Medicare Coverage for Sleep Disorders and CPAP Equipment

Sleep apnea affects an estimated 30–40% of adults over 65, making it one of the most common undiagnosed conditions among Medicare beneficiaries. Untreated sleep apnea increases the risk of hypertension, heart disease, stroke, and cognitive decline — all serious concerns for older adults. Medicare covers both the diagnosis and treatment of sleep apnea and other sleep disorders, including the equipment that makes treatment possible.

Sleep Studies Under Medicare Part B

Before Medicare will cover treatment for sleep apnea, a qualifying diagnostic test must confirm the diagnosis. Medicare covers two types of sleep studies under Part B:

Polysomnography (In-Lab Sleep Study)

A polysomnogram is a comprehensive overnight sleep study performed in a hospital-based or freestanding sleep laboratory. Sensors measure your brain waves (EEG), eye movements, muscle activity, heart rhythm, blood oxygen saturation, airflow, and respiratory effort throughout the night. A registered sleep technologist monitors the study in real time.

Medicare covers in-lab polysomnography when ordered by your physician and when symptoms suggest a sleep disorder — excessive daytime sleepiness, loud snoring, witnessed apneas, or oxygen desaturation episodes. The study is billed under Part B at the standard 80/20 cost-sharing after your annual Part B deductible ($257 in 2025).

Home Sleep Apnea Test (HSAT)

For patients who are reasonably likely to have moderate-to-severe obstructive sleep apnea and who have no significant comorbidities that complicate interpretation, Medicare also covers home sleep apnea testing. A home sleep test is a portable device you wear overnight in your own bed. It typically measures airflow, respiratory effort, oxygen saturation, and pulse, but does not include the full EEG and video monitoring of an in-lab study.

Home sleep tests are significantly less expensive than in-lab studies and are increasingly the first-line diagnostic approach for uncomplicated suspected obstructive sleep apnea. Medicare covers HSATs under Part B at the same 80/20 cost-sharing structure.

When an in-lab study is required: Home sleep tests are not appropriate for all patients. Medicare may require or prefer an in-lab study for patients with suspected central sleep apnea, complex sleep disorders, heart failure, chronic lung disease, or neuromuscular disease.

CPAP Coverage as Durable Medical Equipment

A continuous positive airway pressure (CPAP) machine is the most commonly prescribed treatment for obstructive sleep apnea. Medicare covers CPAP equipment under Part B as durable medical equipment (DME) — but the coverage comes with specific conditions and a structured payment model that differs from a simple purchase.

Qualifying for CPAP Coverage

To qualify for Medicare coverage of CPAP equipment, you must meet three requirements:

1. Positive sleep study result: Your sleep study must show an apnea-hypopnea index (AHI) of 5 or more events per hour with documented symptoms, or an AHI of 15 or more events per hour regardless of symptoms
2. Physician order: A Medicare-enrolled treating physician must order the CPAP and document the diagnosis
3. Medicare-enrolled supplier: The CPAP equipment must be obtained from a Medicare-enrolled DME supplier

The Rental-to-Ownership Model

Medicare does not simply cover a CPAP purchase. Instead, Medicare uses a rental-to-ownership model spread over 13 months:

Months 1–13 (rental period): Medicare pays the DME supplier a monthly rental fee for the CPAP machine and the related accessories (tubing, mask, humidifier). During this period, you pay 20% coinsurance per month after meeting the Part B deductible. You do not own the equipment during the rental period.

After month 13 (ownership transfer): At the end of the 13-month rental period, ownership of the CPAP machine transfers to you automatically at no additional charge. Once you own the machine, Medicare no longer makes rental payments — though supplies (masks, tubing, filters) continue to be covered as replaceable supplies.

Monthly cost during rental: The Medicare-approved rental rate for a standard CPAP is approximately $150–$180 per month. Your 20% coinsurance is therefore roughly $30–$36 per month, or $360–$432 over the 13-month rental period. A Medigap Plan G or Plan N policy covers this 20% coinsurance, effectively eliminating your out-of-pocket CPAP costs.

The 90-Day Effectiveness Requirement: A Critical Gate

This is the most important thing to understand about Medicare’s CPAP coverage: after 90 days of initial CPAP therapy, Medicare requires evidence that CPAP treatment is effective before it will continue paying the rental fee.

