Medicare has announced that it will begin covering Continuous Positive Airway Pressure (CPAP) machines for beneficiaries in 2022. This is great news for the millions of people who suffer from sleep apnea and need CPAP therapy to breathe properly during sleep. Medicare’s decision to cover CPAP machines is a major step in the right direction and should help to improve the health of many Americans.

To qualify for CPAP coverage you must meet the following requirements:

  • Complete a sleep test in a laboratory setting or by using an approved at-home test
  • Be diagnosed with obstructive sleep apnea based on sleep test results
  • Have a prescription for a CPAP machine from your doctor
  • Get the CPAP machine from a participating Medicare supplier

Keep in mind that CPAP does not work for everyone. So Medicare covers the machine for a three-month trial period. After the three months have passed your doctor will check to see how the treatment is working for you.

CTA-The-Ultimate-Guide-to-Medicare-Terminology
CTA-The-Ultimate-Guide-to-Medicare-Terminology

What is The Price for a CPAP Machine Through Medicare?

The good news is that you will not have to pay the full price for a CPAP machine if you qualify for Medicare coverage. Medicare will cover 80% of the cost of the CPAP machine and supplies. You will be responsible for the remaining 20%.

If you have supplemental insurance, such as Medigap or a Medicare Advantage plan, you may be able to get help with the remaining 20%. Be sure to check with your insurance provider to see if they offer any coverage for CPAP machines.

You can also look into financial assistance programs offered by some CPAP manufacturers. These programs can help you pay for a portion of the cost of the machine if you cannot afford it on your own.

If you are a Medicare beneficiary and have been diagnosed with sleep apnea, be sure to talk to your doctor about CPAP therapy. With Medicare coverage, you can get the treatment you need to improve your health and quality of life.

Will Medicare Cover CPAP Supplies?

In addition to CPAP machines, Medicare Part B’s durable medical equipment benefit also covers CPAP supplies, such as face masks, tubing, and filters. Medicare Part B pays 80 percent of the Medicare-approved amount, while you pay 20 percent as coinsurance. Your coinsurance may be paid by your Medicare supplement plan, or your cost may be different if you have a Medicare Advantage plan.

 Since CPAP supplies can get dirty and lose effectiveness with use, Medicare covers replacement supplies on a regular schedule. Depending on the item, you may need replacements every two weeks to every six months. Talk with your doctor or supplier about scheduling replacement supplies.

Does Medicare Advantage Cover CPAP Machines?

Medicare Advantage plans, also known as Part C, are an alternative to Medicare Part A and Part B. With a Medicare Advantage plan, you get your Medicare benefits through a private insurance company rather than directly from Medicare.

Most Medicare Advantage plans cover CPAP machines and supplies, but some don’t. If you have a Medicare Advantage plan, check with your plan provider to see if CPAP machines and supplies are covered. You can also call Medicare at 800-MEDICARE (800-333-4427) to find out if your specific plan covers CPAP machines and supplies.

You may be able to get help paying for a CPAP machine and supplies through Medicaid. Medicaid is a government health insurance program for low-income people. Each state has different rules about who qualifies for Medicaid. To find out if you qualify, contact your state’s Medicaid office.

If you don’t have insurance or your insurance doesn’t cover CPAP machines and supplies, there are other options to help you pay for these items. You may be able to get help from a financial assistance program offered by a CPAP manufacturer. Some manufacturers have programs that can help you pay for part of the cost of a CPAP machine if you can’t afford it on your own.

You may also be able to find used CPAP machines and supplies. Be sure to have the machine and supplies cleaned and disinfected by a healthcare professional before using them.

Medicare Advantage

Will Medicare Advantage Plans Help With CPAP Supplies Also?

Yes, in addition to CPAP machines Medicare Advantage plans will also often help with the cost of CPAP supplies. Depending on your plan, you may have a copayment, coinsurance, or deductible for CPAP supplies. You can check with your insurance provider to see what coverage you have for CPAP supplies.

If you are interested in inquiring as to which plan covers the best when it comes to CPAP. Please give us a call, we would love to help you out.