Is CPAP covered by Medicare Australia

Is CPAP Covered by Medicare in Australia?

Navigating the costs of CPAP therapy can be confusing, especially when you’re just starting out. One of the most common questions we hear at Sove CPAP Clinic is: “Is CPAP covered by Medicare in Australia?” The good news is that depending on your situation, Medicare and other support pathways may assist with various aspects of your sleep apnea care journey. But knowing what’s covered — and what’s not — can be tricky without a clear explanation.

On this page, we break down everything you need to know about Medicare and CPAP. We’ll explore what’s subsidised, where support is available, and what to expect if you’re beginning treatment. We’ll also highlight how Sove CPAP Clinic helps make care more accessible through flexible payment plans and our comprehensive CPAP Care Plans. Our goal is to empower you with accurate, compassionate information so you can make informed decisions about your health and sleep.

What Medicare Covers

Let’s start with the bottom line: Medicare does not currently fund the purchase of CPAP machines for personal home use. However, it does provide rebates and subsidies for related services, particularly in the diagnosis and medical management stages of sleep apnea care. Depending on your eligibility and where you’re located, additional support may be available through hospital-based programs or state services.

Here’s a simple breakdown of where Medicare may assist:

• Sleep studies: Rebate available with a valid referral.
• Consultations: GP and specialist appointments are Medicare-eligible.
• Public hospital programs: Some may provide temporary access to trial CPAP machines.

To be eligible for Medicare-supported pathways, you usually need to:

• Be referred by a GP for assessment.
• Have symptoms consistent with obstructive sleep apnea (OSA).
• Complete a Medicare-approved sleep study to confirm your diagnosis.

Once diagnosed, you may access support for medical care, but the cost of your personal CPAP machine, CPAP mask, and accessories remains an out-of-pocket expense unless you qualify for extra funding (such as through Veterans’ Affairs or state-run assistive technology schemes).

Even if you don’t qualify for full funding, we can help you explore alternatives.

Ongoing Care for Sleep Apnea

Your path to CPAP therapy usually begins with a diagnostic sleep study, and this is where Medicare can make a big difference. Sleep studies are the gateway to understanding what’s happening during your sleep and whether CPAP therapy is the right solution for you.

There are two main types of studies Medicare may cover:

• Level 1 (in-lab) studies, conducted overnight in a hospital or sleep lab. These offer comprehensive monitoring by sleep technicians.
• Level 2 (home-based) studies, which you complete in the comfort of your home using portable diagnostic equipment.

Medicare rebates are available for both, provided you have a GP referral and meet the clinical criteria. Your GP will usually assess your symptoms — such as snoring, excessive daytime sleepiness, or observed pauses in breathing — and then initiate the referral process.

Many sleep clinics offer bulk billing, which means your entire study may be fully covered with no out-of-pocket cost. Others may charge a gap fee depending on your provider, location, and specific health circumstances.

Once you’re diagnosed with moderate to severe OSA, the treatment phase begins. This is where a common misconception occurs — while Medicare helps you get diagnosed, it doesn’t fund the purchase of the treatment device (your CPAP machine) as standard ongoing care. Instead, therapy is considered your responsibility, though support may be available through other programs.

Sove Tip: Sove CPAP Clinic can help you book a Medicare-rebated sleep study with minimal wait time. Once diagnosed, we guide you through the next steps, offering device trials, expert mask fittings, and helpful follow-up consultations.

CPAP Accessories and Supplies

Although Medicare itself doesn’t directly cover the purchase of a CPAP machine or accessories, some government and hospital-based programs offer support, particularly for specific groups like DVA clients or low-income patients.

In Australia, we don’t have a Medicare “Part B” like the US system, but comparable assistance exists through a mix of public hospital systems, state health initiatives, and Department of Veterans’ Affairs (DVA) benefits. Here’s how some of those supports break down:

• Public hospitals may loan CPAP machines for trial periods (usually 1 to 3 months). This allows you to test the therapy before investing in your own machine.
• DVA patients who meet clinical criteria can access CPAP machines, replacement parts, and ongoing maintenance at no cost.
• State programs (such as those in NSW, VIC, and QLD) may provide additional assistance for medical equipment under aged care or disability schemes.