To demonstrate effectiveness, your physician must document that you have used the CPAP for at least 4 hours per night on 70% of nights during any 30-day period within the first 90 days of therapy.

Nearly all modern CPAP machines include a wireless data transmission chip (called a modem) that automatically reports your usage and therapy data to your supplier and physician. At the 90-day mark, your physician orders a compliance report, reviews it, and documents whether you meet the usage threshold.

If you meet the threshold: Coverage continues through the end of the 13-month rental period and beyond for supplies.

If you fail the threshold: Medicare coverage stops. You are responsible for the remaining rental payments or must return the equipment. Your physician may try again with a different mask fitting, additional patient education, or an alternative therapy — and you could potentially restart the Medicare coverage process.

The message is clear: using your CPAP consistently is not just good for your health — it is required to maintain your Medicare coverage.

CPAP Supplies Coverage

Ongoing supplies are covered under Part B after the 13-month ownership period (and during the rental period as part of the rental payment). Medicare covers replacement supplies on a fixed schedule:

You may receive replacements more frequently if your physician documents medical necessity (damage, contamination, changes to your facial structure). You are not required to replace items on the full schedule if they are still in good condition.

Important: Supplies must be obtained from a Medicare-enrolled supplier. Using a non-participating supplier or ordering off Amazon does not trigger Part B reimbursement.

BiPAP Coverage Under Medicare

A bilevel positive airway pressure (BiPAP) machine delivers two different air pressure levels — a higher pressure during inhalation and a lower pressure during exhalation — making it easier to breathe out against the pressure. BiPAP machines are prescribed when:

• CPAP therapy is not tolerated due to difficulty exhaling against constant pressure
• Complex sleep apnea or central sleep apnea requires bilevel support
• Hypoventilation syndromes (as seen in COPD, neuromuscular disease, or obesity hypoventilation) require pressure support

Medicare covers BiPAP under the same DME framework as CPAP: 13-month rental with the same 20% patient coinsurance, the same 90-day effectiveness requirement, and the same supply replacement schedule. The approved rental rate for BiPAP is higher than for standard CPAP (typically $450–$550 per month), reflecting the more sophisticated equipment.

For patients with complex sleep apnea (central apnea or treatment-emergent central apnea), Medicare may cover an adaptive servo-ventilation (ASV) device or a RAD (respiratory assist device) with backup rate — more advanced machines that adapt to your breathing pattern. Coverage requires additional diagnostic criteria and physician documentation.

Auto-Adjusting CPAP (APAP) Coverage

Auto-adjusting CPAP (APAP) machines continuously vary the air pressure throughout the night based on real-time measurement of your airflow and respiratory effort — delivering more pressure when you need it and less when you don’t. APAPs are covered by Medicare under the same framework as fixed-pressure CPAP and at the same rental rate.

Many sleep physicians prefer APAP for initial therapy because it can identify the optimal fixed pressure setting and accommodates pressure needs that change with weight, sleep position, and nasal congestion.

Oral Appliance Therapy

For patients with mild-to-moderate obstructive sleep apnea who cannot tolerate CPAP, oral appliance therapy (OAT) — a custom-fitted dental device that repositions the lower jaw to keep the airway open — is an effective alternative. Medicare covers custom oral appliances for sleep apnea under Part B as DME when:

• Your sleep study confirms obstructive sleep apnea
• Your dentist or physician documents that CPAP is not appropriate or has not been tolerated
• The device is custom-fabricated by a qualified dentist or dental specialist and prescribed by a Medicare-enrolled treating physician

Custom oral appliances are typically covered as a purchase (not a rental) with 20% coinsurance. The Medicare-approved amount for a custom oral appliance is approximately $1,000–$1,800, so your 20% coinsurance is roughly $200–$360. Over-the-counter mouthguards and non-custom devices are not covered.

Note that the dental office component (impressions, fitting, adjustments) is billed under Part B by the treating dentist, not under Part D or any dental supplement. This is a medical benefit, not a dental benefit.

Positional Therapy and Other Approaches

For position-dependent sleep apnea (apnea that primarily or exclusively occurs when sleeping on your back), positional therapy devices — vests or vibrating alarms that prevent supine sleeping — are generally not covered by Medicare. These devices are inexpensive and available over the counter, but they fall outside Medicare’s DME coverage criteria.

