Does Medicare Cover Sleep Apnea Testing ?

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does medicare cover sleep apnea-testing

Sleep Apnea and other sleep related disorders are typically diagnosed through a sleep study such as a polysomnogram. Typically, a doctor will recommend this type of study if you have clinical signs of Obstructive Sleep Apnea (OSA). If you are enrolled in Medicare (Part A and Part B) then you may be eligible for certain types of sleep studies to be covered, assuming that your doctor deeps this medically necessary.

Obstructive Sleep Apnea (OSA) is a disorder in which breathing stops for periods of time during sleep. It is estimated that up to 20% of Americans suffer from sleep apnea, although many people go undiagnosed for long periods of time. Because this serious condition is often related to people who are aging, there is a common need for diagnosis in people who are participants in Medicare.

Symptoms of Sleep Apnea

If you suspect you have sleep apnea, you may be experiencing symptoms such as:

  • Loud snoring
  • Waking up in the morning with a sore throat or dry throat
  • Insomnia or restless sleep
  • Sleepiness during the day, particularly during activities such as driving
  • Waking up in the night with a choking or gasping sensation occasionally
  • Mood changes, irritability, memory loss, difficulty with concentration
  • Decreased libido
  • Weight gain
  • Waking many times in the night to go to the bathroom

Risk Factors for Sleep Apnea

Certain people are more likely to be at risk for developing sleep apnea due to a variety of different circumstances. Here are some of the more common risk factors that may mean a person is more likely to have sleep apnea:

  • Obesity or being overweight
  • Family history of sleep apnea
  • Large neck size (circumference 17” or more for men, 16” or more for women)
  • Middle age
  • Being male
  • High blood pressure
  • Use of narcotics
  • Recessed jaw

If you believe that you may be at risk or showing symptoms of sleep apnea, it is important to be sure that you contact a medical professional right away. Sleep apnea may be associated with many different health problems, including stroke, heart disease, weight gain, and various other serious health issues. Diagnosis of sleep apnea is typically determined through the process of a sleep study.

Types of Sleep Studies

Sleep studies allow medical professionals to determine the presence and severity of various sleeping disorders. This may include sleep apnea, narcolepsy, insomnia, restless leg syndrome, or other sleep related disorders. This provides not only a diagnosis, but also offers information on the best forms of treatment that might work for each specific patient.

Polysomnogram (PSG)

This may also be referred to as a Type I study, a polysomnogram is performed in a clinic with labs dedicated to testing various aspects that allow for a diagnosis of sleep apnea. This may include testing brain activity, oxygen levels in the blood, eye movement, blood pressure, heart rate, and possibly leg or body movement during sleep. A sleep lab room typically resembles a hotel room (more than a hospital or doctor’s examining room) and allows medical professionals to observe and measure your patterns while you sleep.

If your doctor suspects that you have sleep apnea, and the beginning of the test verifies this, you may be connected to a CPAP machine later in the test. This will help to determine if your sleep pattern improves with the use of a breathing machine, and allows the experts to determine the ideal settings for your health needs.

Home Sleep Test (HST)

Similar to a polysomnogram, this sleep test is conducted in the comfort of your own home. You will be given a portable monitor that will allow to measure limited aspects of your sleep patterns, such as blood oxygen levels or heart rate. Type II devices provide up to seven different measurements such as oxygen levels, air flow, or heart rate. Other types of devices will measure different aspects of your sleeping patterns. If you receive this test, your doctor will arrange for you to pick up the needed device at a sleep clinic for your use at home. Medicare sometimes approves coverage for home sleep tests, but they may require it to be supervised by a physician.

Multiple Sleep Latency Test (MSLT)

Typically occurring in conjunction with a polysomnogram (the following day), this test measures the amount of sleepiness you have and what sleep stages and types of sleep you are experiencing. Medicare may or may not cover this in connection with a Type I polysomnogram, so it important to verify this information prior to the test.

Maintenance of Wakefulness Test (MWT)

This test may also be performed on the day following a polysomnogram. A Maintenance of Wakefulness Test measures whether or not you have trouble staying awake, and if your inability to stay awake might be of concern for your safety or the safety of others (for instance, when driving). This test may not be covered by Medicare, so questions should be asked about coverage ahead of time.

Does Medicare Cover Sleep Apnea Testing or Treatment?

People who are eligible for Medicare Part B, who have been diagnosed with obstructive sleep apnea, may be covered for their diagnosis as well as at least a portion of their treatment plan. They should be given at least three months of trial coverage with a CPAP (Continuous Positive Airway Pressure (CPAP) machine. This should also include the necessary accessories such as hoses and masks. The user will typically pay 20% of the cost that Medicare has approved, for rental of the machine and other accessories needed for CPAP therapy.

Typically, Medicare will pay for the rental of the machine and, after 13 months of renting it, the user becomes the owner of the machine. In order to participate in this program, your doctor and/or supplier must be enrolled as a Medicare medical professional.

Sleep Apnea 101 ~ Start Here!

Conclusion

Medicare coverage for sleep studies has specific requirements, so it is important to be sure that your health care provider is aware of your needs. Whether or not you are on Medicare, if you suspect that you may have symptoms of sleep apnea, it is important to speak with a medical professional right away to get a diagnosis and treatment for this serious sleep condition.

 

- DOES MEDICARE COVER SLEEP APNEA TESTING ? - Medicare coverage for sleep studies has specific requirements, so it is important to be sure that your health care provider is aware of your needs.
Rachel has been sleeping comfortably for most of the past 35 years! She is living the 'American Dream' by specializing in sleep. She believes that everybody deserves to dream... So, she vows that she won't sleep well until everybody else can sleep well too.

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