Medicare Part B covers sleep apnea related sleep studies and doctor visits to diagnose and treat the disorder. Medicare also covers a CPAP machine or oral appliance to help with sleep apnea, if your doctor prescribes it.
However, depending on the Medicare plan you have, you may be responsible for a portion of the cost.
What is Sleep Apnea?
Sleep apnea means you involuntarily stop breathing while you are asleep. Your breathing may stop for a minute or longer, and you may stop breathing multiple times during the night.
If sleep apnea isn’t treated, it can lead to high blood pressure, heart disease, stroke, sleepiness, diabetes and depression.
Sleep apnea is more common in men than in women. Hispanic and African American men, overweight people, and people over 40 seem to be at a greater risk, but sleep apnea can occur at any age.
- Loud snoring
- Sleepiness during the day
- Waking up at night feeling out of breath
- Regularly waking up in the morning with a dry mouth or headache.
The most common type of sleep apnea is obstructive sleep apnea, where the soft tissue at the back of the throat collapses during sleep.
How is Sleep Apnea Diagnosed?
The only sure way to diagnose sleep apnea is through a sleep study. A sleep study may involve an overnight visit to a sleep lab or a home sleep study done with special equipment.
During a sleep study, instruments measure your body’s activity over several hours of sleep.
If the study shows you have obstructive sleep apnea, your doctor will look at the data to determine the severity of your sleep apnea. Severity is one of the factors that determines which treatment is best for you.
Sleep studies can cost well over $1,000, but Medicare Part B will pay 80 percent of the cost, as well as 80 percent of the cost of initial and follow-up visits with your doctor.
However, you’ll be responsible for a small deductible before Medicare begins to pay.
Sleep Apnea Treatment
The most common treatment for sleep apnea is a continuous positive airway pressure, or CPAP, machine. Patients are using this machine with a breathing mask during sleep.
CPAP machines send pressurized air into the throat to stop the airway from collapsing.
With a CPAP machine, sleep apnea sufferers can:
- Sleep better
- Snore less
- Avoid the more serious side effects of sleep apnea.
People who have mild to moderate sleep apnea or cannot tolerate a CPAP machine are good candidates for oral appliances.
Like a sports mouth guard, the oral appliance holds the jaw forward in a way that keeps the airway open. Oral appliances are comfortable to wear and are quieter and more portable than CPAP machines.
Medicare Coverage for Sleep Apnea Treatment
If you are diagnosed with sleep apnea, Medicare will cover 80 percent of the cost of an oral appliance or CPAP machine as “durable medical equipment“. To avoid unexpected additional costs, be sure to get your equipment from a supplier that accepts Medicare assignment.
In some states, you must get your equipment from a supplier who participates in Medicare’s competitive bidding program. You can find more information about locating a supplier in your area here.
If you plan to use a CPAP machine, here are 4 things to know about Medicare coverage:
- There is a three-month trial period. During this time, Medicare will pay 80 percent of the cost of renting the CPAP machine, plus 80 percent of the cost of masks, tubing and other necessary supplies.
- Medicare will continue covering your CPAP machine after the first three months if your doctor confirms that CPAP therapy is helping your condition.
- Medicare will pay the CPAP supplier a rental fee for 13 months. After that, you own the machine.
- If you already had a CPAP machine before you went on Medicare, there may be Medicare coverage for replacement machine rental or accessories.
When you have a Medigap plan, your Medigap coverage may reduce or even eliminate the amount you must pay out of pocket for a CPAP machine or appliance.
If you have Medicare Advantage, you also have coverage for sleep apnea diagnosis and treatment, but you may have copays or restrictions on the healthcare providers you can use.
Check with your provider before scheduling a sleep study or getting apnea treatment equipment.
Find Medicare Policies that Cover Sleep Apnea
A Medicare Supplement plan can greatly reduce the amount you have to pay out of pocket to treat sleep apnea and other chronic conditions. MedicareFAQ will help you find a plan that fits your needs and your budget. Fill out our form or call us for a free quote.