Does Medicare Cover Sleep Apnea?

Medicare Benefits Solutions
Aug 28, 2021

It is believed that sleep apnea affects tens of millions of people across the world. In the United States, obstructive sleep apnea is a concern for adults of all ages, although men are affected more frequently than women.

The two main types of sleep apnea are:

  • Obstructive sleep apnea
  • Central sleep apnea

Complex sleep apnea syndrome occurs when you have both central and obstructive sleep apnea.

The Mayo Clinic describes sleep apnea as a medical condition “in which breathing repeatedly stops and starts.” Sleep apnea causes different side effects that range from mildly annoying to downright dangerous.

TIP: Read our companion blog on how to fall asleep fast even when you’re not tired.

Sleep Apnea and Medicare Coverage

Medicare coverage for treatment of sleeping disorders is generally covered by Part B. Medicare Part B is the outpatient benefit of the program, and it provides benefits for things like doctor visits, surgery, and durable medical equipment.

Medicare benefits provided by Part B may include coverage for a three-month trial use of a CPAP machine. If the use of a CPAP machine is prescribed by your doctor, Medicare may cover the rental of the equipment for up to 13 months. In order for your machine to qualify, it will need to be prescribed by a Medicare-participating physician, and the equipment will need to be available from a Medicare-approved supplier.

After the machine has been in use for 13 months, Medicare pays it off. Keep in mind that Medicare coverage for treatment of sleeping disorders using CPAP follows the standard Part B deductible requirements. This means that you will be responsible for 20% of your costs while Medicare benefits cover the remaining 80%.

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What are the Causes of Sleep Apnea?

Apnea during sleep occurs when breathing is interrupted. This can occur for a number of reasons, including problems involving brain signals and the autonomic nervous system.

Additionally, apnea can take place when the throat muscles become too relaxed or weak and not enough air is allowed into the lungs. In some cases, both types of apnea can take place at once. This is referred to as complex sleep apnea syndrome.

TIP: Find out which plans offer the best cover for respiratory care and supplies and compare them against your existing Medicare coverage.

The Effects of Sleep Apnea

For some individuals, the first sign of sleep apnea is snoring. Other people will experience daytime fatigue and brain fog as the result of not reaching deep levels of sleep for long enough overnight.

Sleep apnea symptoms:

  • Snoring
  • Insomnia
  • Daytime sleepiness
  • Irritability
  • Gasping for air while sleeping
  • Morning headache
  • Waking up with a sore throat
  • Dry mouth

If breathing is stopped while sleeping and the process is prolonged, severe damage to the brain and other organs can occur, and death is even a concern in severe cases.

TIP: Try our Medicare plan finder and find out if your existing plan covers CPAP machines or other respiratory equipment for sleep apnea.

How is Sleep Apnea Treated?

If you suffer from sleep apnea, treatment depends on the cause. For many people, lifestyle changes, including losing weight, can help. For others, medications may be necessary.

The use of a continuous positive airway pressure (CPAP) device may be necessary or individuals who suffer from obstructive sleep apnea. A CPAP machine uses a mask that is worn overnight that delivers gently forced air to keep the airway open during sleep.

If you require admittance to a hospital for treatment of your sleep apnea, Medicare Part A, the inpatient benefit, will supply coverage. This coverage also applies when admitted to a skilled nursing facility.

TIP: Read about using a CPAP machine to help manage your sleep apnea.

Medicare and Sleep Apnea Medications

If prescription medications are required to treat your sleep apnea, Medicare may cover these under Part D. This is the prescription drug benefit, and it is optional coverage. If you carry Part D coverage, only medications listed in your plan’s formulary will receive coverage.

A formulary is a list of all prescriptions covered by your plan. If a medication is prescribed, but it is not listed in your plan’s formulary, you may need to work with your doctor to file an exception waiver if no suitable alternative exists.

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