Does Medicare pay for CPAP Equipment? Snoring is no fun. But if it’s sleep apnea you’re suffering from, a cranky partner is the least of your concerns. With obstructive sleep apnea (OSA), you’re in danger of contracting a whole host of other serious ailments, including diabetes, high blood pressure, stroke, heart disease, and depression.
According to the National Sleep Foundation, more than 18 million U.S. adults suffer from sleep apnea, with prevalence as high as 10% to 20% in children who snore habitually. OSA happens to both genders in all age groups.
Thankfully, there’s continuous positive airway pressure (CPAP) therapy for sleep apnea sufferers. But will Medicare and other insurances cover the cost of CPAP machine usage?
The answer is yes, but you must meet certain conditions – very specific conditions, in fact.
To qualify for coverage, you must undergo a face-to-face evaluation with your doctor who then orders the administration of a sleep test. Medicare and other insurances may cover certain sleep studies.
Patients already using CPAP who later become Medicare patients
You must have undergone a Medicare-approved baseline sleep study if you’ve just recently become a Medicare patient. Other insurances generally follow the lead of Medicare when it comes to CPAP therapy tests and equipment. It is important that you check with your own insurance plan. Your doctor should also document that CPAP therapy has helped improve your symptoms.
Renting from a CPAP supplier
As a Medicare beneficiary, you pay 20% of the approved amount for the rental of a CPAP machine and the purchase of supplies (filters, liners, tubing, humidifiers, connectors, adaptors, cleaning supplies, chin straps, headgear, etc.).
If you’ve been using the CPAP device continuously, with your doctor certifying its benefits to your condition, Medicare pays the rental fee for 13 months.
Take note that your doctor or the CPAP supplier must be enrolled in Medicare for Medicare to cover the equipment.
After 13 months, the machine is yours, but you still must purchase the accessories and supplies needed for its upkeep from a Medicare-approved supplier for your insurance to help you pay for them.
Medicare Part B covers medical equipment for home use, provided your doctor prescribes the equipment. Most importantly, you have to remain compliant for Medicare to continue covering the cost of your CPAP machine.
Compliance, in this sense, means:
You must use your device for a minimum of 4 hours each night for 70% of nights within a 30-day period.
Compliance documentation starts after you’ve used the device for 31 days but before 90 days of use. In other words, you must document your CPAP machine usage between days 32 and 89 of the time you started using the device. Most of the newer machine models to track the usage hours and display this information for you.
If you’ve been diagnosed with sleep apnea, Medicare covers the three-month trial period. The coverage may be extended if, during a face-to-face meeting, your doctor notes in your medical records that CPAP therapy is helping with your sleep apnea.
You can obtain a coverage extension on the trial period if you adhere to Medicare’s compliance requirements: 4 hours usage of the CPAP machine each night for 70% of nights in a 30-day period. Otherwise, you will have to be tested for sleep apnea all over again.
CPAP machines for different lifestyles
Medicare covers all types of CPAP equipment, whether it’s for someone with an active lifestyle or someone who prefers a machine with aesthetic appeal. However, not all Medicare-approved suppliers design specialized CPAP devices.
Medicare covers most of the costs of renting CPAP equipment and procuring the needed accessories, but there are out-of-pocket costs to consider. We’d love for you to try our CPAP mask liners and get the maximum amount of comfort while using your CPAP mask, but we advise you to first check with your doctor if CPAP therapy is the right treatment option for you.
If indeed it is, we recommend using RemZzzs® mask liners, so you stay comfortable, compliant, and worry-free!
According to one of our many customers: “I can successfully walk down a gravel road barefoot…. But why would I leave out the comfort of wearing shoes? It’s the same thing with RemZzzs."