Does Medicare Cover Sleep Apnea? 

Getting a good night’s rest is vital at any age, but as you get older, quality sleep is essential to your health and well-being. Seniors tend to require more quality sleep due to the natural slowdown in metabolism and other bodily processes that comes with aging. Additionally, illness and healing from injuries require quality sleep in order for the immune system to overtake viruses and repair damaged tissue.

Unfortunately, quality sleep can be hard to come by as you get older. Many seniors experience changes in sleeping habits as they age, and concerns like sleep apnea can also rob retirees of a good night’s rest. Sleep apnea is one of the leading causes of restless sleep, but sleep apnea can also be a precursor to serious conditions like cardiovascular disease.

What causes sleep apnea?

Sleep apnea can be caused by different factors. One of the more common forms of sleep apnea is obstructive sleep apnea. This condition occurs when your airways become blocked during sleep, and it can result from being overweight, drinking alcohol before sleep or other lifestyle factors.

Central sleep apnea occurs when the brain doesn’t properly send the right signals to the body to continue breathing during sleep. Breathing can become interrupted during central sleep apnea despite no blockages in the airways.

How is sleep apnea treated?

Seniors who suffer from either type of sleep apnea have a variety of treatment options available, but which ones work best will depend on the cause of your sleep apnea as well as the severity of your condition. A continuous positive airway pressure (CPAP) system is usually used to help seniors suffering from obstructive sleep apnea. This machine gently forces air into your nose through a mask that is worn during sleep to keep your airways open. Central sleep apnea may need to be treated using prescription medications and/or behavioral therapy.

How does Medicare cover sleep apnea?

Thankfully, seniors who are experiencing the effects of sleep apnea can turn to Medicare benefits for help. Original Medicare insurance covers sleep apnea treatment in a number of ways, both inpatient and outpatient.

Medicare Part B, the outpatient benefit of Original Medicare, will cover visits with your doctor to discuss your concerns about sleep apnea. It will also help cover the cost of having a sleep study conducted if your doctor believes that it is medically necessary. Medicare Part B is optional Medicare coverage, and it does carry a premium and deductible. Both of these costs can change from year to year, and your premium may go up or down based on your income and tax filing status.

Medicare Part B durable medical equipment (DME) benefits for CPAP Equipment

Medicare Part B also covers durable medical equipment (DME), so coverage is available for CPAP machine rental and purchase agreements. Additionally, accessories like hoses and masks are covered by Medicare Part B’s DME benefits. You need to be aware, however, that the purchase or rental of CPAP equipment is only covered by Medicare benefits if the equipment comes from a Medicare-approved supplier. Purchasing or renting CPAP equipment on your own from a supplier that is not pre-approved by Original Medicare insurance generally results in Medicare recipients being responsible for the full cost of the equipment.

Inpatient sleep apnea treatment and Medicare insurance

Sleep apnea treatment that is administered to Medicare recipients in an inpatient setting will be covered by Medicare Part A. This part of Medicare covers all services, medications and equipment usage while admitted to a hospital or skilled nursing facility within a limited amount of time each benefit period.

Medicare coverage for sleep apnea medications

If you need help paying for prescription drugs, you’ll need to enroll in Medicare Part D. If you have Original Medicare, you can enroll in a stand-alone Prescription Drug Plan (PDP). As an alternative, you can enroll in a Medicare Advantage plan that includes prescription drug coverage.

If your doctor believes that prescription medications are required to treat your sleep apnea, you can rely on Medicare Part D to provide coverage. Medicare Part D plans cover medications that are listed in a formulary, and each plan has its own formulary. If your sleep apnea medication is not listed in your plan’s prescription drug formulary, an exception form can be filed to obtain a coverage review and determination.