket costs will vary depending on the plan provided by the plan providers.
How Much Does CPAP Cost?
CPAP machines may cost between $500 and $3,000. The costs for common CPAP accessories vary quite a bit. CPAP masks cost between $35 to $150. Humidifiers cost from $150 to $200. Hoses and tubes may cost between $10 to $40, and other additional supplies range from $10 to $40.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover Hospital Beds?