Medicare Coverage for Sleep Apnea: 2025 Guide
Sleep apnea affects an estimated 22 million Americans, and untreated sleep apnea significantly increases the risk of cardiovascular disease, stroke, and type 2 diabetes. Medicare covers CPAP therapy, sleep studies, and related supplies — but with a compliance requirement that can cut off your coverage if you don't use your machine enough during the first 90 days.
Sleep Apnea Coverage Quick Reference
| Service | Part | Your Cost (2025) | Notes |
|---|---|---|---|
| In-lab sleep study (polysomnography) | Part B | 20% after $257 deductible | Diagnostic gold standard; overnight in a sleep lab |
| Home sleep apnea test (HSAT) | Part B | 20% after deductible | At-home device; less comprehensive but widely covered |
| CPAP machine rental (months 1–13) | Part B (DME) | 20% after deductible | Rental for first 13 months; then ownership transfers |
| CPAP machine (after 13 months) | Part B (DME) | 20% already paid during rental | Equipment becomes yours after rental period |
| CPAP supplies (masks, tubing, filters) | Part B (DME) | 20% after deductible | Replaced on a schedule; keep records of usage |
| BiPAP/BPAP machine | Part B (DME) | 20% after deductible | For complex sleep apnea or CPAP intolerance; requires documentation |
| Auto-adjusting CPAP (APAP) | Part B (DME) | 20% after deductible | Covered when physician documents medical necessity |
| Oral appliance (mandibular device) | Part B (DME) | 20% after deductible | Alternative to CPAP for mild-moderate apnea; must be custom-fitted |
| Sleep medicine specialist visits | Part B | 20% after deductible | For diagnosis, therapy initiation, follow-up |
| Hypoglossal nerve stimulator (Inspire) | Part A (inpatient) | $1,676 deductible | Implanted device for severe OSA; covered when CPAP-intolerant |
| Telehealth sleep follow-up | Part B | 20% after deductible | CPAP compliance review via telehealth available |
| Tirzepatide (Zepbound) for sleep apnea | Part D | Varies; $2,000 OOP cap | FDA approved Dec 2024 for moderate-severe OSA with obesity; Part D coverage varies by plan |
Getting Diagnosed: Sleep Studies
Medicare covers two types of sleep studies used to diagnose obstructive sleep apnea:
In-Lab Polysomnography (Type I)
The comprehensive overnight sleep study performed in a sleep laboratory. A technician monitors your brain waves, oxygen levels, heart rate, breathing, and leg movements throughout the night. This is the diagnostic gold standard and is covered under Part B at 20% after the deductible.
Home Sleep Apnea Test (HSAT, Type II–IV)
A portable monitoring device you wear at home for one or more nights. Less comprehensive than in-lab polysomnography but widely covered and often the first step. If your HSAT shows apnea-hypopnea index (AHI) of 5 or higher with symptoms, or AHI of 15 regardless of symptoms, you typically qualify for CPAP coverage.
Important: If the home test is inconclusive, Medicare may cover a follow-up in-lab study.
CPAP Coverage: The Rental-to-Own Timeline
Medicare covers CPAP machines as durable medical equipment (DME) through a rental-to-own model:
- Months 1–3: Trial period with mandatory compliance monitoring
- Months 4–13: Continued rental if compliance is met
- After month 13: Equipment ownership transfers to you; supplier must continue to provide maintenance for the next 24 months
You pay 20% of the monthly rental cost after the Part B deductible. Medigap Plan G covers the 20%, making CPAP essentially free during the rental period (after the annual Part B deductible).
The 90-Day Compliance Requirement: Exactly What You Must Do
This is the rule that catches most Medicare patients off guard:
- You must use your CPAP at least 4 hours per night
- On at least 70% of nights (21 out of 30)
- During a consecutive 30-day period within the first 90 days of therapy
- Your doctor must document that you are benefiting from the CPAP therapy
Modern CPAP machines have built-in compliance monitoring (typically via SD card or wireless transmission). Your supplier and doctor can see exactly how much you're using the machine.
