Does Medicare Cover CPAP Machines?

Introduction to Sleep Apnea

Sleep apnea is a condition where a patient is unable to catch his or her breath during sleep; as apnea literally means "without breath". A victim of obstructive sleep apnea (OSA) may stop breathing multiple times per night—sometimes hundreds of times, for a minute or longer each time. The condition is caused when your airway is blocked, often by soft tissue in the rear of the throat that collapses while asleep. Naturally, the brain of the victim arouses wakefulness. A lack of sleep typically creates drowsiness and multiple symptoms of sleep deprivation throughout the day, while the lack of oxygen can create long-term problems that include heart disorders and memory loss. One solution to this disease is the CPAP (positive airway pressure) machine. If you have Medicare coverage, you may be wondering: does Medicare cover CPAP machines?

Fortunately, the answer is "yes". If your physician certifies you for use of a CPAP machine, Medicare will provide coverage for a single level CPAP device. In order to qualify, the patient is administered to a Medicare-covered sleep lab. The patient will be asked to fall asleep inside of the lab as normally, and a number of criteria will be tested, this includes the number of episodes of apnea, the number of times the patient wakes up in the middle of the night, and other general sleep patterns.

This rental period lasts for 3 months, but does Medicare cover CPAP machines for extended periods? Typically, you must be re-certified for use. It's possible your physician may also recommend a surgical procedure for you to end your dependency on CPAP machines. Discuss with your Medicare prescribed physician about different options available to treat you sleep apnea. A CPAP machine works by creating an airtight seal around the face through the mask to help increase airflow through the machine. Some patients adapt to this device better than others, and for those who have difficulty adapting to the machine, a surgical option may be the best solution.

Does Medicare cover CPAP machines as well as the surgical procedure?

Under Medicare Plans A & B, a patient is covered for both visits to the doctor (Plan B) and longer term hospital visits (Plan A). The rental of a CPAP machine is paid for by the annual deductible of $162 for Part B services, and then 80% of the further costs are paid. If you use a supplemental, private insurance option such as a Medigap policy, it may cover the remaining 20%. A surgical procedure, on the other hand, will involve a deductible that is typically over $1,000. This deductible will also pay for initial time spent during recovery in the hospital.

Does Medicare cover CPAP machines through a private insurance affiliate?

Most likely, Medicare Advantage plans (HMOs and PPOs) will offer a number of sleep apnea related coverage. However, when working with a private company, certain deductibles and premium costs may differ from Original Medicare. There may also be specific private insurers designed for patients with sleep apnea, so it could be advantageous to seek out a company with special benefits for apnea patients. Talk to your doctor about different treatment options that are available in the private market.

It's important to ensure you are dealing with a Medicare approved supplier for the CPAP machine, which you can either rent or purchase. If you make this investment through a supplier who is not affiliated with Medicare, then Medicare will not reimburse this service. It may be wise to first rent a CPAP machine to see if the therapy is correct for you before you make the investment to fully purchase a CPAP machine. Discuss with your doctor about the best strategy for beginning CPAP treatment.

Does Medicare cover CPAP machines for specific lifestyles?

The answer is "yes", all types of CPAP machines are covered under Medicare. For instance, there are CPAP machines designed for people with active lifestyles that involve a lot of exercise. And, there are even CPAP machines designed for cosmetic appeal. Some manufacturers even sell CPAP machines disguised as bedroom accessories (such as a large tissue box). However, some specialized CPAP machines may not be designed by Medicare approved manufacturers.

It's important that you consult with your doctor if you suspect a sleep apnea problem. This disease can be dangerous if it's left untreated. A CPAP machine is a good solution that is covered by Medicare. Although, you may want to consider a surgical treatment to permanently fix your sleep apnea problem and alleviate the dependence on an external device. For more information about Medicare coverage, you can call 1-800-MEDICARE.