Medicare coverage for Sleep Medicine

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
marypr2
Posts: 7
Joined: Sun Jan 12, 2025 9:28 am

Medicare coverage for Sleep Medicine

Post by marypr2 » Sun Jan 12, 2025 8:58 pm

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?

User avatar
Pugsy
Posts: 64829
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Medicare coverage for Sleep Medicine

Post by Pugsy » Sun Jan 12, 2025 9:24 pm

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.
Image

_________________
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.

SleepySunflower
Posts: 35
Joined: Wed Oct 01, 2014 11:36 pm

Re: Medicare coverage for Sleep Medicine

Post by SleepySunflower » Thu Jan 16, 2025 4:48 pm

Pugsy wrote:
Sun Jan 12, 2025 9:24 pm
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.
Image
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?

_________________
MachineMask

User avatar
Pugsy
Posts: 64829
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Medicare coverage for Sleep Medicine

Post by Pugsy » Thu Jan 16, 2025 5:15 pm

SleepySunflower wrote:
Thu Jan 16, 2025 4:48 pm
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?
I was on Medicare before I ever had (or thought about having) a 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.

TheWalkman
Posts: 9
Joined: Thu Oct 13, 2011 8:50 pm

Re: Medicare coverage for Sleep Medicine

Post by TheWalkman » Thu Jan 30, 2025 4:57 am

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!

User avatar
ChicagoGranny
Posts: 14990
Joined: Sun Jan 29, 2012 1:43 pm
Location: USA

Re: Medicare coverage for Sleep Medicine

Post by ChicagoGranny » Fri Jan 31, 2025 11:51 am

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.
"It's not the number of breaths we take, it's the number of moments that take our breath away."

Cuando cuentes cuentos, cuenta cuántas cuentos cuentas.