February 26th 2024
By Ari Parker
Medicare only covers sleep studies for people who show symptoms of sleep apnea, but other treatment options for conditions that Medicare covers.
By Ari Parker
There's no doubt that a good night’s sleep is vital to our everyday health, and sleep disorders are more common than you might think. Over 50 million people in the U.S. have a sleep disorder. Sleep studies help doctors diagnose and evaluate sleep disorders to improve energy levels and health. You may need to undergo a sleep study if you have insomnia, hypersomnia, sleep apnea, restless leg syndrome, narcolepsy, or another sleep-related condition.
It’s important to know your coverage options for sleep studies and sleep-related health challenges. Medicare only covers sleep tests if you show symptoms of sleep apnea, but your prescription drug plan may pay for prescriptions that help you sleep better.
Medicare only covers sleep studies for people who show symptoms of sleep apnea. You must have a doctor order the test for you.
After you meet your Part B deductible, you’ll pay 20% of Medicare-approved costs for a sleep study.
There are various types of sleep studies, including a comprehensive overnight polysomnograph and an at-home test that you can administer yourself.
Many Medicare drug plans cover sleeping aids to treat insomnia. Medicare also covers devices and equipment like a CPAP machine to treat sleep apnea.
Also known as polysomnography (PSG), sleep studies are medical tests that diagnose and assess sleep disorders. During a sleep study, doctors monitor different body functions while you sleep to gather information about patterns, breathing, brain activity, and other relevant factors.
There are a variety of sleep tests that are used to diagnose different sleep conditions and measure bodily functions while you sleep. Your doctor will recommend a type of sleep study based on your specific symptoms.
Type I: Type I sleep studies, called polysomnograms, are comprehensive sleep studies conducted at a sleep center or lab. Doctors most often order them to diagnose sleep apnea, a sleep disorder that affects your breathing. During a polysomnogram, a healthcare professional measures your brain activity, eye movement, muscle activity, heart rate, breathing effort, airflow, and oxygen intake through various machines as you sleep.
Multiple sleep latency test (MSLT) and maintenance of wakefulness test (MWT): These tests measure how sleepy you are during the day. You’ll typically undergo these tests the day after a polysomnogram.
Type II, Type III, and Type IV: These are all at-home versions of the polysomnogram test that you can conduct yourself. When you sleep, you connect yourself to a monitor that measures different bodily functions. While a comprehensive Type I test measures many sleeping parameters, Type II, Type III, and Type IV studies focus on a few different measurements depending on the test.
Actigraphy: An actigraphy is a test that measures your sleep and napping times throughout the day through a device that resembles a wristwatch. It also observes your sleeping conditions, like whether or not there is light while you sleep.
Medicare Part B covers sleep studies if your doctor recommends that you need a test based on your symptoms related to sleep apnea. It won’t cover sleep studies for any other sleep-related issue. Another thing to note is that Medicare will only cover a Type I (polysomnogram) test if you meet both of the following conditions:
if your doctor orders the study
if you go to a sleep lab facility
Once you’ve reached your annual Part B deductible, you’ll have to pay 20% of the cost of the service. If you have Original Medicare, a Medigap plan can help you pay for some of these out-of-pocket costs.
Medicare Advantage plans cover the same services that Original Medicare does, but your out-of-pocket costs can vary widely depending on your specific policy. Medicare Advantage plans tend to be more restrictive as well. You may need prior authorization and/or a referral before undergoing a sleep study.
For at-home sleep tests, you’ll need portable study monitors and other equipment to observe you at night. If your doctor orders an at-home sleep test to diagnose sleep apnea, Medicare will cover the devices.
If you are diagnosed with sleep apnea, Medicare covers the cost of a BiPAP or CPAP machine to treat the condition.
While coverage for sleep-related issues outside of sleep apnea can be limited, Medicare drug coverage (Part D) may pay for sleeping aids, like medications for people with insomnia. Part D policies vary in what drugs they cover. Check your formulary to see if medications to treat insomnia or a related sleeping issue are covered by your plan. If your drug plan doesn’t cover sleeping aids, you can request a formulary exception, or you can switch your plan during the annual Open Enrollment Period.
To get Medicare coverage for sleep studies, you’ll need to:
Show signs and symptoms of sleep apnea
Have a doctor order the test at a Medicare-approved sleep study facility
Get a referral and/or prior authorization in certain cases (if you have a Medicare Advantage plan)
Medicare coverage for sleep studies can be limiting, especially if you have a sleeping condition other than sleep apnea. Depending on your plan, there could be other options to cover diagnostic tests or treatment. A licensed Medicare Advisor can help you understand all of your plan’s benefits so you can save money and get the services you need. Get started with a Chapter Advisor by calling 855-900-2427 or scheduling a time to talk.
