Sleep apnea is a common condition with which many people struggle. Medicare Part B provides coverage for sleep apnea, including doctor visits, sleep studies, and equipment to treat the disorder when a physician deems it medically necessary.
Depending on the Medicare plan, you may be responsible for a portion of the cost. We are here to familiarize you with the sleep apnea devices covered by Medicare.
Does Medicare Cover CPAP Machines?
The most common type of sleep apnea is obstructive sleep apnea. When someone has this condition, the soft tissue at the back of their throat collapses during sleep.
Sleep apnea is often treated using continuous positive airway pressure, or CPAP, machines. Patients use these machines with breathing masks during sleep.
Medicare partially covers the cost of a medically necessary CPAP machine as durable medical equipment. To avoid incurring additional costs, Original Medicare (Medicare Part A and Part B) beneficiaries must receive their CPAP machine from a supplier accepting Medicare assignment.
Additionally, required supplies for a CPAP machine receive coverage through Medicare. Keep in mind that the Medicare Part B deductible applies to all equipment.
If you have a Medicare Supplement (Medigap plan), it will cover the remainder of the cost. Medicare Part B will pay for 80% of sleep apnea devices covered by Medicare after you meet the deductible. However, if Medicare approves your device, Medigap will pay for the remaining 20%, and you will receive complete coverage.
Copays, network restrictions, and deductibles could apply for those with Medicare Advantage. Check with your provider before scheduling a sleep study or getting sleep apnea treatment equipment.
Does Medicare Cover Alternative Sleep Apnea Treatment?
Smoking cessation and other lifestyle changes can sometimes keep sleep apnea at bay. However, if your condition is moderate to severe, it may require further treatment.
Popular alternative treatments to CPAP for sleep apnea include BiPAP, APAP, dental appliances, surgery, weight loss, and positional therapy.
Under certain circumstances, Medicare will cover each of these alternative treatment options. However, Medicare will only cover one treatment option at a time.
For example, if you receive a CPAP machine through Medicare, they will not cover the positional therapy you receive simultaneously. The reason for this is that both treatment options have the same goal. Covering two treatment types would be redundant for Medicare.
Medicare CPAP Guidelines for 2022
Beneficiaries must meet specific criteria to qualify for Medicare coverage of a CPAP machine.
- Complete a sleep study monitored by a licensed health professional
- Diagnosed with sleep apnea based on sleep study results
- Obtain a CPAP prescription from your doctor
- Purchase a CPAP from a participating Medicare supplier
Because CPAP treatment is not effective in every case, Medicare covers a three-month trial period with a CPAP machine. After three months, your doctor will reevaluate your need for the CPAP machine and if the treatment is working for your condition.
After this review, Medicare will decide to cover CPAP treatments long-term or not to cover the machine based on your doctors’ assessment.
Does Medicare Cover a Sleep Study for Sleep Apnea?
Medicare can offer coverage for sleep studies. However, before treatment, the patient must meet specific criteria.
Medicare Part B can cover a sleep study test if your doctor orders it, if medically necessary to diagnose a condition such as sleep apnea and if sleep is recorded and staged. However, Medicare will not cover a sleep study for chronic insomnia.
Even with coverage, you may be responsible for some of the costs. If you have a Medicare Advantage plan, talk to your plan provider about in-network practitioners, coverage, and costs. Those with a Medigap policy may pay little to nothing out-of-pocket when receiving treatment.
Does Medicare Pay for Dental Appliances for Sleep Apnea?
Oral appliances for obstructive sleep apnea receive coverage if you meet specific criteria. The mandibular advancement device is the most popular dental appliance to help treat sleep apnea. This retainer-style medical oral appliance is one of the sleep apnea devices covered by Medicare if the situation qualifies. Thus, Medicare will cover the device if it is medically necessary.
A dental appliance is only covered by Medicare if it is your only form of treatment for sleep apnea. If you receive positive airway pressure (PAP), Medicare will not cover the dental appliance as it is viewed as a convenience item. The same applies to CPAP, BiPAP, and APAP.
PAP treatment is considered superior to dental appliances. So, Medicare tends to cover PAP over dental appliances.
How to Get a CPAP Machine Through Medicare
If you are looking for the best coverage for your sleep apnea needs, we can help! A Medigap plan can cover the holes Original Medicare leaves open and save you money. So, if you qualify for a CPAP machine or any of the other sleep apnea devices covered by Medicare, a Medigap plan can provide you with complete coverage!
Call the number above for a free Medicare consultation. Can't speak on the phone now? Fill out our online rate form to receive a comparison of plans near you.
- Sleep Apnea, Mayo Clinic . Accessed May 2022.
- Sleep Apnea, Sleep Foundation. Accessed May 2022.
- CPAP Coverage, Medicare. Accessed May 2022.
- Sleep Studies, Medicare. Accessed May 2022.