Medicare pays most costs of CPAP, a common therapy for people with obstructive sleep apnea, or OSA. To get coverage, you’ll need a physician to prescribe a CPAP machine based on tests — including a sleep study — showing that you have OSA.
OSA, which afflicts 25 million adults in the United States, is a serious condition that, in addition to disturbing your sleep, increases the risk of cardiovascular disease, diabetes and depression. A CPAP machine provides continuous positive airway pressure via a mask to keep your upper airway clear for easier breathing, better sleep and improved overall health.
What’s required to get coverage for CPAP
Medicare Part B covers CPAP therapy in two stages. There’s a three-month trial period prescribed by your doctor to determine if CPAP works for you. If the trial is successful, there’s a rental period of up to 13 months, after which you own the machine. To obtain coverage, you must rent the machine from a Medicare-approved supplier of durable medical equipment.
But even before you begin the trial, you must have a sleep test to determine that you meet the clinical criteria for obstructive sleep apnea. The good news is that if home sleep test equipment is available through a local physician’s office or sleep clinic, you need not spend the night in a sleep lab.
CPAP therapy comes with continuing expenses
CPAP therapy requires periodic purchase of replacement supplies, including masks, filters, headgear, the water reservoir in the humidifier and the tubing that connects the CPAP machine with your face mask. Medicare covers these supplies on varying schedules; a competent supplier will help you optimize the timing of these purchases.
What you pay for CPAP
Because CPAP is covered as durable medical equipment, the Medicare Part B deductible applies; it’s $203 in 2021. Then you pay 20% of the Medicare-approved amount for the CPAP machine rental and ongoing supply purchases.
Be sure that both your doctor and your CPAP supplier are enrolled in Medicare; if not, your supplier might charge you more.
Medicare Advantage may provide greater coverage for CPAP. Contact your local Medicare Advantage providers to find out what the savings might be.