Does Medicare Cover Sleep Studies? Coverage, Costs, and CPAP

Does Medicare cover sleep studies, and under which part?

Sleep studies are covered under Medicare Part B (medical insurance), not Part A. Coverage applies when you have clinical signs and symptoms of sleep apnea and a doctor or other health care provider orders the test. Without a provider's order, Medicare will not pay.

Medicare recognizes four types of sleep tests. Type I is in-lab polysomnography (PSG), the overnight study done in a sleep lab where staff monitor your breathing, brain activity, and oxygen. Types II, III, and IV are simpler tests that can be done at home with a portable monitor. Medicare covers a Type I test only when it is performed in a sleep lab facility; Types II, III, and IV may be performed as home sleep tests.

This matters because the test type determines where you can have it done and what equipment is used. Your provider chooses the test that fits your situation, but both lab-based and qualifying at-home tests are covered when the medical-necessity rules are met.

• Type I (in-lab polysomnography): covered only in a sleep lab facility.
• Type II, III, and IV: may be covered as home sleep tests.
• A provider order is required for any sleep test to be covered.
• Part B, not Part A, is the part that pays for sleep studies.

How much does a sleep study cost with Medicare in 2026?

For a covered sleep study, you first pay the annual Part B deductible, which is $283 in 2026. After the deductible is met, you typically pay 20% of the Medicare-approved amount, and Medicare pays the remaining 80%. There is no separate cost just for choosing a home test versus an in-lab test; the same 20% coinsurance applies.

Keep in mind that the Part B deductible resets each calendar year, so if you have already met it through other care, you may owe only the 20% coinsurance for your sleep study. Your standard Part B monthly premium in 2026 is $202.90, which you pay whether or not you use any services that year.

If you have a Medigap (Medicare Supplement) policy, it may cover some or all of the 20% coinsurance and the deductible, depending on the plan you have. Costs can also differ if you are in a Medicare Advantage plan (see below).

• 2026 Part B deductible: $283 per year, paid before coinsurance begins.
• After the deductible: you pay 20% of the Medicare-approved amount.
• 2026 standard Part B premium: $202.90 per month.
• Medigap may reduce or cover your share, depending on the plan.

Does Medicare cover a CPAP machine after a sleep apnea diagnosis?

Yes. If a sleep test shows you have obstructive sleep apnea, Medicare Part B may cover a continuous positive airway pressure (CPAP) machine, plus accessories like masks and tubing. CPAP is treated as durable medical equipment (DME).

Medicare uses a national coverage rule to decide who qualifies. Under CMS NCD 240.4, an initial 12-week CPAP trial is covered if your sleep test shows an apnea-hypopnea index (AHI) or respiratory disturbance index (RDI) of 15 or more events per hour, OR an AHI/RDI of 5 to 14 events per hour together with documented symptoms (such as excessive daytime sleepiness, impaired cognition, mood disorders, or insomnia) or documented hypertension, ischemic heart disease, or a history of stroke. The AHI or RDI can be measured by in-facility polysomnography or by a Type II, III, or IV home sleep test (a Type IV monitor must measure at least 3 channels).

After the 12-week trial, Medicare may continue covering CPAP only if you meet in person with your provider, who documents that you meet the requirements and that the therapy is helping you. This re-evaluation visit is required to keep coverage going, so do not skip it.

CPAP coverage follows DME billing rules. The supplier rents the machine to you for 13 continuous months as long as you keep using it; after 13 months of continuous use, you own the machine. For the rental and related supplies, after the Part B deductible you pay 20% of the Medicare-approved amount when the supplier accepts assignment.

• AHI/RDI of 15+ qualifies; or 5-14 with documented symptoms or specific conditions.
• Initial coverage is a 12-week CPAP trial.
• An in-person re-evaluation showing benefit is required to continue beyond 12 weeks.
• Machine is rented for 13 continuous months, then you own it.
• You pay 20% after the deductible for rental and supplies (masks, tubing).

Suppliers, compliance, and other situations

To avoid surprise charges, use a CPAP supplier that participates in Medicare. A participating supplier must accept assignment, meaning it can charge you only the coinsurance and deductible. A non-participating supplier may charge more, so confirm the supplier accepts assignment before you pick up any equipment.

Using your machine matters. Medicare expects documented use during the trial period, and continued coverage depends on records showing the therapy is helping. If you do not use the machine enough, coverage for ongoing rental and supplies can be affected, which is one reason the in-person re-evaluation is required.

If you already had a CPAP machine before you got Medicare and you meet certain requirements, Medicare may cover a rental or replacement machine and accessories. Talk to your provider and supplier about documenting your prior use.

Coverage of other devices, such as BiPAP or oral appliances, depends on your diagnosis and meeting the applicable medical-necessity rules; ask your provider whether your situation qualifies and confirm coverage before treatment.

• Confirm your supplier accepts Medicare assignment before getting equipment.
• Document your CPAP use; ongoing coverage depends on it.
• Pre-Medicare CPAP users may qualify for rental or replacement coverage.
• BiPAP and oral appliances depend on your diagnosis; verify coverage first.

Sleep studies and CPAP with Medicare Advantage

Medicare Advantage (Part C) plans are required to cover everything Original Medicare Part B covers, including sleep studies and CPAP. However, the way you access these benefits can differ.

Medicare Advantage plans may require you to use in-network providers and suppliers, may require prior authorization before a sleep study or CPAP is approved, and may set different cost-sharing (such as copays instead of the standard 20% coinsurance). Because the details vary by plan, check your plan's Evidence of Coverage and call your plan before scheduling a test or getting equipment.

If you are in Original Medicare, there is generally no prior authorization for a covered sleep study, but you still need a provider's order and must meet the medical-necessity rules.

• Medicare Advantage must cover at least what Part B covers.
• Networks, prior authorization, and copays vary by plan.
• Check your Evidence of Coverage and call your plan to confirm the details.