Weight loss programs are also not a covered Medicare benefit despite being clinically effective for sleep apnea. Medicare Part B covers behavioral counseling for obesity (annual intensive therapy visit plus additional sessions), which can support weight loss, but the program itself is limited in scope.

Medicare Advantage and Sleep Disorder Coverage

Medicare Advantage plans cover sleep studies and CPAP/BiPAP equipment because federal law requires them to cover everything Original Medicare covers. However, the practical experience may differ:

Prior authorization: Many MA plans require prior authorization before approving a sleep study or before authorizing CPAP equipment. Getting the authorization in place before the sleep study is scheduled prevents delays.

Preferred supplier networks: Many MA plans have preferred or exclusive DME supplier networks. You may be required to obtain your CPAP through the plan’s preferred supplier, which may not be the same supplier your physician typically works with.

Plan-specific supply allowances: Some MA plans offer enhanced supply allowances (more frequent mask replacements, for example) as supplemental benefits. Read your Evidence of Coverage to understand your specific plan’s supply schedule.

For a full comparison of Original Medicare vs. Medicare Advantage for ongoing medical equipment and chronic disease management, see Medicare Advantage vs. Original Medicare.

CPAP Coverage and Medigap

Since CPAP is covered under Part B as DME, Medigap plans that cover Part B coinsurance eliminate your 20% share. A Medigap Plan G policyholder pays nothing for CPAP after meeting the annual Part B deductible — no monthly rental coinsurance during the 13-month rental period, and no coinsurance for ongoing supply replacements.

For patients managing multiple chronic conditions who may also use other DME (nebulizers, oxygen, walkers, hospital beds), the value of Medigap coverage for ongoing Part B cost-sharing is substantial. See Medigap Plans Compared: Which Supplement is Right for You? for details.

The Connection Between Sleep Apnea and Other Medicare-Covered Conditions

Untreated sleep apnea is strongly linked to conditions that carry high Medicare costs:

Cardiovascular disease: Sleep apnea increases the risk of hypertension, atrial fibrillation, heart failure, and stroke — all major cost drivers in Medicare. Treating sleep apnea reduces cardiovascular risk. See Medicare Coverage for Heart Disease.

COPD and respiratory disease: Sleep-disordered breathing and COPD frequently co-occur (overlap syndrome). BiPAP therapy is often required for patients with both conditions. See Medicare Coverage for COPD and Lung Disease.

Cognitive function: Emerging evidence links untreated sleep apnea to accelerated cognitive decline and increased dementia risk. Medicare’s recent expansion of cognitive assessment through the Annual Wellness Visit makes this connection clinically relevant.

Type 2 diabetes: Sleep apnea and diabetes share metabolic risk factors and each worsens the other. Medicare covers comprehensive diabetes management under Part B and Part D. See Medicare Coverage for Diabetes.

Getting Your Sleep Disorder Diagnosed and Treated

If you or your physician suspects you have sleep apnea, the path to coverage is straightforward:

1. Talk to your primary care physician: Describe your symptoms — snoring, witnessed pauses in breathing, excessive daytime sleepiness, unrefreshing sleep, morning headaches. Your physician will assess whether a sleep study is appropriate.

2. Get the sleep study ordered: Your physician writes an order for either a home sleep test or an in-lab polysomnogram. Both are covered under Part B.

3. Receive a CPAP prescription: Based on the sleep study results, if CPAP is indicated, your physician writes a prescription for the equipment, specifying the device type, pressure settings, and accessories.

4. Contact a Medicare-enrolled DME supplier: Your physician’s office can often help connect you with a supplier. Confirm that the supplier is Medicare-enrolled and participates with your Medigap or MA plan if applicable.

5. Use the CPAP consistently: Track your usage through the device’s data reporting feature. Aim for at least 4 hours per night on 70% of nights to meet the 90-day effectiveness threshold.

6. Follow up with your physician at 90 days: Your physician reviews your compliance data, documents effectiveness, and clears your continued Medicare coverage.

Sleep disorders are treatable, and Medicare’s coverage of sleep studies and CPAP equipment removes the financial barrier for most beneficiaries. The key is understanding the 90-day effectiveness requirement and committing to consistent CPAP use in the early weeks of therapy — before coverage can be withdrawn for non-compliance.