Does Medicare Cover Sleep Apnea and CPAP Machines in 2026?

Sleep apnea affects an estimated 30% of adults over 65, and untreated sleep apnea significantly increases the risk of heart disease, stroke, and cognitive decline. The good news: Medicare covers both the diagnosis and treatment of sleep apnea -- including CPAP machines.

The rules are specific, though. Here is exactly what Medicare covers and what you need to qualify.

Before Medicare will cover a CPAP machine, you need a formal diagnosis of obstructive sleep apnea. Medicare Part B covers sleep studies to diagnose sleep apnea:

In-lab polysomnography (PSG):

• Conducted at a sleep center
• Monitors brain waves, oxygen levels, heart rate, breathing, and movement
• Most comprehensive diagnostic test

Home sleep apnea test (HSAT):

• Conducted at home with a portable monitoring device
• Less comprehensive but often sufficient for diagnosis
• More convenient and less expensive

Your cost: After meeting the Part B deductible ($283 in 2026), you pay 20% of the Medicare-approved amount. With Medigap Plan G, your cost is $0 after the deductible.

To qualify for Medicare coverage of a CPAP machine, you must meet specific criteria:

Diagnosis requirements:

• Apnea-Hypopnea Index (AHI) of 15 or more events per hour, OR
• AHI of 5-14 with documented symptoms (excessive daytime sleepiness, impaired cognition, mood disorders, insomnia, or hypertension, ischemic heart disease, or history of stroke)

Prescription requirements:

• A face-to-face clinical evaluation by your treating physician before the sleep test
• A written order from your doctor after the diagnosis

If you meet these criteria, Medicare will cover a CPAP machine as Durable Medical Equipment (DME) under Part B.

Medicare covers CPAP machines through a rent-to-own model:

Months 1-3: Medicare pays for the rental. You pay 20% of the rental cost (after deductible).

Months 4-13: Medicare continues paying rental. You continue paying 20%.

After 13 months: If you have been using the CPAP consistently (more on this below), Medicare considers the machine purchased. The supplier must continue providing supplies for the remainder of the 5-year useful life period.

Typical costs:

• CPAP rental: ~$100-$150/month (Medicare pays 80%, you pay 20%)
• Your monthly cost: ~$20-$30/month
• With Medigap: $0/month after Part B deductible

Here is the part that trips up many Medicare beneficiaries:

Medicare requires you to demonstrate that you are actually using the CPAP machine. This is called the compliance requirement.

During the first 90 days of rental, your doctor must document that you are using the CPAP for at least 4 hours per night on 70% of nights during any consecutive 30-day period.

Modern CPAP machines have built-in data cards that record your usage. Your doctor will review this data. If you do not meet the compliance threshold, Medicare will stop covering the CPAP rental.

Tips for meeting the compliance requirement:

• Use your CPAP every night, even if it is uncomfortable at first
• Work with your doctor to adjust the pressure settings if needed
• Try different mask styles if your current mask is causing problems
• Use a humidifier attachment if dryness is an issue

Once your CPAP is covered, Medicare also covers replacement supplies on a regular schedule:

You pay 20% of the Medicare-approved amount for supplies (or $0 with Medigap after deductible).

If a standard CPAP is not effective, your doctor may prescribe a BiPAP (bilevel positive airway pressure) or ASV (adaptive servo-ventilation) machine. Medicare covers these as well, with similar requirements and cost-sharing.

BiPAP machines are typically prescribed for:

• Central sleep apnea
• Complex sleep apnea syndrome
• Patients who cannot tolerate CPAP pressure

If you have Medicare Advantage, your plan covers sleep studies and CPAP equipment under the same federal rules as Original Medicare -- but you may have different cost-sharing.

Some Medicare Advantage plans have:

• Lower copays for DME
• In-network DME suppliers you must use
• Prior authorization requirements for CPAP equipment

Always verify your plan's DME coverage and preferred suppliers before ordering a CPAP machine.

To have Medicare cover your CPAP, you must use a Medicare-enrolled DME supplier. Your doctor can refer you to approved suppliers in your area.

Be cautious of online CPAP retailers -- not all are Medicare-enrolled, and purchasing from a non-enrolled supplier means Medicare will not pay.

If you have questions about how your specific Medicare plan covers sleep apnea treatment, I am happy to help. I work with Florida seniors every day to navigate Medicare coverage questions.

Call me at (386) 871-3858 or schedule a free consultation.

William Gray is an independent Medicare insurance broker serving Florida seniors. FL License W690237.