Does Medicare Cover CPAP Machines? (2026)

Direct Answer: What Medicare Covers for CPAP in 2026

Yes. Medicare Part B covers CPAP machines, masks, tubing, and supplies as durable medical equipment when a Medicare-covered sleep study diagnoses obstructive sleep apnea in 2026. Coverage requires a 12-week compliance trial; you must use the device at least 4 hours nightly on 70% of nights before Medicare continues paying. After the 2026 Part B deductible of $283, Medicare pays 80% and you pay 20% coinsurance, and you own the machine after 13 months of rental.

What Original Medicare Part B Covers for CPAP Therapy

Original Medicare covers CPAP therapy as a durable medical equipment (DME) benefit under Medicare Part B, not Medicare Part A. Medicare Part A (hospital insurance) does not typically apply because sleep studies and CPAP equipment are furnished as outpatient services, not inpatient hospital care. To qualify, you first need a face-to-face visit with your doctor documenting symptoms of sleep apnea (loud snoring, witnessed pauses in breathing, excessive daytime sleepiness), followed by a Medicare-covered sleep study, either an in-lab polysomnogram (PSG) or a home sleep apnea test (HSAT).

Medicare requires the sleep study to show an Apnea-Hypopnea Index (AHI) or Respiratory Disturbance Index (RDI) of at least 15 events per hour, or 5 to 14 events per hour along with documented symptoms such as excessive daytime sleepiness, hypertension, ischemic heart disease, or a history of stroke. Once the diagnosis is confirmed, your physician writes an order for a standard CPAP device (HCPCS code E0601), and a Medicare-enrolled durable medical equipment supplier provides the machine.

The 12-Week Compliance Trial: What You Must Do to Keep Your Machine

Medicare's most-missed CPAP rule is the 12-week (90-day) compliance trial. Starting the day you receive the machine, your DME supplier's built-in data card or wireless modem tracks how many hours per night you use the device. To pass the trial, you must use the CPAP for at least 4 hours a night on at least 70% of nights (21 of 30 consecutive nights) at some point during the first 3 months. Between day 31 and day 91, you must have an in-person, face-to-face visit with your treating physician, who documents that your symptoms have improved and that you are meeting the usage threshold.

If you do not meet the usage threshold or skip the required reevaluation visit, Medicare stops paying for the rental and the supplier can reclaim the equipment. You are not permanently locked out: you can restart the process with a new sleep study and a new compliance trial once you are ready to try again. Many beneficiaries who fail the first trial succeed on a second attempt after switching to a different mask style, since mask discomfort is the most common reason people stop using CPAP.

CPAP Supplies and Medicare's Replacement Schedule

Once you pass the compliance trial, Medicare continues covering replacement supplies on a fixed schedule, because masks, tubing, and filters wear out with daily use. Your DME supplier bills Medicare directly for each item as it becomes due; you do not need a new prescription for routine replacements within the standard schedule.

What Medicare Advantage May Add or Change for CPAP in 2026

Medicare Advantage plans (Medicare Part C) must cover CPAP therapy at least as broadly as Original Medicare, including the sleep study, the 12-week compliance trial, and the equipment itself. Beyond that floor, plan rules vary: many Medicare Advantage plans require prior authorization before approving a sleep study or CPAP order, and most restrict you to an in-network DME supplier. Some plans offer expanded benefits, such as covering a travel-size CPAP machine or premium mask styles that Original Medicare would not separately reimburse.

Cost-sharing on Medicare Advantage plans often replaces the 20% coinsurance structure with a flat copay for DME rental, which can be lower or higher than Original Medicare's cost depending on the plan. Use the Medicare Plan Finder at medicare.gov/plan-compare to check DME cost-sharing and network suppliers before enrolling. The Medicare Advantage Open Enrollment Period runs January 1 through March 31, 2026, and the Annual Election Period (AEP) for 2027 coverage runs October 15 through December 7, 2026.

Cost Without Medicare Coverage: What CPAP Costs Self-Pay in 2026

Patients without Medicare or other insurance pay retail rates for a CPAP machine, which run substantially higher than Medicare's rental payments spread over 13 months. In 2026, a new standard CPAP machine typically costs $500 to $1,000 at retail, with the full range spanning $300 to $1,500 depending on brand and features; automatic (APAP) and bilevel (BiPAP) machines with more advanced pressure algorithms often run $1,000 to $1,600. Annual supply costs (masks, tubing, filters) for a self-pay patient typically add $300 to $800 a year.

Uninsured patients should request a Good Faith Estimate (GFE) before ordering CPAP equipment. Under the No Surprises Act, any provider or DME supplier that schedules equipment or services for an uninsured or self-pay patient must provide a GFE at least three business days before delivery if requested. If your final bill exceeds the GFE by more than $400, you can initiate a Patient-Provider Dispute Resolution process through the federal dispute resolution portal. Some DME suppliers and manufacturers, including ResMed and Philips Respironics, also offer cash-pay discount programs and payment plans for uninsured buyers.

If you are under 65 and not yet eligible for Medicare, ACA-compliant marketplace health plans also must cover CPAP therapy as durable medical equipment, because rehabilitative and habilitative devices are one of the ACA's 10 essential health benefits. Unlike medically underwritten plans sold before 2014, ACA marketplace insurers cannot deny coverage or charge more because of a preexisting condition such as previously diagnosed sleep apnea.

