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How Medicare Can Help with Sleep Apnea

Sleep apnea is a potentially serious condition that can lead to a number of uncomfortable symptoms and can ruin your sleep (as well as the sleep of your family). While mild sleep apnea may be able to be treated some lifestyle changes, more severe cases may require durable medical equipment or even surgery. In some cases, you may even need specific tests to figure out if you have sleep apnea or how bad it is. If you have Medicare, you may have some of these needs and services covered!

What is Sleep Apnea?

So, what exactly is sleep apnea, and why can it be so serious? Sleep apnea is a sleep disorder where the sufferer occasionally stops and starts breathing while asleep. Some symptoms of sleep apnea are loud snoring, insomnia, excessive tiredness during the day, and waking up with a dry mouth and headache. While you’re asleep, your bedmate may experience episodes where you stop breathing while you’re asleep or fits where you’re gasping for air.

More than 18 million adults have some form of sleep apnea in the United States. Technically, there are two types of sleep apnea. First, there is obstructive sleep apnea, the more common of the two, which is caused when soft tissue collapses during sleep, causing a blockage. The other type is central sleep apnea, which is caused by the brain failing to signal to the muscles to breath while you’re asleep. In 2006, the Mayo Clinic discovered a third type of sleep apnea that they called complex or treatment-emergent sleep apnea. People are diagnosed with complex sleep apnea when they have both obstructive and central sleep apnea.

In more severe cases of sleep apnea require further treatment, sometimes even medical equipment or surgery.

In many cases, sleep apnea can be treated through lifestyle changes that can prevent snoring. In more severe cases of sleep apnea, especially in cases of central or complex sleep apnea, require further treatment. Sometimes, the condition may even need medical equipment or surgery.

Sleep Studies and Medicare

To determine if you have sleep apnea and the severity, your doctor may order one of several types of sleep tests, sometimes called a sleep study or polysomnograph. The test’s type (under CMS Guidelines) is defined by where and how they’re given. Type 1 is a test given at a specialized facility under oversight by a sleep technologist. A Type 2 test is given at home without supervision with a portable type 2 monitor and at least 7 channels. Type 3 is similar to Type 2, with the differences regarding the portable monitor (Type 3 instead of Type 2) and the number of channels (4 instead of 7). Type 4 tests utilize Type 4 monitors with a minimum of 3 channels.

What’s Covered?

These sleep tests can be covered under Medicare Part B coverage. It will also assist with devices required for the tests. If you meet the requirements for coverage, you’ll only owe 20 percent of the Medicare-approved amount once you’ve met your Part B deductible.

What are the Requirements?

In order to qualify for Medicare coverage for polysomnography, you’ll need to display symptoms of sleep apnea to the extent that it becomes obstructive. A doctor’s order for a test will likely help significantly. Medicare will also only cover a Type 1 test (the only not at home test) is it’s given at a sleep lab facility and ordered by your doctor.

Medicare Coverage of CPAP

One of the most common treatment options for sleep apnea are continuous positive airway pressure (CPAP) machines. The CPAP machine utilizes a pump to control the flow of air by pushing air into the user to keep the airways open. There are other parts of the CPAP machine, like the masks and straps to keep the airflow connected to your face while you sleep. While some people dislike certain aspects of CPAP machines, these can be avoided, making it an effective solution to your sleep apnea.

What’s Covered?

If you qualify for coverage under Medicare, the rental of a CPAP machine similarly to other durable medical equipment. In order for the machine to be covered, though, your doctor and the supplier must accept Medicare assignment. Medicare pays the supplier for the rental of the machine if you use it for 13 months and if you use it without interruption. Once the 13 months ends, you own the machine. In terms of what you owe, you’ll pay 20 percent of the Medicare-approved amount for the rental of the machine and purchase of the necessary supplies. The Part B deductible will also apply.

What are the Requirements?

The requirements to get Medicare coverage for CPAP machines come in two main ways. First, you can qualify for coverage of CPAP therapy if you’ve been diagnosed with obstructive sleep apnea. If you’re unsure about a CPAP machine, Medicare may cover a three month trial, too. If you end up liking the machine, this can be extended under specific conditions. If you had a CPAP machine before enrollment, Medicare may cover the cost of a replacement machine rental or necessary supplies in certain circumstances.

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Sleep apnea can ruin your sleep, which can become a massive hinderance on your everyday life. If you qualify for Medicare, getting treatment and potentially fixing your sleep apnea problem becomes more achievable. Once that’s solved, you can finally get some z’s!

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