Does Medicare Cover CPAP Machines and Sleep Apnea Testing?

In this article...
  • If you don’t feel you are getting restful sleep and that you are constantly fatigued throughout the day, you may be suffering from some form of sleep apnea. This disorder can have a negative impact on your cardiovascular health and increase your chance of heart attack, stroke and other serious medical conditions. Some people delay testing and receiving treatment for sleep apnea due to one question — does Medicare cover CPAP machines used to treat this condition?

One of the first things you may think about when confronted with the reality that you might have sleep apnea is how you will pay for treatment. If you are enrolled in Medicare Part B or the Medicare Advantage plan, the good news is that treatment may be covered. It's important to make sure that your primary doctor and any specialists you see are approved by Medicare to ensure you are covered. 

If you are enrolled with Medicare Part B, testing and medical devices are covered under your plan. You will typically be required to cover 20% of the total cost, and CPAP machines can cost up to $3000. Testing services are also covered as long as they are performed by a Medicare-approved medical facility.  

Medicare Advantage plans cover all of the services under Medicare Plan B, but you will need to check your coverage to make sure you select the right providers. Not doing so can impact your eligibility to receive benefits for treatment.  

What Is Sleep Apnea? 

Sleep apnea is a condition that affects millions of people each year, and many are unaware that they suffer from it. When you fall asleep, it's possible for you to stop breathing while you are asleep, which can cause your brain and vital organs to receive less oxygen than is needed to function properly. When your brain detects that it isn’t receiving enough oxygen, you may wake up so that you begin breathing again. 

The symptoms of sleep apnea can include the following. 

  • Your partner reports that you snore loudly during sleep 
  • You are observed not breathing at all while sleeping 
  • You become irritable throughout the day 
  • Waking up thirsty and with a dry mouth 
  • Waking up multiple times throughout the night 
  • Feeling as though it is difficult to focus throughout the day 
  • Suffering from headaches that occur as you wake up 
  • Feeling fatigued all the time as if you did not get much sleep, despite sleeping through the night 

It's important to know that sleep apnea can affect both men and women and that age is not a limiting factor. You may be at a higher risk if you are a man, obese, suffer from cardiovascular disease, have a family history of sleep apnea or use certain medications that may cause your throat muscles to function improperly. 

If you are diagnosed with an obstructive form of sleep apnea, you may be advised to purchase a CPAP machine. The way the machine works is that it covers your mouth and supplies a steady supply of air, keeping your throat muscles from constricting. It can take some time to get used to the device, but people report that their sleep feels much more restful and they have more energy after getting accustomed to the machines. 

What Will Medicare Cover? 

As stated above, Medicare will cover most of your costs in regard to testing and the cost of renting or buying a machine. It is very important that you review the terms of your Medicare plan and see which doctors and testing centers are approved. Not doing this might disqualify you for coverage.  

However, since Medicare does cover needed medical devices, you should be able to receive the machine that you need. Make sure to talk with your doctor about any requirements that need to be filled, such as having your doctor provide proof of your medical need for the treatment.