Does Medicare Cover Sleep Apnea? CPAP, Costs, and Alternatives

Medicare does cover sleep apnea. Original Medicare pays for the sleep study used to diagnose it, the CPAP machine and supplies used to treat it, oral appliances and certain surgeries when CPAP is not an option, and, through Part D, the medication Zepbound for qualifying patients. Most of this coverage sits in Part B, which means after you meet the annual deductible you pay 20% of the Medicare-approved amount. The catch worth knowing before anything else: CPAP coverage comes with a mandatory 90-day trial, and if you do not use the machine enough during that window, Medicare stops paying.

Getting Diagnosed

Part B covers sleep testing when a doctor orders it based on your symptoms. Testing can be done in a sleep lab (Type I polysomnography) or, in many cases, at home using a portable monitor (Types II, III, and IV).¹ Home testing is only an option for patients with a high likelihood of moderate to severe obstructive sleep apnea, and it is not allowed if you have moderate to severe pulmonary disease, neuromuscular disease, or congestive heart failure. Home studies also cannot be used to diagnose central sleep apnea, narcolepsy, or insomnia.²

To qualify for a CPAP machine, your study must show an Apnea-Hypopnea Index (AHI) or Respiratory Disturbance Index (RDI) of 15 or more events per hour. An AHI between 5 and 14 can also qualify if you have documented symptoms like excessive daytime sleepiness, cognitive impairment, mood disorders, or insomnia, or if you have hypertension, ischemic heart disease, or a history of stroke.³

The 90-Day CPAP Trial You Have to Pass

Once you qualify, Medicare covers an initial 12-week trial of CPAP therapy.⁴ Think of it as a probationary period. To keep coverage past day 90, you have to meet two conditions.

First, usage. During any consecutive 30-day stretch within those first three months, you must use the machine at least four hours per night on at least 70% of nights, roughly 21 nights out of 30.⁵ Your machine logs this automatically through a built-in data chip, so telling your doctor you wore it does not count.⁶

Second, the follow-up. Between day 31 and day 91 of therapy, you must see your prescribing doctor in person. The doctor reviews the compliance data and documents that the therapy is working. If you miss the usage threshold or the doctor fails to submit documentation during that window, Medicare stops paying for the rental, and the supplier can take the machine back.⁵ Requalifying after a failed trial generally means a new face-to-face evaluation and a repeat facility-based sleep study.²

Recent legislation has extended Medicare telehealth flexibilities through early 2026, and the American Academy of Sleep Medicine has said virtual PAP follow-ups are permitted “when clinically appropriate” under those provisions.⁷ Confirm with your provider that a telehealth visit will satisfy the requirement in your case before relying on one.

How You End Up Owning the Machine

Medicare does not buy the CPAP outright. It pays a monthly rental for 13 consecutive months, and if you use the machine without interruption the whole time, ownership transfers to you at the end of month 13.⁴ A gap in use can reset or disrupt the clock.

Auto-adjusting CPAP (APAP) machines are not treated differently from fixed-pressure machines. Both bill under the same code, HCPCS E0601, and follow the same coverage rules. If standard CPAP does not work for you, Medicare will cover a bilevel PAP device (BiPAP) under code E0470, but your doctor has to document that mask fit was addressed, that CPAP pressure settings did not control your symptoms, and that bilevel therapy is medically necessary.⁸

The machine has a five-year reasonable useful lifetime. After five years, a replacement is covered with a new written order and a clinical evaluation showing you still have sleep apnea and still benefit from therapy. No new sleep study is needed for a routine replacement. Earlier replacement is only covered if the machine is lost, stolen, or irreparably damaged in a specific incident.⁹

Supplies and Replacement Schedules

Once you own the machine, Part B covers accessories and supplies separately on a set schedule.⁸ Suppliers can no longer ship refills automatically. As of January 2024, they must contact you no sooner than 30 days before your current supply runs out and get your affirmative request before sending anything.⁵

Maximum replacement frequencies for common supplies:¹⁰

Nasal, nasal pillow, or oral/nasal mask cushions: 2 per month
Full face mask cushion: 1 per month
Disposable filters: 2 per month
Mask frame or system: 1 every 3 months
Tubing: 1 every 3 months
Headgear: 1 every 6 months
Chinstrap: 1 every 6 months
Humidifier water chamber: 1 every 6 months
Non-disposable filter: 1 every 6 months

What You’ll Actually Pay

Under Original Medicare in 2026, the Part B annual deductible is $283.¹¹ After that, you pay 20% of the Medicare-approved amount for the sleep study, CPAP rental, and supplies, as long as the supplier accepts assignment. A supplier that accepts assignment agrees to charge no more than the Medicare-approved amount. A supplier that does not accept assignment can charge more and may require you to pay the full price upfront and then seek reimbursement.⁴

