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I’m 75 years old and a snorer. I also wake up in the middle of the night because of the snoring. Or my wife wakes me up.
I’m considering speaking to my doctor about the problem and have read some articles about sleep apnea. Maybe I have that.
But I’m worried about the cost. If I have sleep apnea, it looks like an expensive machine is the only fix. I’m wondering, does Medicare cover CPAP machines?
Trying to stop waking my wife,
Marshall from Peoria, Arizona
Snoring is a common sleep issue. Believe it or not, nearly 25% of all adults snore regularly, and 45% snore occasionally. John Hopkins reports that snoring can also get worse as you age. We understand how it can cause a poor night’s sleep and frustration between you and your wife.
If you think you have sleep apnea, we recommend contacting your primary care physician. They can help refer you to a sleep specialist for a sleep test. This sleep study will verify whether you have sleep apnea or if there is another issue causing your snoring.
If you’re diagnosed with Obstructive Sleep Apnea (OSA), then Original Medicare may cover a 3-month trial period of Continuous Positive Airway Pressure (CPAP) therapy. This would include the device and its accessories. Once the trial concludes, Medicare may continue to cover CPAP therapy if you meet with your doctor in person and they document that you meet certain conditions and that the treatment is helping you.
“You must be diagnosed with Obstructuve Sleep Apnea for Medicare to cover a CPAP machine and supplies. If you have not been diagnosed you can ask your doctor about having a sleep test or study done.“
Coverage for CPAP therapy falls under Original Medicare Part B. Once you meet the Part B deductible, you pay 20% of the Medicare-approved amount for the machine rental and supplies. These include masks, tubing, and more. Medicare pays the CPAP machine rental for 13 months if used without interruption. At the end of 13 continuous months, you’ll own the machine.
You should ensure that the Durable Medicare Equipment (DME) supplier accepts Medicare assignment to avoid the CPAP machine and supplies being charged to you without Medicare coverage. Also, note that you may need to pay the entire bill when you get the Durable Medical Equipment. Then, Medicare will reimburse you.
You’re probably wondering what the average CPAP machine and supplies cost. CPAP machines range from $500 to $1,000, with most falling in the $500 to $800 range. You would be responsible for 20% of the cost with Medicare Part B.
If your CPAP machine costs $650, you owe $130 in Part B coinsurance. You would own the machine after 13 months of continuous use. Recurring costs include the supplies.
Supplies that would need to be replaced on an ongoing basis are air filters ($5 to $30 per month), humidifier parts ($20 to $40 every six months), tubing ($10 to $30 every three months), headgear and face masks ($100 or more every six months), and mask cushions ($20 to $100 per month).
Every month supplies could cost $25 to $130. Your share would be $5 to $26 per month. Then you need to replace the tubing every three months, costing $10 to $30; your share is $2 to $6. And humidifier parts, headgear, and masks must be replaced every six months. These cost $120 to $140, with your share being $24.
In a year, you could spend a low of $116 and a high of $392, depending on the humidifier, headgear, and masks. The average annual coinsurance cost is $254, plus the $130 for the machine in the first year of use. And don’t forget your Medicare Part B deductible.
The good news is that the $130 is a one-time annual cost (if you continuously rent the CPAP machine for 13 months), as well as the annual Part B deductible. What you’ll need to weigh is the coinsurance costs for supplies. Ask your doctor which supplies to purchase for the best combination of cost and quality.
If you have additional Medicare questions, call a local Connie Health agent. We’re here to support you throughout your Medicare journey—call (623) 223-8884 to speak with a local licensed agent.
Yes, Original Medicare and Medicare Advantage plans cover the cost of CPAP supplies. These are covered under Original Medicare Part B. After you pay the Medicare Part B deductible, you are responsible for the 20% coinsurance for all Medicare-approved Durable Medicare Equipment (DME).
These CPAP DME supplies include air filters, humidifier parts, tubing, headgear and masks, and mask cushions. In a year, you could spend a low of $116 and a high of $392, depending on the humidifier, headgear, and masks. The average annual coinsurance cost is $254 for supplies plus the $130 coinsurance for the machine (if you continuously rent for 13 months). And don’t forget your Medicare Part B deductible.
Medicare does not cover CPAP cleaners and sanitizers. CPAP machines require daily cleaning, and CPAP cleaning machines can make it a lot faster. There are two primary cleaning methods for CPAP machines, and neither uses chemical cleaners.
Activated oxygen CPAP cleaning machines create oxidants that eliminate germs and bacteria. Or ultraviolet light (UV) cleaners use specific wavelengths of UV light to break down microorganisms and sanitize the machine and supplies.
Depending on your budget, a CPAP cleaning machine can cost between $5 and $300. This would be an out-of-pocket cost that is not covered by Medicare plans.
Yes, Medicare Part B covers CPAP machines for sleep apnea. If you are diagnosed with Obstructive Sleep Apnea (OSA), you will pay the Medicare Part B deductible and 20% of the coinsurance for the CPAP machine (Durable Medical Equipment).
The average CPAP machine costs $650, so you could owe $130 coinsurance (if you continuously rent for 13 months). The nice part is that if you continuously rent the machine for 13 months, the device will be yours, not a rental.
Read more by Sammy Menton
I am an Arizona Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2009. I enjoy coaching youth and high school sports, watching sports, and spending time with family. I also like taking road trips and vacationing anywhere that has a beach.