CPAP stands for continuous positive airway pressure. A CPAP machine uses positive pressure air delivered into your airways at night to help you literally breathe easier at night. While CPAP therapy has been the standard treatment for sleep apnea for thirty years, it has become popular due to increased acceptance and an aging population that has greater need for it. Does Medicare cover CPAP therapy? The answer is that it does in some cases. However, there are options for paying for a CPAP machine in other cases.
When Medicare Will Pay Part or All of the Bill for Your CPAP Therapy
If you are diagnosed with obstructive sleep apnea, Medicare will probably pay for a three month trial of CPAP therapy. Your doctor must document the results and verify that you meet certain conditions for Medicare to continue to cover it. If your doctor won’t fill out the paperwork or you don’t meet these conditions, Medicare won’t pay for it any longer.
If you already had a CPAP machine and get diagnosed with obstructive sleep apnea, Medicare may pay for the cost of a replacement machine or CPAP accessories.
How Much Medicare Pays for CPAP If Properly Diagnosed
Medicare may pay for the machine or the rental payments, but this doesn’t mean you don’t have any out of pocket expenses. In general, you have to pay twenty percent of the amount Medicare allows for both the machine and the supplies like tubing. (This helps prevent over-charging and kickbacks.) After you’ve rented it for 13 months, you own it.
Note that Medicare will only pay for the durable medical equipment (DME) if your doctor or the equipment supplier is enrolled in Medicare. If you saw a private doctor and use a private durable medical equipment supplier, Medicare often won’t cover anything. Conversely, Medicare won’t limit what the supplier can charge you or determine the type of equipment you can own.
Other Costs You May Have to Pay
Your doctor may recommend services more often than Medicare covers or services Medicare doesn’t cover at all. In these cases, health insurance may help you pay the bill. Ask your doctor why they’re recommending certain services and whether or not Medicare pays for them when you’re creating a plan for diagnosing or treating a condition. Ask how much your doctor charges and the type of facility the tests are being done at. For example, you may pay more for a sleep study done at a private hospital than a public one.
When you’re shopping for durable medical equipment, find out whether the business accepts Medicare before you commit to buying from them. Learn how often you can buy replacement parts before you agree to a set schedule for replacement items. Do your research, too, because items like machines that clean CPAP face masks may not be covered by Medicare at all.
What Happens If You Aren’t Diagnosed with Sleep Apnea
If you aren’t diagnosed with sleep apnea or a related, serious condition, Medicare may not pay anything toward the cost of the machine and the related supplies. In these cases, insurance may still contribute toward the costs if your doctor makes the case that it reduces your risk of serious health problems or dramatically improves your quality of life.