Medicare's BiPAP Standards

Medicare is a U.S. government health insurance program for people who qualify, including those 65 and older. Medicare provides money to cover the cost of health care and equipment under a set of standards. These extend to BiPAP machines for the treatment of sleep apnea.

Sleep Apnea

• Sleep apnea is a condition that affects breathing during sleep. It is characterized by shallow breaths or pauses in breathing. These pauses can last for a few seconds or stretch into minutes. Usually, someone with sleep apnea resumes breathing normally after the pause, sometimes after making a choking noise. The lighter effects of sleep apnea include interruption of sleep, leading to increased drowsiness during the day. Serious effects can include high blood pressure, stroke, heart attack or diabetes.

BiPAP Machines

• Bilevel positive airway pressure, or BiPAP, machines can help treat sleep apnea. A BiPAP machine uses positive ventilation through a breathing mask as a non-invasive method of treating breathing problems. These machines provide an alternative to more invasive methods of treating breathing problems, such as endotracheal tubes or tracheostomy tubes.

Qualifying for Equipment

• For the use of BiPAP equipment to qualify for Medicare coverage, you will need a letter of medical necessity from your physician. Medicare standards require that this physician be qualified by experience and training in the use of non-invasive respiratory assistance. Medicare also requires that the physician monitor the use of the equipment. If these requirements are met, then Medicare will provide an initial three months of coverage.

Coverage and Deductible

• According to the 2008 Medicare Guidelines, Medicare will cover 80 percent of the costs of your equipment. The exact cost of the equipment varies from state to state, within the range set by Medicare. The remaining 20 percent of the cost counts as the patient's deductible. To continue this coverage beyond the initial 90 days, the equipment provider must certify that you are using your equipment. Additionally, the patient needs to complete a consultation with a respiratory therapist by the end of the 90-day term.