For most people, however, the purchase of accessories such as:

• Masks
• Tubing
• Filters
• Humidifier chambers

…must be paid for privately. These parts need regular replacement — often every 3 to 12 months — to maintain hygiene and therapy effectiveness.

At Sove CPAP Clinic, we make these costs more manageable through subscription-based supply plans. Our packages allow you to receive the parts you need regularly — without surprise expenses — and ensure your therapy is always working at its best.

Additionally, we offer:

• Flexible pricing on leading brands like ResMed and Philips.
• Ongoing technical support to help maintain your device.
• Bundled discounts for patients who join our CPAP Care Plans.

For patients not eligible for government assistance, these value-packed services can provide reassurance and peace of mind.

ALWAYS FOLLOW THE DIRECTIONS FOR USE. CPAP is used for Obstructive Sleep Apnoea treatment. When considering whether a sleep study or CPAP is right for you, speak to your doctor. Medicare criteria and T&Cs apply.

Payment plans available for approved applicants only; fees, terms, conditions, minimum amounts and exclusions apply.

Frequently Asked Questions

Can I claim a CPAP machine under other private health insurance policies?

Yes, many private health insurance providers offer partial reimbursement for the purchase of a CPAP machine or accessories if you hold extras cover that includes medical devices or respiratory equipment. Coverage and rebate amounts vary significantly between providers and depend on your level of cover.

To make a claim, you’ll typically need:

• A prescription or letter from your sleep specialist confirming the need for CPAP.
• An invoice or receipt from the provider where you purchased your machine.

Our clinic staff can provide quotes and itemised invoices tailored for private health claims. We can also advise on which funds offer the most supportive cover based on our patients’ experiences.

Is a personal CPAP machine covered by Medicare, or just in-person services?

Currently, Medicare does not reimburse the cost of purchasing a personal CPAP machine for use at home. However, it does cover the consultations, sleep studies, and specialist reviews that lead to a CPAP prescription.

This approach means that while Medicare helps diagnose and manage your condition medically, the equipment is considered an out-of-pocket expense unless you qualify for state-based programs or DVA support.

To make CPAP machines more accessible, Sove offers interest-free payment plans and value bundles that include setup, education, and follow-up support.

Do I need a referral to access Medicare-covered sleep studies?

Yes, to access a sleep study under Medicare, you must be referred by a general practitioner (GP) or relevant specialist. The referral is necessary to ensure that the clinical criteria are met for the rebate.

Medicare rebates only apply to sleep studies that are deemed clinically appropriate — for example, where there is a strong suspicion of obstructive sleep apnea based on symptoms like loud snoring, daytime sleepiness, or observed pauses in breathing.

If you suspect sleep apnea, speak to your GP about your symptoms and request a referral. Sove CPAP Clinic can also assist with booking a sleep study once you have your referral.

Is a prescription required if I choose to buy a CPAP mask outside of insurance?

Technically, you do not need a prescription to buy CPAP accessories such as masks or tubing if you’re paying privately. However, it’s highly recommended to consult a CPAP clinician or supplier to ensure compatibility with your device and proper fit.

Poorly fitting masks can cause air leaks, discomfort, and ineffective therapy — issues that are easily avoided with professional guidance.

We offer free mask consultations and fittings to ensure you get the most from your therapy, whether you’re an existing patient or purchasing your first mask.

Are there payment plans when purchasing a CPAP machine upfront?

Yes. At Sove CPAP Clinic, we understand that the upfront cost of CPAP equipment can be a barrier for some patients. That’s why we offer:

• Interest-free payment plans over a flexible number of months.
• Equipment bundles that include machines, masks, accessories, and follow-ups.
• Option to upgrade or switch machines during your trial period.

Our goal is to ensure every patient can access the therapy they need without financial stress.

Speak to our team about our tailored payment options and let us help build a plan that suits your budget.

What are CPAP Care Plans at the Sove CPAP Clinic?

Our CPAP Care Plans are our all-inclusive service packages designed to support you at every stage of your therapy. It includes:

• Initial consultation and education.
• Ongoing access to clinical support.
• Mask fittings and pressure adjustments.
• Regular follow-up calls and data reviews.
• Discounted pricing on accessories and filters.

It’s ideal for patients who want peace of mind and professional guidance throughout their CPAP journey.

Ask us about enrolling in a CPAP Care Plan — it’s a comprehensive, cost-effective way to stay on top of your therapy and get the most value from your investment.