Medicare CPAP Coverage & Compliance Rules, Explained
Medicare covers CPAP — but with rules that surprise almost everyone: a rental you may not know you're in, a 90-day trial, a usage requirement measured by your machine, and a follow-up visit with a deadline. Here's how it actually works, in plain English.
The Bottom Line
To keep Medicare paying for your CPAP, two things must happen in your first three months: your machine must record adequate usage (at least 4 hours a night on 70% of nights across a consecutive 30-day stretch), and you must see your treating practitioner face-to-face between day 31 and day 91 to document that the therapy is helping. Miss either one and coverage can be interrupted. Both are very manageable — if you know about them.
The Rules That Matter
How the machine is paid for
Medicare pays for CPAP as a rental — typically 13 months of continuous use, after which you own the machine. You pay your Part B coinsurance during the rental months.
The 90-day trial
Initial coverage starts with a roughly 12-week trial period. Continued coverage beyond it depends on demonstrating both benefit and usage.
The usage (compliance) requirement
Medicare defines adherence as using the machine at least 4 hours per night on at least 70% of nights, measured over a consecutive 30-day window within the first 90 days.
The follow-up visit
Between day 31 and day 91, you must have a face-to-face visit with your treating practitioner documenting that CPAP is helping you. Without it, continued coverage is at risk even if your usage is perfect.
Supplies
Masks, cushions, tubing, and filters are covered on a replacement schedule. A good supplier keeps you current; you can also ask for the schedule and track it yourself.
These are Medicare's rules — not "insurance rules." Commercial plans and Medicare Advantage plans have their own versions with different details. Coverage always depends on your specific plan; we verify yours for free before anything begins. Rules current as of August 2026.
If You're Falling Short — or Already Did
Why These Rules Exist — and How to Make Them Work for You
The compliance window is really a support window. The patients who sail through it are the ones whose mask fits, whose comfort settings were dialed in early, and who had someone to call when something went wrong in week two. The patients who fail it are usually fighting a fixable problem alone. If you're inside your first 90 days and struggling, that is the moment to get help — see our CPAP troubleshooting guide or bring the problem straight to Thomas.
Free Medicare Verification
Not sure where you stand — with compliance, coverage, or what Medicare will pay for next? Call us. We verify your Medicare benefits for free and tell you exactly what your plan covers before anything begins.