Does insurance cover CPAP in USA?
Continuous Positive Airway Pressure (CPAP) devices, accessories, & therapy
Medicare may cover a 3-month trial of CPAP therapy if you’ve been diagnosed with obstructive sleep apnea. After the trial period, Medicare may continue to cover longer CPAP therapy if you meet with your doctor in person, and your doctor documents in your medical record that you meet certain conditions, and the therapy is helping you.
Note
If you had a CPAP machine before you got Medicare and you meet certain requirements, Medicare may cover a rental or replacement CPAP machine and/or CPAP accessories.
Your costs in Original Medicare
After you meet the Part B deductible, you pay 20% of the Medicare-Approved Amount for the machine rental and purchase of related supplies (like masks and tubing). Medicare pays the supplier to rent a CPAP machine for 13 months if you’ve been using it without interruption. After Medicare makes rental payments for 13 continuous months, you’ll own the machine.
Medicare will only cover your durable medical equipment (DME) if your doctors and suppliers are enrolled in Medicare. If a DME supplier doesn’t accept assignment, there’s no limit on the amount they can charge you. You may also have to pay the entire bill (your share and Medicare’s share) at the time you get the DME.
Note:
To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:
Other insurance you may have
How much your doctor charges?
If your doctor accepts assignment
The type of facility
Where you get your test, item, or service
Note:
Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.
