Does Medicare Cover Sleep Apnea Treatment? Sleep Studies, CPAP, and the Inspire Implant

Does Medicare cover sleep studies, including at-home tests?

Medicare Part B covers sleep studies (sleep tests) when you have clinical signs and symptoms of sleep apnea and your doctor orders the test. The test must be ordered by your treating doctor, and under Medicare's national rules your doctor must do an in-person clinical evaluation before the test to check for obstructive sleep apnea.

Medicare covers four types of sleep tests, labeled Type I, II, III, and IV. Type I is an attended, in-lab study (polysomnography) and is only covered when performed in a sleep lab facility. Types II, III, and IV are simpler tests that can be done at home. Medicare has covered home sleep testing for diagnosing OSA, under set criteria, since March 13, 2008.

After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for a covered sleep study. Important: Medicare does not cover sleep testing for insomnia, restless leg syndrome, circadian rhythm disorders, chronic lung disease, or actigraphy.

• Type I (attended polysomnography): covered only in a sleep lab.
• Type II, III, IV: may be done with a home sleep test.
• Your cost: 20% of the Medicare-approved amount after the Part B deductible.
• Requires a doctor's order plus an in-person evaluation first.

What diagnosis criteria (AHI/RDI) does Medicare require for CPAP?

Medicare uses your sleep-test results to decide whether you qualify for a CPAP machine. The key number is your AHI (apnea-hypopnea index) or RDI (respiratory disturbance index) — the number of breathing events per hour of sleep.

Under Medicare's national coverage rule (NCD 240.4), you qualify for CPAP if your AHI or RDI is 15 or more events per hour (with at least 30 events recorded), OR if your AHI/RDI is 5 to 14 (with at least 10 events) AND you have documented symptoms such as excessive daytime sleepiness, impaired thinking, mood disorders, or insomnia. The AHI/RDI can be measured by in-lab polysomnography or by a Type II, III, or IV home sleep test (a Type IV test must measure at least 3 channels).

• AHI/RDI of 15 or more per hour (at least 30 events) — qualifies on its own.
• AHI/RDI of 5 to 14 per hour (at least 10 events) — qualifies only with documented symptoms.
• Measured by in-lab study or a qualifying home sleep test.

How Medicare covers CPAP: the trial, the 13-month rental, and your costs

If you are diagnosed with obstructive sleep apnea, Medicare Part B covers a 12-week (3-month) trial of CPAP therapy. After the trial, Medicare continues coverage only if you meet in person with your doctor and they document that the therapy is helping you and that you meet the conditions. This is Medicare's way of confirming the machine is being used and is working.

CPAP is covered as durable medical equipment (DME). Medicare pays an approved supplier to rent the machine for 13 continuous months of use. After those 13 months of use, you own the machine. If you had a CPAP machine before you joined Medicare and you meet the requirements, Medicare may cover a rental or replacement machine and/or accessories.

On cost: after you meet the Part B deductible ($283 in 2026), you pay 20% of the Medicare-approved amount for the machine rental and for supplies like masks and tubing, as long as the supplier accepts assignment. The standard Part B premium in 2026 is $202.90 per month.

• 12-week (3-month) trial first.
• Continued coverage requires an in-person follow-up documenting the therapy is helping.
• Supplier rents the machine for 13 months of continuous use, then you own it.
• You pay 20% of the Medicare-approved amount after the $283 (2026) deductible.
• Supplies (masks, cushions, tubing, filters) are covered on a replacement schedule; ask your supplier how often each item can be replaced.

Does Medicare cover the Inspire implant (hypoglossal nerve stimulation)?

Medicare can cover hypoglossal nerve stimulation — the device commonly known by the brand name Inspire — for moderate-to-severe obstructive sleep apnea, but only when your records document that CPAP failed or you could not tolerate it. Medicare defines CPAP failure as an AHI greater than 15 despite using the machine, and CPAP intolerance as using it under 4 hours per night for 5 nights a week, or returning the device.

Beyond the CPAP requirement, Medicare's coverage rules (a Local Coverage Determination) set specific clinical criteria for this implant: a sleep study (polysomnography) within 24 months of your consult must show an AHI of 15 to 65 events per hour; your events must be predominantly obstructive (central and mixed apneas under 25% of the total AHI); and a drug-induced sleep endoscopy (DISE) must show no complete concentric collapse at the soft palate and no anatomical findings (such as grade 3-4 tonsils) that would compromise the device.

Because the implant is usually placed in an outpatient setting, your share is generally 20% of the Medicare-approved amount under Part B after your deductible. The exact amount depends on the setting and whether providers accept assignment, so confirm costs with your surgeon and Medicare before scheduling.

• Documented CPAP failure (AHI over 15 despite use) or intolerance (under 4 hrs/night, 5 nights/week, or returned device).
• Polysomnography within 24 months showing AHI of 15 to 65 events/hour.
• Predominantly obstructive events (central and mixed apneas under 25% of AHI).
• DISE showing no complete concentric palatal collapse and no disqualifying anatomy.

Suppliers, Medicare Advantage, Medigap, and alternatives

Use a Medicare-approved supplier for your CPAP equipment. If a supplier participates in Medicare, they must accept assignment, meaning they can only charge you the 20% coinsurance and the Part B deductible based on the Medicare-approved amount. Using a non-participating or non-enrolled supplier can cost you more.

If you have a Medicare Advantage (Part C) plan, it must cover at least what Original Medicare covers, but provider networks, prior-authorization rules, and approved-supplier lists vary by plan. Check your plan's Evidence of Coverage and confirm the supplier and any prior authorization before you start. If you have a Medigap (Medicare Supplement) policy, it can help pay the 20% coinsurance and the Part B deductible that Original Medicare leaves to you, depending on which Medigap plan you have.

If CPAP does not work for you, talk with your doctor about alternatives such as a BiPAP machine or, for qualifying patients, the Inspire implant described above. Coverage for any alternative depends on your diagnosis and meeting Medicare's medical-necessity rules.

• Participating suppliers must accept assignment — you pay only coinsurance and the deductible.
• Medicare Advantage covers at least as much as Original Medicare, but rules and supplier lists vary by plan.
• A Medigap plan may cover your 20% coinsurance and the Part B deductible.
• Ask your doctor about BiPAP or Inspire if CPAP is not tolerated.