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Medicare Coverage for Sleeping Disorders

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Medicare Coverage for Sleeping Disorders

Thursday, February 8, 2018 6:56 AM

 Medicare Sleeping Disorders

Most experts recommend older adults get seven to nine hours of sleep per night; however, age-related changes in sleep patterns­ – including trouble falling or staying asleep – can make it difficult to catch enough Z’s. Lack of sleep can cause many problems, such as excessive daytime sleepiness, falls, overuse of sleep aids, depression, irritability, problems with attention and memory, high blood pressure, diabetes, stroke, and obesity.

If you or a loved one has a sleeping disorder, Medicare may be able to help with a good night’s sleep. Learn which tests, items, and services Medicare covers for sleeping disorders.

Does Medicare cover sleep studies?

Sleep studies help doctors diagnose sleep disorders such as sleep apnea, periodic limb movement disorder, narcolepsy, restless legs syndrome, insomnia, and nighttime behaviors such as sleepwalking and REM sleep behavior disorder. Medicare may pay for “medically necessary” testing [such as a multiple sleep latency test (MSLT) or maintenance of wakefulness test (MWT)] that sometimes occur with sleep studies. Sleep testing devices measure “channels” of information while you sleep that may include eye movements (EOG), leg movements, respiratory effort, pulse, oxygen saturation, nasal flow, and snoring. These channels vary in every lab and may be adapted to meet the doctor's requests.

Does Medicare cover sleep apnea testing? Medicare Part B (Medical Insurance) may cover type I, II, III, and IV sleep tests and devices when ordered by a doctor to help diagnose obstructive sleep apnea (OSA) in beneficiaries with clinical signs and symptoms of OSA. The Centers for Medicare & Medicaid Services categorizes sleep study types as follows:

  • Type I: A polysomnogram (PSG) performed overnight in an attended sleep lab facility.
  • Type II: Performed unattended in or out (home sleep test [HST]) of a sleep lab facility or attended in a sleep lab facility. A sleep testing device that measures seven different channels, including heart rate, air flow, and oxygen levels.
  • Type III: Performed unattended in or out (home sleep test [HST]) of a sleep lab facility or attended in a sleep lab facility. A sleep testing device that measures four different channels, including airflow, respiratory effort, heart rate, and oxygen levels.
  • Type IV: Performed unattended in or out (home sleep test [HST]) of a sleep lab facility or attended in a sleep lab facility. A sleep testing device measuring three or more channels, one of which is airflow. Sleep testing devices with three or more channels that include actigraphy, oximetry, and peripheral arterial tone may be covered.

Does Medicare cover CPAP therapy?

Continuous positive airway pressure (CPAP) therapy is a common treatment for obstructive sleep apnea. A mask or nosepiece worn over the face delivers constant and steady air pressure from a machine to help with breathing while asleep. If you are diagnosed with obstructive sleep apnea after sleep study tests, Medicare may cover a three-month trial for CPAP therapy (including CPAP or sleep apnea equipment and accessories) to learn how well you are responding to treatment for sleep apnea with a CPAP machine. Medicare may extend coverage if you meet in person with your doctor, and your doctor notes in your medical record that the CPAP therapy is helping you. 

Supplemental Medicare Coverage for Sleeping Problems

Although Original Medicare (Part A and Part B) helps cover seniors with certain sleeping disorders, it does not cover everything. If you have been diagnosed with sleep apnea and need additional coverage, you may want to consider a Medicare Supplement Plan (Medigap).

Get a quote from Medicare.org. We offer free comparisons for Medicare Advantage Plans (Part C), Medicare Supplement (Medigap), and Medicare Prescription Drug (Part D) Plans. Contact a licensed sales agent at (888) 815-3313 - TTY 711 to help you find the right Medicare coverage for your needs.

Related Information:

What Is Medigap?

10 Reasons to Consider a Medicare Advantage Plan

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Last Revised 11/15/2017