Practical advice:
- Put your CPAP on even if you only sleep for a few hours — every night counts
- If you travel, bring your CPAP and use it
- Schedule your follow-up appointment at week 6–8 to review your compliance data
- If you're struggling with comfort, contact your supplier immediately to try different masks or pressure settings — don't stop using it
CPAP Supplies: Coverage Frequency Schedule
Medicare covers replacement CPAP supplies on a schedule. You can request replacements at these intervals:
| Supply Item | Replacement Frequency |
|---|---|
| Full face mask (frame + cushion) | 1 per 3 months |
| Nasal mask (frame + cushion) | 1 per 3 months |
| Mask cushion/pillow only | 2 per month |
| Headgear straps | 1 per 6 months |
| Chinstrap | 1 per 6 months |
| Tubing | 1 per 3 months |
| Disposable filters | 2 per month |
| Non-disposable filters | 1 per 6 months |
| Humidifier water chamber | 1 per 6 months |
You don't have to replace supplies on the maximum schedule — but you are entitled to. Keep records and request replacements when needed. The 20% coinsurance applies (covered by Medigap Plan G).
Zepbound for Sleep Apnea: New 2024 FDA Approval
In December 2024, the FDA approved tirzepatide (Zepbound) specifically for the treatment of moderate-to-severe obstructive sleep apnea in adults with obesity. This is the first medication approved specifically for sleep apnea.
Clinical trials showed that Zepbound reduced the apnea-hypopnea index by approximately 63% (in patients not using CPAP) — a dramatic improvement.
Medicare coverage status:
- Zepbound is covered under Medicare Part D for approved indications
- The 2025 $2,000 annual out-of-pocket cap under Part D limits your maximum drug spending
- Coverage requires the sleep apnea + obesity indication; obesity-only prescriptions remain excluded from Medicare Part D under current law
- Prior authorization is required by most Part D plans
Hypoglossal Nerve Stimulator (Inspire Device)
For patients with moderate-to-severe obstructive sleep apnea who cannot tolerate CPAP, Medicare covers the Inspire upper airway stimulation device. This is a surgically implanted device similar to a pacemaker that stimulates the hypoglossal nerve to keep the airway open during sleep.
Medicare coverage requirements:
- Diagnosis of moderate-to-severe OSA (AHI 15–65)
- Documented CPAP intolerance or failure after adequate trial
- BMI ≤32 (some plans have adjusted this)
- No complete concentric collapse at the soft palate (requires drug-induced sleep endoscopy evaluation)
The surgery and device are covered under Part A (inpatient) or Part B depending on setting. Ongoing remote monitoring and battery replacement are also covered.
Frequently Asked Questions
Yes. Medicare Part B covers CPAP machines as durable medical equipment for patients diagnosed with obstructive sleep apnea. You pay 20% of the monthly rental cost after the $257 Part B deductible. Medicare rents the machine for 13 months, after which ownership transfers to you. Medigap Plan G covers the 20%, making the rental essentially free after the deductible. Critical: you must use the machine at least 4 hours per night on 70% of nights within the first 90 days to maintain coverage.
Yes. Medicare Part B covers both in-lab polysomnography and home sleep apnea tests (HSAT) at 20% coinsurance after the Part B deductible. Your doctor must order the test. In-lab studies are conducted overnight in a sleep center and are the most comprehensive. Home tests involve a portable device you wear at home. If your home test is negative but your doctor still suspects sleep apnea, Medicare may cover a follow-up in-lab study.
If you don't meet the 70%/4-hour compliance requirement within the first 90 days of CPAP therapy, Medicare can stop covering your CPAP rental — and your supplier may reclaim the machine. You would then need to pay out of pocket or appeal the decision. To avoid this: use your CPAP every single night from the start. If you're having trouble tolerating it, contact your supplier immediately to troubleshoot mask fit, pressure settings, or humidification — don't just stop using it.