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Does Medicare Cover CPAP

Does Medicare Cover CPAP?

Navigating Medicare coverage for CPAP equipment and therapy can be confusing, especially if you’re new to sleep apnea treatment. At Sove CPAP Clinic, we’re here to make the process as straightforward and supportive as possible. In this article, we’ll explain how Medicare works with CPAP in Australia, how to get coverage, and practical tips for managing your therapy – plus, how Sove can help at every step.

Medicare Requires a Sleep Test Before CPAP Coverage is Approved

In Australia, there is no universal Medicare coverage for CPAP machines or CPAP masks. You cannot walk into a store, buy a CPAP device, and get Medicare to reimburse you as you might for medication.

Instead, public hospitals and state health services fill this role for those who qualify. Each state and territory manages its own CPAP support programs through public sleep clinics or respiratory departments, meaning the level of assistance depends on where you live.

Medicare will cover your sleep study (diagnostic test for sleep apnea) and relevant doctor consultations under the public system, but not the CPAP device itself. If you’re eligible for a state or hospital CPAP program, you might receive a machine on long-term loan at little or no cost – but if you’re not eligible or face long waits, you’ll need to consider private options. We’ll explore those alternatives later.

Initial 12-Week Trial of CPAP Therapy

Medicare itself does not directly fund the purchase or rental of CPAP machines or supplies, many state-run public hospital sleep clinics do offer a 12-week trial program where a CPAP machine is loaned to the patient. This program typically includes: After your diagnosis is confirmed, Medicare often covers an initial 12-week trial of CPAP therapy through state-funded sleep clinics. During this trial, you’ll usually be provided with a CPAP machine on loan from a public hospital or clinic. The aim is to monitor your usage, ensure the therapy is effective, and assess your compliance with treatment.

Compliance typically means using the machine at least four hours per night on 70% of nights – a standard that helps show that CPAP therapy is benefiting your health. If you complete the trial successfully, your sleep physician may recommend continuing therapy, either through state programs or by purchasing your own machine.

Tip: Keep a therapy log or use your machine’s app (like ResMed’s myAir or Philips DreamMapper) to monitor your usage and stay on track. Sove CPAP Clinic can assist with troubleshooting and ensuring you meet compliance standards.

Medicare does not cover the cost of purchasing a personal CPAP machine for home use. This means that if you want to continue therapy long-term with your own machine, the expense will be out-of-pocket. That said, investing in your own CPAP machine gives you the flexibility to choose the model that best fits your needs and lifestyle.

At Sove CPAP Clinic, we offer a Lowest Price Guarantee on personal CPAP equipment, including popular models like the ResMed AirSense 11 and Philips DreamStation. Owning your machine means you can tailor your settings, choose your preferred mask, and access ongoing support from our expert team. We also offer payment plans and rental options, so therapy can remain affordable and accessible.

Tip: Our clinic provides training on machine setup, mask fitting, and maintenance to help you get the most from your therapy, ensuring comfort and confidence as you continue at home.

Alternative Funding Sources for CPAP

If you’re not eligible for a fully funded CPAP machine through a public hospital or you simply want a broader choice of equipment, don’t worry. There are several other avenues that can make CPAP more affordable:

  • Private Health Insurance (Extras Cover): In Australia, many private health insurers include CPAP machines and accessories under their “Extras” or ancillary cover. Typically, if you have mid to top-tier extras cover, you might get a rebate ranging from a few hundred dollars up to around $1,000 towards a CPAP device.
  • Department of Veterans’ Affairs (DVA): If you are a veteran with a DVA Gold Card (which covers all health conditions) or a White Card that includes sleep apnoea, you are likely eligible for fully funded CPAP equipment through DVA. DVA’s Rehabilitation Appliances Program provides CPAP machines, masks, and ongoing supplies at no cost to the patient. The process typically involves an application form (usually completed by your doctor or a specialist) and submitting it to DVA or an authorised DVA equipment supplier.
  • National Disability Insurance Scheme (NDIS): The NDIS funds supports for Australians under 65 with significant disabilities. Sleep apnoea by itself is usually considered a medical condition rather than a disability, so not everyone with OSA will be on NDIS. However, if you do have an NDIS plan (for example, you have another condition or disability and OSA is a related issue), you may use part of your plan funding to cover CPAP equipment and support as a disability-related health support. Talk to your NDIS planner or support coordinator about adding CPAP funding to your plan.
  • Other Options – Payment Plans and Rentals: Many CPAP suppliers understand that cost can be a barrier for some patients. At Sove CPAP Clinic, for instance, we offer flexible payment plans and rentals to spread out the expense. You could also rent a CPAP machine on a weekly or monthly basis, which is a good short-term solution or even a long-term try-before-you-buy strategy. This can be a lifesaver if you’re not eligible for other funding and can’t afford upfront costs.

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

Does Medicare cover the cost of personal CPAP machines in Australia?
No, Medicare does not directly reimburse or cover the purchase of personal CPAP machines for home use. Medicare focuses on diagnostic services and consultations but leaves the purchase of a device up to the patient. However, during the 12-week trial phase, some state-based clinics may provide a CPAP machine on loan. Sove CPAP Clinic offers competitive pricing, payment plans, and our Lowest Price Guarantee to help you purchase the right machine for your needs.

What other out-of-pocket CPAP expenses should I expect under Medicare?
Beyond the initial purchase of the machine, you may need to buy accessories like masks, tubing, filters, and humidifier chambers. Medicare does not cover these ongoing costs. Some private health insurance plans may offer partial rebates for these items, depending on your coverage. At Sove CPAP Clinic, we offer bundle deals and expert advice to help you manage these expenses and maintain your therapy effectively.

Can insurance policies like Medicare reimburse my CPAP treatment?
Medicare itself does not reimburse you for the cost of CPAP machines or supplies. However, some private health insurers do offer partial reimbursement or rebates for CPAP equipment and accessories under Extras Cover or Hospital Cover, depending on the policy. It’s worth checking with your insurer to see what’s available. The team at Sove CPAP Clinic can also guide you through the process and help you maximise your insurance benefits.

Do I need a referral from my GP for a Medicare-covered sleep test?
Yes, a referral from your GP or a specialist is required to access a Medicare-funded sleep study. This ensures that your sleep study is medically necessary and meets Medicare’s requirements. At Sove CPAP Clinic, we can help you obtain the right referral and coordinate your sleep study, ensuring a smooth process.

Will Medicare cover my CPAP therapy if I did a sleep test years ago?
Medicare typically requires a recent sleep study to approve or continue funding for CPAP therapy. If your sleep study is outdated (usually more than two years old), you may need to undergo a new one to confirm that CPAP therapy is still necessary. Sove CPAP Clinic can help arrange a new sleep test and ensure you remain eligible for Medicare coverage.

Do I need to visit a CPAP sleep clinic or can I get help online?
While it’s beneficial to visit a clinic for a hands-on mask fitting and device setup, Sove CPAP Clinic offers both in-person and online support. You can schedule virtual consultations, receive expert guidance, and even have your machine delivered to your door. Our team can help you adjust your settings, troubleshoot any issues, and ensure your therapy is working effectively.

How often do you have to wear CPAP for insurance?
To meet insurance or program requirements, you generally need to use CPAP for at least 4 hours per night on 70% of nights. This is the standard used by many health services to prove compliance and ensure therapy is effective. Your CPAP machine tracks your usage data so you and your providers can see your progress. Sove CPAP Clinic helps patients meet compliance goals and offers support if you’re struggling.