Does Medicare Cover CPAP Masks?

CPAP therapy is a well-known treatment for a sleep disorder.

When buying a CPAP machine, the machine’s cost is not the only thing that you need to consider. There’s also the cost of the supplies that come with it. And one of those supplies is the CPAP mask.

For those with Medicare that use CPAP, a common question is, “Does Medicare cover CPAP masks?” In this article, we answer that question in clear, plain English. You will also find the average costs of CPAP masks, as well as other helpful info.

The short answer is yes; Medicare will cover the cost of CPAP masks. 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 masks. Below we look at what these are so you know what to expect.

In order to get coverage, your health care providers must consider CPAP to be medically necessary. In the case of CPAP, that usually means you’ve been diagnosed with obstructive sleep apnea.

Medicare usually covers this therapy for a 3 month trial period. Though that can be extended if your doctor says the therapy is working and you need it longer.

CPAP machines and the supplies that come with them are considered Durable Medical Equipment. Or DME for short.

One of the supplies that a CPAP machine needs to function is a mask. Medicare Part B provides coverage for DME, which includes the machine and supplies, including a mask.

You will need to get your CPAP mask from a Medicare enrolled supplier, however. If you do not, Medicare may not cover the costs and you could end up paying higher prices.

Medicare Advantage plans (Medicare Part C) also provide coverage for CPAP masks. They cover everything Original Medicare (Medicare Part A and Part B) covers and some additional benefits.

Coverage and costs differ between Medicare Advantage plans. Contact your plan provider to find out about their specific coverage for CPAP masks.

How Much Does CPAP Masks Cost?

CPAP masks usually cost between $35 and $150. It’s recommended that CPAP masks be replaced every three to six months. There are several types of CPAP masks available. And your cost will depend on the type of the mask you get.

What Is A CPAP Machine?

A CPAP machine is medical equipment known for treating a sleep order called OSA. Through air pressure, the machine keeps the patient’s airway open while he/she is sleeping. The air that blows through the hose is attached to the mask.

The air pressure can be adjusted for the patient’s ideal air pressure. Before undergoing CPAP therapy, some patients go through a sleep study to determine their ideal air pressure.

What Is A CPAP Mask?

A CPAP mask is one of the essential parts of the overall CPAP therapy. With it, the air pressure that goes through the hose is delivered to your nose and mouth. This keeps your airways open, thus treating symptoms of OSA.

However, CPAP therapy’s overall functionality and effect on you may depend on the mask you use. Luckily, CPAP masks are designed to be comfortable and sealed so do not leave any marks and irritation on the skin.

Three Types Of CPAP Masks

Full Face Masks cover both your mouth and nose
Nasal Masks only fit over your nose and are lighter than full face masks
Nasal Pillow Masks are even smaller than Nasal Masks and, in turn, offer more visibility.

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.