Diagnosing Sleep Apnea At Home
Getting a sleep apnea diagnosis does not need to be a stressful experience. You should always make regular visits to your doctor, but, if they want you to get tested for sleep apnea, they will just refer you to a sleep lab or a home sleep test provider. Rather than jumping through costly, drawn-out hoops, you are able to diagnose your sleep apnea at home with a home sleep testing kit.
Most at-home sleep testing kits do not even required a referral. You can take our patient questionnaire to see if you are a good candidate for sleep testing, and receive your kit in as few as 2-3 business days. Dont wait because your home sleep testing kit is the first step to a better nights sleep and a better quality of life.
Medicare Coverage Of Sleep Studies
Medicare Part B covers certain medically necessary sleep study tests if your doctor believes you have obstructive sleep apnea and you have clinical signs and symptoms for this condition you pay 20% of Medicare-approved charges plus any applicable Part B deductible. Medicare covers the PSG test test only if it is performed in a certified sleep lab facility. It may also cover certain types of home sleep study monitors if you have clinical signs and symptoms of obstructive sleep apnea. If youre diagnosed with obstructive sleep apnea, Medicare may also cover a three-month trial for CPAP therapy to determine how well you are responding to treatment for sleep apnea with a CPAP machine.
Because the Medicare coverage requirements are quite specific, its important to talk to your health-care provider about the test being ordered and whether the sleep study lab accepts Medicare assignment to determine your costs for any sleep studies he or she recommends.
Do you have more questions about Medicare coverage for sleep studies at home or in a sleep lab? Im available to discuss Medicare plan options with you at your convenience you can learn more about me by clicking the View profile button below. If you prefer, you can schedule a phone call or request an email by clicking one of the links below. To view plans in your area you may qualify for, click the Compare Plans button.
For more information on sleep studies:
How It Is Done
Sleep studies are usually scheduled for evening and night hours in a special sleep lab. But if you usually sleep during the day, your test will be done during the hours you normally sleep. You’ll be in a private room, much like a hotel room. For portable sleep monitoring, you’ll use equipment at home that records information about you while you sleep.
You’ll need to be at the sleep lab before the test so the technician can prepare you for the study. You may fill out a form about your sleep the night before. You may also be asked to fill out another form after the study about your sleep during the study.
After the test, you can shower and shampoo your hair to remove the glue from your body. Hair conditioner may help get the glue out of your hair.
Don’t Miss: Does Medicare Cover Gastric Bypass Revision
Does Medicaid Cover Cpap
Many sleep study diagnoses are treated using therapies such as CPAP, particularly for beneficiaries experiencing severe and unambiguous obstructive sleep apnea. The use of CPAP is covered under Medicaid when prescribed by the attending licensed technician.
However, if the beneficiary has been utilizing CPAP therapy under a different insurance plan and is looking to switch to Medicaid, the issue requiring CPAP may be considered a preexisting condition. In this case, the beneficiary must first be found in accordance with all applicable policy guidelines. This typically includes an initial doctors visit, even in the event that you are currently using CPAP therapy or have in the past.
To find out more about how much your sleep study may cost you, talk to your doctor or health care provider.
Supplemental Medicare Coverage For Sleeping Problems
Although Original Medicare 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 .
Get a quote from Medicare.org. We offer free comparisons for Medicare Advantage Plans , Medicare Supplement , and Medicare Prescription Drug Plans. Contact a licensed sales agent at TTY 711 to help you find the right Medicare coverage for your needs.
Recommended Reading: How Old Before You Qualify For Medicare
Will Medicare Cover A Cpap Machine
Medicare covers CPAP machines used to treat sleep apnea under the durable medical equipment benefit. To qualify for CPAP coverage, you must meet the following requirements:
- Complete a sleep test in a laboratory setting or by using an approved at-home test
- Be diagnosed with obstructive sleep apnea based on sleep test results
- Have a prescription for a CPAP machine from your doctor
- Get the CPAP machine from a participating Medicare supplier
Since CPAP treatment doesnt work for everyone, Medicare first covers the machine for a three-month trial period. After three months, your doctor will check how the treatment is working for you. Medicare may cover CPAP therapy long term if your doctor verifies in your medical record that you are using the machine and that its helping you.
But How Does The Affordable Care Act Impact Sleep Testing
The Affordable Care Act allowed insurance will continue to cover sleep testing as long as it is prescribed by a physician. The only costs patients have to pick up are the deductible and co-pay as designated in their insurance plans.
The biggest most notable change is the shift in the healthcare industry towards results-oriented treatment. This incentivizes insurance providers and patients to look at home sleep apnea testing as an option for diagnosis instead of the standard in-lab test. We’ve previously discussed the pros and cons of home sleep apnea testing vs. an in-lab study here. While home sleep apnea testing is indeed a cheaper alternative to an in-lab test, not all patients, especially those with complicated sleep conditions like respiratory failure or other comorbidities, can use HSAT as an option.
