Medicare and Sleep Apnea Coverage What to Expect

November 13, 2025
Medicare and Sleep Apnea Coverage What to Expect

Introduction

Sleep apnea affects millions of older Americans, often leading to daytime exhaustion, heart complications, or increased health risks if unmanaged. Social rumors and scattered online advice make it confusing for Medicare beneficiaries to learn what testing, tools, and ongoing treatment for sleep apnea are actually covered. This blog walks you through Medicare’s approach to diagnosing and treating sleep apnea—so you can get the restorative rest you need to live well.

Diagnosing Sleep Apnea With Medicare

If you experience persistent snoring, daytime sleepiness, pauses in breathing, or your physician suspects sleep-disordered breathing, a sleep evaluation may be ordered:

  • Laboratory sleep studies: Medicare Part B pays for polysomnography in an approved facility, typically after referral from a doctor that accepts Medicare and if your symptoms suggest sleep apnea is likely.
  • At-home sleep testing: For appropriate candidates, Medicare covers some types of at-home diagnostic studies—but only with provider documentation showing home testing is a safe and cost-effective alternative.

Your doctor will determine which is suitable after a thorough clinical review. Preauthorization is not always required, but all test sites and physicians should participate in Medicare to avoid excess charges.

CPAP Therapy Coverage and Requirements

The main treatment for obstructive sleep apnea under Medicare is continuous positive airway pressure—or CPAP—therapy. Medicare provides coverage for:

  • Initial CPAP equipment rental (usually for the first 3 months), masks, humidifiers, and supplies: Medicare Part B pays for these if sleep apnea is confirmed via documentation and prescription.
  • Ongoing therapy continuation: For continued coverage beyond the trial, you must demonstrate improvement and adherence using documentation reviewed by your sleep medicine doctor. Criteria include verified CPAP use (typically a minimum of 4 hours per night on most nights of the week).
  • Replacement supplies: Routine accessory and supply replacement (mask cushions, tubing, filters) as needed/determined by your treatment plan and Medicare supply schedules.

Financial note: You pay the annual Part B deductible then 20% coinsurance of the Medicare-approved amount for both the equipment and related sleep services (unless you also have Medigap/offered secondary coverage).

Maximizing Results and Claims Success

  • Seek sleep centers and durable medical equipment suppliers enrolled in Medicare, and ask directly if they accept Medicare’s guidelines ("assignment") for lower patient costs.
  • If you have a Medicare Advantage Plan, confirm with your insurer which providers and brands are approved before scheduling sleep studies or ordering a device.
  • Document your sleepiness and symptoms thoroughly for your provider’s medical record during appointments; follow training for safe and optimal use of all prescribed medical devices.
  • If there are device issues, supply fit concerns, or mask allergies, report promptly for alternative mask options and reduce the risk of losing continued coverage with poor adherence reporting.

Some programs offer online download and compliance checks—check if your “smart” CPAP device can upload usage data for easy conferencing with sleep coordinator clinics.

Your Partner for Restful Sleep With Medicare Support

Sleep apnea is highly manageable with Medicare when diagnosed early and treated with eligible equipment and smart, thorough follow-up. For guidance picking equipment partners, smoothing billing after supply claims, or aligning your plan with new coverage options as needs evolve, contact Vista Mutual Insurance Services. Our sleep coverage specialists make healthy breaks—and healthy aging—easier for you and your loved ones from diagnosis to lifelong rest.