Medicare coverage for Sleep Medicine
Medicare coverage for Sleep Medicine
A friend of mine told me recently that Medicare does not cover sleep medicine. That sounded absurd to me, so I asked my insurance agent. She said it is covered under Part D. We are totally new to medicare and trying to figure things out as we go. Does anyone know about this, and Medicare's limitations on care?
Re: Medicare coverage for Sleep Medicine
Medicare does indeed cover cpap/apap machines as well as masks.
It is NOT part D though....part D is prescription drug coverage.
Instead the machines and masks are covered under part B coverage.
There are some limitations and criteria that need to be met but I have been on cpap for over 15 years now and Medicare paid for the sleep studies as well as my equipment.
Here's a list of items and their replacement time frame that Medicare goes by.

It is NOT part D though....part D is prescription drug coverage.
Instead the machines and masks are covered under part B coverage.
There are some limitations and criteria that need to be met but I have been on cpap for over 15 years now and Medicare paid for the sleep studies as well as my equipment.
Here's a list of items and their replacement time frame that Medicare goes by.

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Re: Medicare coverage for Sleep Medicine
I'm new to Medicare as well. Once you were on Medicare, did you need to have a sleep study done before you could get CPAP supplies (filters, masks, tubing, etc.)? Was preauthorization required for the sleep study?Pugsy wrote: ↑Sun Jan 12, 2025 9:24 pmMedicare does indeed cover cpap/apap machines as well as masks.
It is NOT part D though....part D is prescription drug coverage.
Instead the machines and masks are covered under part B coverage.
There are some limitations and criteria that need to be met but I have been on cpap for over 15 years now and Medicare paid for the sleep studies as well as my equipment.
Here's a list of items and their replacement time frame that Medicare goes by.
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Re: Medicare coverage for Sleep Medicine
I was on Medicare before I ever had (or thought about having) a sleep study....SleepySunflower wrote: ↑Thu Jan 16, 2025 4:48 pmOnce you were on Medicare, did you need to have a sleep study done before you could get CPAP supplies (filters, masks, tubing, etc.)? Was preauthorization required for the sleep study?
so I don't know about the preauthorization (wasn't part of that) but it wouldn't surprise me if it was required and obtained without my participation in the process.
Medicare does require a sleep study and documentation or proof of need before they will pay for anything.
The sleep study (home or in a lab setting) does have to meet certain diagnostic criteria though.
_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier |
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/ |
I may have to RISE but I refuse to SHINE.
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Re: Medicare coverage for Sleep Medicine
Same question here: I’ve been using a CPAP for over a dozen years and am soon starting on Medicare. Will I need a sleep study to get supplies? (I hope not!)
Thanks for any guidance!
Thanks for any guidance!
- ChicagoGranny
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Re: Medicare coverage for Sleep Medicine
If you or your doctor has copies of a sleep study which diagnosed you before you were Medicare-eligible, you do NOT have to have another study for Medicare.
You will need a prescription for supplies, masks and machines.
You will need a prescription for supplies, masks and machines.
"It's not the number of breaths we take, it's the number of moments that take our breath away."
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