How Medigap Covers Your CPAP Coinsurance (and Dual-Eligible Beneficiaries)

Medigap plans (Medicare Supplement Insurance) cover some or all of the 20% Part B coinsurance that Original Medicare leaves to the patient for CPAP rental and supplies. Medigap Plan G, the most widely purchased plan for new Medicare enrollees in 2026, covers 100% of the Part B coinsurance after the annual deductible, effectively eliminating the ongoing coinsurance cost for CPAP therapy. Medigap Plan N covers Part B coinsurance with some copays. Medigap does not change Medicare's underlying compliance-trial or replacement-schedule rules; it only offsets the cost-sharing.

About 12 million Americans are dual-eligible for both Medicare and Medicaid. For CPAP therapy, Medicare pays first as the primary payer (covering 80% of the approved rental and supply cost after the Part B deductible), and Medicaid acts as a secondary payer that covers some or all of the remaining 20% coinsurance and the deductible, depending on the state Medicaid program's rules. In most full-benefit dual-eligible cases, the combined coverage results in zero or near-zero out-of-pocket cost for CPAP equipment and supplies.

What If CPAP Doesn't Work: Covered Alternatives

Some beneficiaries cannot tolerate standard CPAP pressure even after switching masks. Medicare covers two common fallback options when standard CPAP fails and is documented as not working: bilevel positive airway pressure (BiPAP) devices, which deliver a lower pressure on exhale and a higher pressure on inhale, and oral mandibular advancement devices fitted by a dentist, which reposition the jaw to keep the airway open. Both require their own physician order and, in most cases, their own qualifying sleep study documentation.

Postoperative Note: Prescription Drugs Are Not Part of CPAP Coverage

Medicare Part D does not cover the CPAP machine itself, since it is durable medical equipment billed under Part B, not a prescription drug. Part D does cover medications prescribed for conditions linked to untreated sleep apnea, such as hypertension medications, and it covers the 2026 Part D out-of-pocket cap of $2,100 that limits total drug spending once reached. If your doctor prescribes a stimulant medication for residual daytime sleepiness while you adjust to CPAP, that prescription runs through your Part D plan separately from your DME benefit.

Does Original Medicare cover CPAP machines?

Yes. Medicare Part B covers CPAP machines as durable medical equipment once a Medicare-covered sleep study diagnoses obstructive sleep apnea. Coverage begins with a 12-week compliance trial, and after the 2026 Part B deductible of $283, Medicare pays 80% of the approved rental cost while you pay 20% coinsurance. The machine is a capped rental; you own it outright after 13 continuous months of Medicare-paid rental payments.

Does Medicare cover CPAP masks and supplies?

Yes. Medicare covers CPAP supplies on a fixed replacement schedule: mask cushions monthly, full masks and tubing every 3 months, disposable filters every 2 weeks, and humidifier chambers and headgear every 6 months. Your DME supplier bills Medicare directly for each item as it becomes due, and the standard 80/20 cost-share applies after your Part B deductible is met for the year.

What happens if I don't pass the CPAP compliance trial?

Medicare stops paying for the rental and the supplier can reclaim the equipment. To pass, you must use the device at least 4 hours a night on 70% of nights (21 of 30 consecutive nights) during the first 90 days, and see your physician in person between day 31 and day 91 to confirm compliance and symptom improvement. If you fail the trial, you can restart with a new sleep study and a new trial once you are ready to try again, often with a different mask style.

Does Medicare Advantage cover CPAP machines?

Yes. Medicare Advantage plans must cover CPAP therapy at least as broadly as Original Medicare, including the sleep study and the 12-week compliance trial. Many plans require prior authorization and restrict you to in-network DME suppliers. Cost-sharing often takes the form of a flat copay instead of 20% coinsurance, which can be lower or higher than Original Medicare depending on the plan. Compare DME benefits at medicare.gov/plan-compare.

What is the out-of-pocket cost for a CPAP machine on Medicare in 2026?

With Original Medicare and no supplemental coverage, you pay 20% coinsurance on the monthly rental and supply costs after the 2026 Part B deductible of $283 is met. With a Medigap Plan G, that coinsurance drops to $0 after your annual deductible. Without any Medicare or insurance coverage, a new CPAP machine costs $300 to $1,500 at retail in 2026, with most models between $500 and $1,000.

Does Medicare cover a new CPAP machine after mine wears out?

Yes. Medicare treats a CPAP machine as having a 5-year reasonable useful lifetime (RUL). Medicare covers a replacement device after 5 years of use, or earlier with documented loss, theft, or damage beyond repair. A new physician order and, in most cases, updated documentation of continued medical necessity are required before Medicare approves the replacement.

Does Medigap cover CPAP coinsurance?

Yes. Medigap plans that cover Part B coinsurance, including the widely purchased Plan G, cover 100% of the 20% coinsurance you would otherwise owe on CPAP rental and supplies after your annual Medigap deductible. Medigap does not change Medicare's compliance-trial rules or replacement schedule; it only offsets the patient cost-share.

Does Medicare cover BiPAP machines or oral appliances if CPAP doesn't work?

Yes. When standard CPAP is documented as not tolerated, Medicare covers bilevel positive airway pressure (BiPAP) devices, which use different pressures for inhaling and exhaling, and oral mandibular advancement devices fitted by a dentist. Both require a physician's order and, in most cases, their own qualifying sleep study documentation before Medicare approves coverage.