Sleep Apnea and Medicare Coverage

If you’ve been waking up feeling tired, noticed frequent snoring, or your partner mentions pauses in your breathing while you sleep, you might be experiencing symptoms of sleep apnea. This common condition becomes more likely with age and can affect your energy, focus, and overall health. If you’re getting ready to enroll or are currently enrolled in Medicare, understanding your basic Medicare coverage can help you take the next step toward diagnosis, treatment, and better rest.

What is sleep apnea?

Sleep apnea is a common but serious sleep disorder that causes your breathing to repeatedly stop and start during sleep. These pauses in breathing can last from a few seconds to minutes and may occur 30 or more times per hour. This disruption prevents your body from getting enough oxygen and can lead to serious health problems.

The most common type is obstructive sleep apnea (OSA), which happens when throat muscles relax and block your airway during sleep. This condition tends to become more prevalent with age, and many older adults experience symptoms without realizing the cause. Some of the signs that you might have sleep apnea include:

• Loud snoring
• Episodes of stopped breathing during sleep (often reported by another person)
• Gasping for air during sleep
• Morning headaches
• Difficulty staying asleep
• Excessive daytime sleepiness
• Difficulty concentrating during the day
• Irritability

If left untreated, sleep apnea can increase your risk for high blood pressure, heart disease, stroke, diabetes, and depression. The good news is, with proper diagnosis and treatment, many people experience significant improvements in sleep and overall well-being.

How Medicare helps cover the cost of sleep studies

If you’re experiencing signs of sleep apnea, before you can get Medicare coverage for sleep apnea treatment, you’ll need a proper diagnosis through a sleep study.¹ A sleep study monitors your breathing patterns, oxygen levels, heart rate, and other vital signs while you sleep to determine if you have sleep apnea and how severe it is.

Medicare helps cover several types of sleep studies when they’re medically necessary and ordered by your doctor:²

• Type I (in a sleep lab)
• Type II, III, and IV (home tests)

Medicare Part B covers 80% of the Medicare-approved amount for these sleep studies after you meet your annual Part B deductible. You will be responsible for the remaining 20% of the cost.

Does Medicare cover CPAP machines?

Yes. A confirmed diagnosis of obstructive sleep apnea through a Medicare-approved sleep study opens the door to treatment. One of the most common and effective therapies is CPAP, a machine that uses gentle air pressure to keep your airway open while you sleep.³ Medicare Part B may help cover the cost of durable medical equipment (DME), including CPAP machines. To qualify, you need:

• A diagnosis from a Medicare-covered sleep study
• Your doctor and supplier both accept Medicare assignments

Coverage begins with a 3-month trial period to make sure CPAP therapy is working for you. If your doctor verifies that you’re using the machine regularly and seeing results, Medicare will continue covering it. After you meet your Part B deductible ($257 in 2025), Medicare covers 80% of the Medicare-approved amount, leaving 20% as your portion.³

Once you’ve used the device continuously for 13 months, Medicare considers it yours to keep.¹

Medicare Coverage for CPAP supplies

CPAP therapy requires regular replacement of supplies. Original Medicare Part B helps cover essential items like masks, filters, and tubing if you meet the coverage requirements and use a Medicare-approved supplier.³

After meeting your Part B deductible, Medicare typically pays 80% of the cost. You’re responsible for the remaining 20%,

Replacement schedule for CPAP equipment

Medicare follows specific guidelines for replacing CPAP supplies to ensure they remain in good condition:

• Masks: Every 3 months
• Mask cushions: Every month
• Filters: Disposable every month, non-disposable every 6 months
• Tubing: Every 3 months
• Headgear and chinstraps: Every 6 months
• Water chamber for humidifier: Every 6 months

Medicare will replace your CPAP machine every 5 years. If it breaks before then, Medicare may cover repairs or replacement.³

Managing sleep apnea without a CPAP machine

CPAP is the most commonly prescribed treatment for obstructive sleep apnea, but it’s not the only option. If it isn’t the right fit for you, Medicare may help cover other treatments if they are deemed medically necessary:

• Oral devices: These custom-fitted devices gently move your jaw forward to help keep your airway open during sleep.⁴
• Bilevel Positive Airway Pressure (BiPAP) machines: Provide two pressure settings—one for inhaling, another for exhaling—to make breathing more comfortable.
• Inspire therapy: A small device is surgically implanted to stimulate your airway muscles and prevent blockages. Medicare may cover this option if CPAP therapy has not been effective.⁴
• Lifestyle changes: Improving your sleep position, maintaining a regular sleep schedule, avoiding alcohol before bed, and losing weight (if needed) can help manage mild sleep apnea and support other treatments.

