Will Medicare Cover a Sleep Study?
- Medicare does cover sleep studies if you show signs of obstructive sleep apnea. Learn about the levels of sleep studies that Medicare will cover, and find out if you’re eligible.
Medicare covers you day or night, and it will even cover you while you’re sleeping.
Many people may be surprised to learn that Medicare covers sleep studies. Below we’ll explain Medicare coverage for sleep studies and what you need to know if you’re considering participating in a sleep study.
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When Does Medicare Pay for a Sleep Study?
Sleep studies are covered by Medicare Part B health care coverage. And because Medicare Advantage insurance plans (Medicare Part C) are required by law to provide all of the same coverage as Part A and Part B, sleep studies are covered by these private Medicare plans as well.
In order to qualify for Medicare coverage, your doctor must confirm that you display clinical signs and symptoms of obstructive sleep apnea. The sleep study must be deemed medically necessary and requested by a Medicare-approved doctor.
All four levels of sleep studies (Type I, Type II, Type III and Type IV) are covered by Medicare. But a Type I study, which requires you to sleep overnight in a sleep lab facility under the supervision of a sleep specialist, must be specifically ordered by a doctor before Medicare will cover it.
Medicare may also pay for medically necessary sleep studies to test for:
- Periodic limb movement disorder
- Narcolepsy
- Restless legs syndrome
- Insomnia
- Sleepwalking
- REM sleep behavior disorder.
How Much Does It Cost to Have a Sleep Apnea Test?
When your sleep test is covered by Medicare Part B, you will typically be responsible for a 20% coinsurance payment of the Medicare-approved amount after you meet your annual Part B deductible ($203 per year in 2021).
If you have a Medicare Advantage plan, your coinsurance and deductible amounts may vary according to your plan.
What Types of Sleep Studies Does Medicare Cover?
There are four levels of sleep studies:
Type I
Type I sleep studies take place exclusively in a dedicated sleep lab facility and are observed in real-time by a Registered Polysomnographic Technologist (sleep specialist).
Type II
Type II sleep studies can be conducted in your home, a lab or a hospital. These home studies monitor your breathing, oxygen, heart rate and brain and muscle activity.
Type III
Type III sleep studies are conducted in your home and are often referred to as home sleep apnea testing. A sleep study kit records your sleep metrics, particularly snoring and airflow, in order to diagnose sleep apnea.
Type IV
Type IV sleep studies measure oximetry, or blood oxygen levels, and may also measure your heart rate. Type IV studies are often used to detect pediatric sleep disorders.
Is Sleep Apnea Covered by Medicare?
If you’ve been diagnosed with sleep apnea, Medicare Part B may provide coverage for a three-month trial of Continuous Positive Airway Pressure (CPAP) therapy. Coverage may be extended longer if your doctor determines the therapy is helping.
A CPAP machine is a form of positive airway pressure ventilation that provides a constant level of pressure to the upper airway and is used to help treat sleep apnea. Medicare Part B and Medicare Advantage plans will cover the rental of the machine and the purchase of necessary supplies.
Medicare Part D plans and Medicare Advantage plans with prescription drug coverage may cover medications used to treat sleep apnea and other sleep disorders.
You can compare Medicare Advantage and Part D plans online for free, with no obligation to enroll.
