Medicare Rents the CPAP for 13 Months. Miss Its Four-Hour Test in the First 90 Days and It Stops Paying Before the Machine Is Yours

A 68-year-old walks out of the sleep lab with an obstructive sleep apnea diagnosis and a CPAP prescription. The supplier delivers the machine, Medicare approves it, and he settles in for what he thinks is a straightforward path: rent for 13 months, then own it. The mask leaks. He rips it off around hour three most nights. Ten weeks in, the supplier calls to say his usage report failed Medicare’s compliance test. Rental coverage is ending. The machine may need to go back. Despite the mask’s imperfections, he still needs it.

He paid every premium, but he missed a test he did not know he was taking.

Rental for 13 Months, but Only If You Pass the Test

Under Original Medicare, a CPAP is durable medical equipment covered by Part B as a capped rental. After the $283 annual Part B deductible, Medicare pays 80% of the approved monthly rental and the beneficiary pays 20%. After 13 continuous months of covered rental, the device becomes the patient’s property.

The catch: the first 12 weeks function as a trial period rather than a simple rental. Medicare pays during that window, but continued coverage past the trial depends on proving two things simultaneously. The patient has to use the machine enough, and a clinician has to document that it is actually helping. Fail either test and payments stop before month four, long before the ownership clock runs out.

Four Hours, 21 Nights, One 30-Day Window

Medicare’s usage rule is specific. The patient must use the CPAP at least four hours per night on at least 70% of nights during one consecutive 30-day period within the first three months. In practice, that is roughly 21 qualifying nights inside a chosen 30-day stretch, not four hours every night for 90 days straight.

Two details matter. First, the machine reports objective data. The machine keeps its own record of how long he uses it. Saying he wore it most nights won’t override the data log. Second, any qualifying 30-day window inside the trial counts. A rough first week does not sink the trial as long as a clean 30-day stretch shows up before day 90.

Appointment Almost Nobody Circles on the Calendar

Medicare adds a second requirement beyond usage. It requires a face-to-face reevaluation with the treating clinician, generally between days 31 and 91, at which the practitioner must document that the patient is benefiting from therapy. A patient can hit every usage target and still lose coverage because the follow-up visit slipped past the window or the note in the chart did not say what Medicare needs it to say. Coverage can resume after a later visit, but Medicare generally will not go back and pay for the gap. This is the trap that is easy to miss in the paperwork. The supplier tracks the hours. The clinician has to close the loop.

Count the Cost

When the trial fails, Medicare denies further rental payments and the associated mask, tubing, and filter supplies as not reasonable and necessary. Because the 13-month clock has not finished, the patient does not own the device. The supplier can require its return unless the patient pays privately or negotiates another arrangement. That is the realistic consequence, not a guaranteed federal seizure, but planning around it is the right default.

Restarting is harder than fixing the first attempt. A genuine trial failure generally requires a new in-person clinical evaluation explaining why therapy failed and a repeat sleep study conducted in a facility-based setting. Solving a mask leak, a pressure setting, or claustrophobia during the original trial is dramatically cheaper and faster than qualifying from scratch.

CPAP compliance is one of those Medicare rules that never shows up in the enrollment brochure, and it is not the only one (we mapped the surcharges and coverage traps most retirees run into in a free Medicare guide).

What to Do Before Day 90

• Pull the usage report at week four or five, not week eleven. Ask the supplier for the compliance numbers early enough that a bad stretch still leaves time for a clean 30-day window inside the trial.
• Call the clinician the first week the mask or pressure prevents four-hour nights. A different mask, a pressure adjustment, or added humidity can make the machine easier to tolerate.
• Book the face-to-face reevaluation for roughly day 60 to day 80, and confirm in writing that the supplier has received both the compliance report and the practitioner’s benefit documentation before day 91.

The 13-month rental is a real path to ownership. The first 90 days decide whether the patient is allowed to walk it out.

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