Insurance, Medicare and cost
Replacing Your CPAP After 5 Years: Medicare and Insurance Rules
Medicare treats 5 years as the reasonable useful lifetime of a CPAP. After that, it can pay for a replacement if your treating practitioner documents at an in-person visit that you still use and benefit from the machine; no new sleep test or trial is needed. Many private plans use a similar 5 year rule.
Medicare's 5 year rule
Under CMS policy L33718, a PAP device replaced after its 5 year reasonable useful lifetime requires an in-person evaluation by your treating practitioner documenting that you continue to use and benefit from it. A new sleep test or trial period is not required.
ResMed's AirSense 11 user guide lists the design life of the device and power supply as 5 years, which lines up with this window.
Before 5 years: loss, theft or damage
If your machine is lost, stolen or irreparably damaged by a specific incident before 5 years, Medicare can replace it without a new evaluation, sleep test or trial, according to the LCD. Documentation of the incident, such as a police or insurance report, is usually needed.
Normal wear before 5 years is generally handled by repair or warranty rather than replacement.
Signs your machine needs replacing
Error messages that keep returning, motor noise, the machine shutting off, the humidifier not heating, or pressure that seems inconsistent. Write down any error code and call your supplier or the manufacturer.
Do not open the machine yourself. ResMed says to stop using the device and contact your care provider if it does not perform as usual, makes unusual sounds or is damaged.
Steps to get a replacement
Check the date your current machine was delivered. Book a visit with your clinician once you pass 5 years and ask them to document ongoing use and benefit. Ask your supplier what else they need.
If your old machine is a Philips model affected by the 2021 recall and was never remediated, raise that too; see our Philips recall guide.
Frequently asked questions
How often will Medicare replace a CPAP?
Generally once its 5 year reasonable useful lifetime has passed, with an in-person visit documenting continued use and benefit. Earlier replacement is possible for loss, theft or irreparable damage from a specific incident.
Do I need a new sleep study for a replacement CPAP?
Not for Medicare after 5 years. The LCD says no new sleep test or trial is required, only the in-person evaluation.
How long do CPAP machines last?
Manufacturers commonly design them for about 5 years; ResMed lists 5 years for the AirSense 11. Many keep working longer, but wear is more likely after that.
Can I upgrade my CPAP before 5 years?
You can buy one yourself with a prescription, but insurance usually will not pay for a new machine just to upgrade before the 5 year mark.
Sources
Last reviewed October 11, 2026. How we research · Report an error