Don’t Miss: When Can You Get Medicare Health Insurance
A Medigap Plan Can Help Pay For Sleep Apnea Medicare Costs
The cost of sleep apnea testing and treatment can be lowered even more with the help of a Medicare Supplement Insurance plan.
There are eight standardized Medigap plans that fully cover the cost of the 20% Part B coinsurance payment required for covered sleep apnea testing and CPAP machine treatment.
A licensed agent can help you decide on a Medicare option that works for you. Call today to speak with a licensed agent and compare the Medigap plans that are available where you live.
Improved Quality Of Life With Cpap
While the idea of sleeping with a CPAP may be worrisome for many, the benefits of CPAP therapy far, far outweigh the drawbacks. The quality of life in sleep apnea was better after CPAP therapy than from baseline, according to Calgary Sleep Apnea Quality of Life Index. The SAQLI is a useful tool to evaluate the quality of life in sleep apnea, especially to highlight the benefits of CPAP therapy, even with short time monitoring.
After receiving CPAP therapy for only three months, individuals reported an improvement in daily functioning, social interactions, emotional functioning, symptoms, and their SAQLI baseline.
Recommended Reading: Is Silver Sneakers Part Of Medicare
Why It Is Done
Sleep studies may be done if your sleep is not restful or if you are tired all day. These studies can help find sleep problems, such as:
- Problems staying awake, such as narcolepsy.
- Problems with nighttime behaviors. These include sleepwalking, night terrors, bed-wetting, and REM behavior disorders .
- Conditions such as periodic limb movement disorder. This is repeated muscle twitching of the feet, arms, or legs during sleep.
- Seizures that occur at night .
- Ongoing problems that have not responded to treatment.
What Sleep Disorders Can Home Tests Detect
Currently, at-home sleep tests are designed to test for obstructive sleep apnea. These tests are recommended only for people with symptoms that indicate moderate to severe obstructive sleep apnea. Those with a history of cardiorespiratory diseases, stroke, insomnia, or hypoventilation should do their sleep study in a lab and not conduct an at-home sleep test.
Don’t Miss: Does Medicare Cover Lasik Eye Surgery
Types Of Sleep Apnea Tests
Essentially, a sleep apnea test is a study that measures your vitals during sleep. There are a few different ways to test for these vitals, so you and your doctor need to decide which of these options is best for your particular needs.
There are two basic forms of sleep testing: at-home sleep tests or in-lab sleep studies. Both of these options will vary in scheduling, time commitment, cost, and severity of potential disorder.
Home Sleep Apnea Tests
A home sleep test is an overnight unattended sleep study that is performed in the comfort of your own home, in your own bed. After receiving your Home Sleep Test device and activating the recording session, the device will monitor a series of biometric data while you sleepbreathing patterns, blood oxygen saturation, heart rhythms, respiratory effort, sleep positions, and more. After you mail the device back to your HST administrator, a board-certified sleep physician will interpret your results, giving you a diagnosis and, if necessary, a prescription for a treatment machine. Please note, that HSTs are only approved for adults 18 years and older and are frequently limited to only testing for Obstructive Sleep Apnea .
Polysomnography
What Are The Criteria For Medicare To Cover An In
Don’t Miss: What Is A Medicare Physical Exam
Youre Our First Priorityevery Time
We believe everyone should be able to make financial decisions with confidence. And while our site doesnt feature every company or financial product available on the market, were proud that the guidance we offer, the information we provide and the tools we create are objective, independent, straightforward and free.
So how do we make money? Our partners compensate us. This may influence which products we review and write about , but it in no way affects our recommendations or advice, which are grounded in thousands of hours of research. Our partners cannot pay us to guarantee favorable reviews of their products or services.Here is a list of our partners.
Who Can Interpret A Sleep Study For A Medicare Patient
Once the sleep study is completed and the data is scored, the report is sent to a sleep specialist for review and interpretation. Only a sleep boarded or board-eligible physician can interpret sleep studies for Medicare patients. The physician must meet one of the following requirements:
- Current certification in Sleep Medicine by the American Board of Sleep Medicine or,
- Current subspecialty certification in Sleep Medicine By a member board of the American Board of Medical Specialties or
- Completed residency/fellowship training by an ABMS member board
- Completed all requirements for subspecialty certification in sleep medicine and only until the time of reporting of the first exam which physician eligible or,
Recommended Reading: Is Medicare Medicaid The Same
Therapies For Sleep Apnea
While many experience anxiety or stress around the decision to treat their sleep apnea with continuous positive airway pressure or automatic positive airway pressure machines, these devices remain the most effective treatment for those suffering from all levels of sleep apnea.
