Does Medicare Cover CPAP Machines? Medicare CPAP Guidelines and How to Qualify

Medicare coverage can be confusing, even when you ’ re not fighting excessive day sleepiness. Will it cover CPAP equipment ? Will my deductible lend oneself ? Do I need another sleep test ?
That ’ second why we ’ ve made this childlike guide to Medicare coverage for CPAP therapy. Below we ’ ll explore how to get Medicare to cover your CPAP machine ( deoxyadenosine monophosphate well as a regular agenda of refilling CPAP supplies ) and what you ’ ll need to do to qualify ! Let ‘s start with some good news : Yes, Medicare will cover your CPAP car ! not only that, they ’ ll cover a regular agenda of replacement supplies– like masks, filters, headgear, etc. !
Your CPAP device ( or ‘ continuous Positive Airway Pressure ’ machine ) is considered “ durable aesculapian equipment ( DME ) ”, which means that it is covered under Medicare Part B. This is authoritative for reasons we ’ ll pay back into late !

Medicare will besides cover unlike types of PAP machines, such as BiPAP or APAP, and even alternate treatment options like oral appliances and mouthguards .
however, this coverage does require that you meet certain requirements and adopt certain guidelines .What Does Part A or Part B Mean?
“ original Medicare ” or “ traditional Medicare ” is made up of two parts : Parts A and B.
Medicare Part A covers hospital expenses, including nurse facilities, hospice, and home healthcare services.
Medicare Part B is more like individual health insurance and covers outpatient aesculapian concern, routine hindrance caution, a well as durable medical equipment .

How Do I Qualify For CPAP Coverage? Medicare CPAP Guidelines

To have Medicare cover your CPAP equipment you ’ ll have to meet the surveil guidelines :

  • Be enrolled in Medicare. To enroll, you must be 65 or older and a U.S citizen (or permanent resident for five consecutive years). You can learn more about enrollment at
  • Be diagnosed with Obstructive Sleep Apnea (OSA). This will require a sleep study, which can be performed in-lab or at-home.
  • Get a prescription for a CPAP machine. Your prescription must come from a doctor that participates in the Medicare program.
  • Order a new CPAP machine from a Medicare-approved DME supplier. We make this part easy! is an approved durable medical equipment supplier!
  • Complete a 90-day Compliance Period. Think of this like a 3-month trial of CPAP therapy. This shows that you’re using your CPAP machine and that your CPAP therapy is effective.

What Is Medicare CPAP Compliance?

once you receive your CPAP or BiPAP equipment, you ’ ll begin a “ submission period. ” Think of it like a three-month test period. This is to demonstrate both that you ’ re using your equipment and that it ’ s an effective treatment option for your OSA .
During the submission period your doctor will monitor how much you use your CPAP. This is recorded by your CPAP device, either through an SD memory card or via Bluetooth connectivity .
To meet submission, Medicare requires that you use your CPAP machine 1 ) at least 4 hours per night, 2 ) for at least 70 % of nights, 3 ) for 30 back-to-back days of the first three months .
That can be a fiddling confuse, but what you need to know is : Use your CPAP machine for 30 days in a row, and at least 21 of those days need to be 4 hours or more per night .
last, you ’ ll need to meet with your doctor between the 31st and 90th sidereal day of the submission period !

How Much Does a CPAP Machine Cost with Medicare?

Since your CPAP equipment is covered under Medicare Part B, you ’ ll first base need to meet your Part B deductible .
once your deductible is met, and your complaisance period is successful, Medicare will require a 13-month machine rental. During this rental period Medicare will pay for 80 % of the cost of your CPAP machine and supplies. After 13 months, you ’ ll own your CPAP machine wholly .
Your price during the rental period will be your normal 20 % coinsurance. This means the accurate cost depends on :

  • How much of your deductible you’ve met
  • The price of the CPAP device
  • Any other secondary insurance plans or Medicare supplement plan you may have

Your personal sleep specialist from can help you figure out what you can expect to pay for a CPAP machine. They ’ ll connect with your doctor of the church and your indemnity providers on your behalf. They ’ ll help oneself you choose the CPAP machine that ’ s correct for you, then help you understand how your deductible and coinsurance will probably affect the price !What Does Deductible Mean?
Deductible – How much you ’ ll give for covered healthcare before Medicare or your insurance company will begin to pay.
Coinsurance – A helping of the monetary value of covered healthcare you pay after your deductible is met. Your aesculapian policy will cover the lie.
Out-of-Pocket Maximum – The most you ’ ll pay up for covered healthcare in a given plan class .

How Often Can I Get a New CPAP Machine on Medicare?

Medicare will normally cover a new CPAP machine every 5 years ! This is besides how long most manufacturers estimate that a CPAP machine will stopping point, indeed even if your machine seems to be working, it ’ s a good idea to replace it before it breaks toss off.

Are CPAP Cleaners Covered by Medicare?

unfortunately, CPAP cleaners and sanitizers aren ’ thymine covered by Medicare ; however, they are eligible to purchase with your HSA/FSA funds ! offers a wide survival of CPAP cleaners at the lowest prices, so an low-cost sanitizer may silent be in your budget.

Medicare CPAP Supplies Replacement Schedule

With time and use your CPAP equipment will begin to break down, reducing the potency of your CPAP therapy. To keep your treatment both effective and hygienic Medicare will cover replacements for your CPAP supplies according to the follow schedule :

  • Full Face Mask Cushions – 1 every month
  • Nasal Pillows/Nasal Mask Cushions – 2 every month
  • Disposable Filters – 2 every month
  • Reusable Filters – 1 every 6 months
  • CPAP Mask – 1 every 3 months
  • CPAP Tubing – 1 every 3 months
  • CPAP Headgear – 1 every 6 months
  • CPAP Chin Strap – 1 every 6 months
  • Humidifier Water Chamber – 1 every 6 months
  • CPAP Machine – 1 every 5 years

It may seem like a draw to keep track of, but don ’ triiodothyronine catch overwhelmed ! Your personal sleep specialist from can keep track of what you qualify for and when. When you ’ re ready for fresh equipment, we ’ ll commit you a reminder. To get started, fill out a simpleton qualify form and we ’ ll handle all of the paperwork for you !

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Category : Finance

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