Sleep apnea is a serious disorder that affects your body’s ability to breath while you are sleeping. It results in your breathing stopping and restarting randomly, which can be dangerous for your overall health. The most common form of sleep apnea is obstructive sleep apnea, and Medicare does offer coverage for some dental appliances that can be used by Medicare recipients to address this issue.

What is Sleep Apnea?
Sleep apnea is described as a sleep disorder that results in the cessation of breathing, and the various types include obstructive sleep apnea, central sleep apnea, and complex sleep apnea syndrome. Obstructive sleep apnea is by far the most common sleep apnea diagnosis, and it is the main problem that Medicare coverage offers services for.

Obstructive sleep apnea occurs when the muscles in the back of the throat relax. These muscles are responsible for providing support for the tonsils, throat, and tongue, and when they relax, the opening in your mouth and throat can become much smaller. This limits airflow and can make it difficult for your body to get enough oxygen as you sleep.

If the body senses that its oxygen levels are dropping too low, it briefly wakes the individual up to improve breathing and increase airflow by contracting the throat muscles and opening the airway. However, this period of awakening is usually very short and often unnoticeable.

When the body does this, it can result in choking, snorting, or gasping for air, and this can repeat itself many times each hour for the duration of the night. This constant cycle can prevent deep sleep from occurring, leaving you tired the following day. Sleep apnea can also result in snoring, dry mouth, fatigue during the day, decreased focus, increased irritability, morning headaches, and more.

What Coverage Options Does Medicare Provide?
Medicare recipients that are diagnosed with sleep apnea have treatment options available to them. First, in order for Medicare to officially recognize a sleep apnea diagnosis, they require that a sleep study be done. A sleep study requires a physician’s order, and these studies can occur either at home or in a sleep lab facility. The at-home tests require that you wear a monitor while you sleep, and the sleep lab facilities include Type I tests that assess sleep stages and brain activity. If a type I test is ordered, it must be completed in a sleep lab facility.

If the sleep study confirms the sleep apnea diagnosis, Medicare coverage is available to provide you with equipment to help manage this issue. One of the most used pieces of equipment is a Continuous Positive Airway Pressure, or CPAP, machine. This machine utilizes a pressurized mask that helps to keep your airway open while providing you with humidified oxygen to increase oxygen levels in the lungs, reduce snoring, and improve your sleep.

Medicare also covers some other dental appliances that can help reduce the symptoms of sleep apnea. Many of these are mouthpieces that work to move the jaw into a specific position that opens the airway and promotes better breathing while you sleep. These dental appliances are much less bulky and are generally much more comfortable, making them easier to wear when falling asleep.

Regardless of the treatment option you select, if you have Original Medicare, you will most likely be responsible for covering 20 percent of the Medicare-approved costs as long as your physician accepts assignment and you get any equipment you are prescribed from a supplier that is participating in Medicare. The Part B deductible may apply. The remaining portion of the device is covered by Medicare Part B. If you are enrolled in a Medicare Advantage (MA) plan, you will have at least the same benefits as Original Medicare, but many MA plans offer additional coverage.

Sleep apnea is a fairly common diagnosis that can have serious health implications if it is left untreated. It is important to recognize the signs and symptoms of this disorder and seek your physician’s opinion if you feel you may have sleep apnea. Medicare does offer coverage options for both sleep studies to confirm the diagnosis and for the dental appliances used for treatment.

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