Medigap supplemental insurance can take care of most or all of the 20%. Plans A, B, C, D, F, G, and N cover the full Part B coinsurance; Plans K and L cover 50% and 75%, respectively.¹²

Medicare Advantage plans must cover everything Original Medicare covers, including sleep studies and CPAP therapy when medically necessary.¹³ Copays, coinsurance, and network rules vary by plan, and some Advantage plans add supplemental sleep benefits that Original Medicare does not offer.¹⁴ If you are on an Advantage plan, check with the plan on cost-sharing and on which DME suppliers are in network.

If CPAP Isn’t an Option

Oral Appliances

Medicare covers custom-fabricated mandibular advancement devices, which hold the lower jaw forward during sleep. The appliance must be prescribed by your treating physician and provided by a licensed dentist, and the same AHI thresholds that apply to CPAP apply here. For patients with an AHI above 30, the appliance is covered if you cannot tolerate PAP or if your physician determines PAP is contraindicated.¹⁵ Prefabricated appliances are not covered. Fittings and adjustments during the first 90 days are included in the price of the device. The appliance has a five-year useful lifetime.¹⁶

Inspire (Hypoglossal Nerve Stimulation)

Medicare covers the Inspire implant for moderate to severe obstructive sleep apnea. To qualify, you must be at least 22 years old, have a BMI under 35, have an AHI between 15 and 65 with predominantly obstructive events, and have documented CPAP failure or intolerance. A drug-induced sleep endoscopy must confirm you do not have complete concentric collapse at the soft palate, and the procedure must be done by a board-certified otolaryngologist with manufacturer-specific training.¹⁷ After the Part B deductible you owe 20%; average out-of-pocket costs for the hospital outpatient procedure have been estimated at roughly $1,839, not counting separate charges from the surgeon, anesthesiologist, and follow-up visits.¹⁸

Conventional Surgery

Medicare covers several traditional surgeries when you have a confirmed diagnosis from an accredited sleep lab, an RDI of 15 or higher, documented failure of CPAP or non-invasive therapy, and physician counseling on risks and benefits:¹⁹

Uvulopalatopharyngoplasty (UPPP), when there is evidence of retropalatal obstruction
Mandibular maxillary osteotomy and genioglossus advancement, for retrolingual obstruction or after a failed UPPP
Tracheostomy, when the attending physician determines other treatments are ineffective or unsuitable
Correction of enlarged tonsils, an enlarged tongue, or hypertrophied nasal turbinates when these significantly contribute to obstruction

Several procedures are explicitly excluded: laser-assisted uvulopalatoplasty, the Pillar Procedure (palatal implants), Somnoplasty, and radiofrequency ablation of the tongue base.¹⁹

Zepbound

Part D may cover Zepbound (tirzepatide) specifically for the treatment of moderate to severe obstructive sleep apnea in patients with a BMI of 27 or higher who are also doing a reduced-calorie diet and increased physical activity program. Prior authorization may apply, and costs vary by plan.²⁰ It is not covered for central sleep apnea, weight loss alone, diabetes, or cardiovascular disease under this indication. Part D generally still excludes drugs used solely for weight loss.²¹

Central and Complex Sleep Apnea Have Different Rules

Everything above assumes you have obstructive sleep apnea. If you have central sleep apnea (where the brain intermittently fails to signal the breathing muscles) or complex sleep apnea, the rules are narrower. Medicare covers bilevel PAP devices (E0470 and E0471) when a facility-based polysomnogram documents the diagnosis and shows the device significantly improves your breathing on the prescribed settings. Initial coverage runs three months, after which your doctor must document that you are using the device an average of at least four hours per night and benefiting from it.²²

Adaptive servo-ventilation (ASV) is harder to get approved. Medicare may require that you first fail on a bilevel device without a backup rate, and coverage can be denied if a different PAP device was covered within the prior five years. ASV is also contraindicated for patients with symptomatic heart failure and an ejection fraction below 45%.²³

Picking a Supplier

Every doctor and DME supplier involved in your treatment has to be enrolled in Medicare. You can find enrolled suppliers through the search tool at Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227).⁴ In areas covered by the DMEPOS Competitive Bidding Program, Original Medicare beneficiaries generally need to use a contract supplier. Using a non-contract supplier in a competitive bidding area can mean Medicare will not pay, leaving you on the hook for the full cost. Repairs can be done by any Medicare-enrolled supplier regardless of contract status.²⁴

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