People who suffer from breathing problems often turn to continuous positive airway pressure, or CPAP, treatment. This method of breathing assistance utilizes mild air pressure that keeps your airway open. It's most commonly used by people who have sleep apnea, a disorder that causes a person to pause breathing or have shallow respiration while they're asleep. The treatment is also used on preterm infants with underdeveloped lungs. CPAP machines, also known as sleep apnea machines, which run automatically while you're asleep, typically consist of three parts:
- A motor that pushes air through a tube
- The tube, which connects the motor to the mask
- A mask that fits snugly over your mouth and nose
What is a CPAP mask?
A CPAP mask is a piece of durable medical equipment that is generally made from medical-grade plastic. While most go over both your mouth and nose, some masks only cover your nose. A CPAP mask comes with straps that attach behind your ears to keep the mask in place as you sleep. It may also have rubber lining around the edges to ensure a tight seal so no air escapes. While the mask is essentially included as a part of the CPAP machine, some people require specially fitted masks.
Additionally, masks need to be replaced more often than other components of the CPAP machine in order to ensure a comfortable and hygienic piece of equipment. That's because the more you use your mask, the less effective it becomes – the oils on your face and the chemicals you use to clean it wear out the plastic over time. That's why it's important to inspect often for air leaks and replace your mask regularly.
Does Medicare cover CPAP masks?
Your CPAP therapy supplies and equipment are covered under Medicare Part B if continuous positive airway pressure treatment is deemed medically necessary. Note that program does not pay for purchase of the machine – it covers rental costs for 13 months, after which point you automatically own the machine. The mask, however, is purchased at the time that you receive your machine.
How do I qualify for coverage?
To qualify for coverage, you must get a prescription from a physician who participates in the national health care program. That doctor must determine that you suffer from sleep apnea. You will then go through a three-month trial of CPAP therapy, after which your doctor will decide whether or not the treatment has helped improve your condition. If so, Medicare will continue to provide coverage for the machine, mask and other supplies. You must purchase your mask through a provider that is approved by Medicare. Beneficiaries who purchased their sleep apnea machines and masks before joining Medicare may still qualify for coverage of replacement parts and masks.
How much will it cost?
Medicare Part B pays for 80 percent of the cost of your CPAP mask and other related supplies, as well as for the rental cost of the machine. That leaves you to pay 20 percent of your CPAP rentals and purchases. This amount must be approved before purchasing or renting your equipment. You will also be required to pay your Part B deductible.
How do I get a CPAP mask?
After your physician determines that you require a CPAP machine, you may meet with a durable medical equipment provider to select the machine that is right for you and decide if you need a specially fitted mask. After the three-month trial, you may keep the mask you have or apply for a better-fitting one with approval from your physician.