CPAP and AutoPAP Treatment
For those curious about the differences between these two machines, the CPAP provides a continuous stream of light air pressure that prevents obstructions to the throat and chest during sleep, preventing apnea events.
The AutoPAP is a newer, more innovative option that senses obstructions or disturbances in your breathing and provides an increasing amount of airway pressure until the obstruction is eliminated. This is an extremely effective treatment for those experiencing severe snoring, apneas, and hypopneas during sleep. Some newer AutoPAP machines include built-in humidifiers to combat dryness that can result from the increased airway pressure.
Oral Appliances May Be An Option
If You’ve Already Been Diagnosed With Sleep Apnea
The good news is that under the Affordable Care Act insurance providers are not allowed to discriminate against people with preexisting conditions, including sleep apnea. In addition, patients cannot be denied coverage or charged more because of their diagnosis of sleep apnea.
A PAP machine is considered durable medical equipment , which means it may be subject to a new tax under the Affordable Care Act. Patients with Medicare are able to test a PAP machine for three months, and if the results are shown to be beneficial, Medicare will rent it for a period of 13 months prior to purchasing it.
Most insurance plans will continue to cover the costs of a PAP machine, but will require proof of patient compliance from the equipment provider before they pay for on-going device rental, purchase or additional replacement supplies.
In fact, most insurance compliance guidelines require that you show proof of using your device for a minimum of 4 hours per day at least 22 days out of a consecutive 30 day period within the preceding 90 days .
Don’t Miss: Do I Qualify For Medicare If I Am Disabled
How Does Medicare Cover Sleep Apnea
Sleep Apnea becomes more common as individuals age and is most prevalent among men over age 40. More than 50% of adults over 65 have some form of sleep-related concerns. Weight, smoking, alcohol use and other factors can also play a part in causing sleep apnea.
Fortunately, Medicare does provide benefits for the diagnosis and treatment of sleep apnea. You can qualify for Medicare if you are age 65 and older or if you are younger than 65 on Social Security Disability Income benefits for more than 24 months.
Medicare breaks its coverage down into two main parts: Part A hospital benefits and Part B outpatient benefits. Heres how these parts work to provide coverage for healthcare related to sleep apnea.
Use Of Serum Level Of Advanced Glycation End Products And Obstructive Sleep Apnea
In a meta-analysis, Wu and co-workers examined the difference in the serum level of advanced glycation end-products between patients with OSAHS and controls. These investigators carried out a systematic literature search using PubMed, Elsevier, SCI, Wanfang, Weipu, and China National Knowledge Internet. Eligible studies that reported the serum AGE level in patients with OSAHS were identified by 2 reviewers. Review Manager version 5.2 and R version 3.10 were employed for data synthesis. A total of 5 studies involving 670 subjects were identified. The meta-analysis showed that the mean serum AGE level in the OSAHS group was 0.98 mmol/L higher than those in the control group . The authors concluded that the findings of this meta-analysis showed that the serum AGE level was elevated in patients with OSAHS suggesting that AGEs may play an important role in insulin resistance in OSAHS and serve as a biomarker for patients with OSAHS with a high risk of type 2 diabetes mellitus.
Read Also: How To Qualify For Extra Help With Medicare Part D
Medicare Coverage For 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 Zs. 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 nights sleep. Learn which tests, items, and services Medicare covers for sleeping disorders.
The Silent Partner Osa Appliance
The Silent Partner was designed as an alternative to CPAP therapy for the treatment of night-time snoring and/or mild-to-moderate OSA by repositioning of the mandible. It is customized for each individual patient. The SilentPartner consists of a lower tray fitted over the lower teeth, an upper tray over the upper teeth, and a mechanism to attach the lower tray to the upper tray. The device allows the practitioner to determine the advancement of the mandible and the vertical opening for desired results. This technology platform consists of a stylus, slider, and the channels into which they are placed. The device has a 10-mm long channel in the lower tray behind the anterior teeth that is perpendicular to the patient’s tongue. This allows the upper component, which locks into the channel, to provide lateral excursion for the patient’s comfort. Prior to final insertion, the upper and lower trays are connected together by keying the stylus into the lower channel. The device’s upper component consists of a 16-mm long titanium channel into which a 9-position latched slider will let the practitioner place the stylus in the optimum position. Both the slider and the stylus are placed into the channel’s frontal opening and secured into place by tension attachment.
Don’t Miss: Does Medicare Cover Laser Surgery
Don’t Overlook Your Insurance Benefits
If you find yourself with symptoms of a sleep disorder and your doctor refers you for a sleep study, almost all insurance programs will cover all or most of the cost. Some plans like Medicare and Medicaid, also cover a home sleep apnea test, a secondary option for determining sleep apnea in patients with high probability.