Sleep apnea costs under other parts of Medicare

While Original Medicare primarily covers sleep studies and CPAP equipment through Part B, Medicare consists of additional parts that may affect your coverage.

Here’s what to know about sleep apnea coverage under these other parts:

• Medicare Advantage (Part C): Medicare Advantage plans must cover everything Original Medicare covers, including sleep studies and CPAP therapy when medically necessary. Some plans may offer additional benefits related to sleep health. Coverage details can vary by plan.
• Medicare Part D (Prescription Drug Coverage): While Part D generally doesn’t cover durable medical equipment like CPAP machines, it may help cover the costs of medications prescribed for sleep apnea-related conditions.
• Medicare supplement insurance: Medicare supplement insurance may help cover some of the cost-sharing for Medicare-approved sleep studies or CPAP equipment, such as the 20% coinsurance under Part B.

Understanding the specifics of your Medicare coverage is essential to managing your costs associated with sleep apnea diagnosis and treatment.

Medicare sleep apnea FAQs

Q1. Do Medicare Advantage plans cover sleep studies?
Yes, Medicare Advantage (Part C) plans are required to provide the same coverage as Original Medicare, which includes sleep studies when medically necessary. Coverage details, such as copayments and network requirements, may vary depending on the plan, so it’s important to review your specific policy or speak with your plan provider.

Q2. What are the requirements for CPAP with Medicare?
To qualify for CPAP coverage under Medicare Part B, you must be diagnosed with obstructive sleep apnea through a Medicare-approved sleep study. Your doctor and the equipment supplier must also participate in Medicare. Medicare typically covers a three-month trial period, and continued coverage depends on your doctor confirming that the CPAP therapy is helping and that you are using the machine regularly.

Q3. What are the eligibility requirements for CPAP coverage under Medicare?
Medicare may approve CPAP coverage if your sleep study shows an Apnea-Hypopnea Index (AHI) of 15 or more events per hour, or 5–14 events per hour if accompanied by symptoms such as excessive daytime sleepiness, insomnia, or conditions like high blood pressure or heart disease.5 Your healthcare provider will assess your results and symptoms to determine if CPAP is appropriate for your treatment.

Q4. Are sleep studies fully covered by Medicare for diagnosing sleep apnea?

Medicare Part B helps pay for sleep studies used to diagnose sleep apnea, but doesn’t cover the full cost. After you meet your Part B deductible, you’re responsible for 20% of the Medicare-approved amount. To qualify, your doctor must order the test, and the provider must accept Medicare assignment. Depending on your situation, Medicare-approved sleep studies can be performed in a sleep lab or at home.

Q5. Does Medicare cover BiPAP machines for sleep apnea treatment?

Yes, Medicare Part B may cover BiPAP (bilevel positive airway pressure) machines if they are considered medically necessary for treating your sleep apnea. Your doctor must confirm that CPAP therapy was tried and didn’t work or isn’t appropriate. As with other durable medical equipment (DME), you’re responsible for 20% of the Medicare-approved amount after meeting your Part B deductible.

Supporting your sleep health needs

No matter which treatment path you pursue, taking steps to manage sleep apnea is an important part of protecting your long-term health. Getting quality rest each night can improve energy, mood, and overall well-being—helping you stay active and engaged in daily life. 

When considering how Medicare fits into your sleep apnea treatment, it’s worth exploring the full range of options. That includes reviewing your Medicare coverage for diagnostic sleep studies, equipment like CPAP machines, and alternative therapies when needed.

You might also find it helpful to explore the broader landscape of Medicare coverage options to ensure your sleep care needs are fully supported. If you have questions or want help evaluating your options, visit the Medicare Advice Center.

Sources

¹ Medicare.gov. Web page: Sleep Studies. Retrieved April 13, 2025 from www.medicare.gov/coverage/sleep-studies

² GM Insights. Industry Analysis: Sleep Study Market. Retrieved April 13, 2025, from www.gminsights.com/industry-analysis/sleep-study-market

³ Medicare.gov. Web page: Continuous Positive Airway Pressure (CPAP) devices and accessories. Retrieved April 13, 2025, from www.medicare.gov/coverage/continuous-positive-airway-pressure-devices

⁴ NerdWallet. Article: Does Medicare Cover Inspire for Sleep Apnea? Retrieved April 13, 2025, from www.nerdwallet.com/article/insurance/medicare/does-medicare-cover-inspire

⁵ Centers for Medicare & Medicaid Services. Web page: National Coverage Determination (NCD) Continuous Positive Airway Pressure (CPAP) Therapy For Obstructive Sleep Apnea (OSA). Retrieved May 28, 2025, from www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=226

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