While Medicare typically covers CPAP devices when deemed medically necessary, that coverage rarely includes sanitizing systems.
If you need a continuous positive airway pressure (CPAP) device, you’ll also need accessories to care for the machine and ensure it’s in its best working condition, such as headgear, a CPAP mask, and CPAP cleaning and sanitizing products. These devices are expensive, and maintenance and part replacement can also be costly.
That’s why it’s important to know if your Medicare insurance covers CPAP devices and accessories. The good news is you will have some coverage if you meet certain conditions. Read on to learn more about Medicare CPAP device, accessory, and therapy coverage.
Does Medicare cover CPAP machines?
A 3-month trial of CPAP therapy may be covered by Medicare if you’ve been diagnosed with obstructive sleep apnea. Obstructive sleep apnea, the most common sleep-related breathing disorder, causes you to stop and start breathing repeatedly while you sleep. A CPAP can help use positive pressure to keep your airway open while you sleep.
After that 3-month period, Medicare may continue to cover longer CPAP therapy as long as:
- You meet with your doctor in person
- Your doctor documents in your medical record that you meet certain conditions, and the therapy is helping you
You may also need a prescription from your doctor for a CPAP machine.
If you had a CPAP machine before you enrolled in Medicare and you meet certain requirements, you may get coverage for a rental or replacement CPAP machine and/or CPAP accessories.
Medicare CPAP cost
After meeting the Part B deductible, you’ll pay 20% of the Medicare-approved amount for the machine rental/purchase, and purchase of related supplies.
Medicare pays a durable medical equipment (DME) supplier to rent a CPAP machine for 13 months if you’re using it without interruption; after Medicare makes rental payments for 13 months, you own the machine.
Your DME will only continue to be covered if the doctors and suppliers are enrolled in Medicare and accept assignment.
Does Medicare cover CPAP cleaners?
SoClean and SoClean 2 and 3 are sanitizing systems used to clean and dry CPAP machine parts. Because the machine attaches to your nose and mouth, germs and bacteria can build up and cause illness or the machine to not work properly. Parts that must be cleaned and sanitized include hoses, masks, and the CPAP humidifier.
SoClean systems connect to the CPAP machine and its humidifier directly and creates activated oxygen, which enters the CPAP and its accessories. This oxygen eliminates bacteria and germs, sanitizing the components and allowing clean air to exit the machine.
Unfortunately, SoClean and other cleaners and sanitizers are not covered by Medicare, and you’d have to pay 100% of the cost. This is because CPAP cleaning machines are not considered “medically necessary” by Original Medicare because there are other, manual ways to clean your CPAP machine.
However, the good news is you can use your HSA* (healthcare savings account), HRA (healthcare reimbursement account), or FSA (flexible spending account) funds to purchase these products.
SoClean CPAP Cleaner and Sanitizer costs about $290, though you may find ranges in prices depending on where you purchase from.
*Please note that you cannot make contributions to an HSA while you have any part of Medicare. You can, however, make withdrawals from an HSA.
Related reading: What Is the Penalty for Having an HSA and Medicare?
Medicare durable medical equipment coverage
Medicare Part B covers medically necessary DME as long as it’s prescribed by your doctor and if the doctor and supplier is enrolled in Medicare.
DME is defined as:
- Used for medical reasons
- Used in your home
It typically has an expected lifetime of at least three years and is usually only useful to someone who is sick or injured. DME that Medicare covers may include (but isn’t limited to):
- CPAP machines and equipment
- Blood sugar meters and test strips
- Canes, walkers, wheelchairs, scooters, and crutches
- Hospital beds
- Home infusion services, infusion pumps, and supplies
- Oxygen equipment and accessories
- Lancet devices and lancets
Depending on the type of equipment, you may need to rent the equipment or you may need to buy it. In some cases, you can choose whether you want to rent or purchase the equipment. After meeting the Part B deductible, you’ll pay 20% of the Medicare-approved amount for DME.
To find a medical equipment supplier enrolled in Medicare, use this free, online tool.
Who needs a CPAP?
You may need a CPAP if you have signs and symptoms of obstructive sleep apnea such as:
- Excessive tiredness during the day
- Loud snoring
- Episodes of stopped breathing during sleep
- Abrupt awakenings, accompanied by gasping or choking
- Waking up with a dry mouth or sore throat
- Difficulty concentrating
- Mood changes
- High blood pressure
- Decreased libido
You should see a doctor if you have, or your partner observes:
- Snoring that’s loud enough to disturb your sleep or the sleep of others
- Waking up gasping or choking
- Pausing breathing
- Excessive daytime drowsiness, causing you to fall asleep while working, watching TV, or even driving
A CPAP isn’t necessarily right for everyone but working closely with your doctor will help ensure you get the right and best treatment for you.
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