Getting enough sleep on a nightly basis is important for your body and brain to continue functioning correctly. The amount of sleep you need each night varies based on age and depends on individual needs, but the effects of lack of sleep are well documented. Exhaustion, depression, muscular fatigue, lack of balance, increased blood pressure levels, decreased attention span, and weight gain are just a few of the potential complications from a lack of sleep.

Sleep issues can arise for many reasons. Some people have difficulty falling asleep or staying asleep. If your sleep issues become chronic and start affecting your daily activities and overall health, there is help available. Sleep studies can help determine what is causing your disorder, and can lead to a diagnosis and treatment. If you are eligible for Medicare, your Part B coverage may help you get the sleep study care you need to get back to a regular sleep schedule.

What is a Sleep Study? 

During a sleep study, physicians evaluate a patient for a number of different sleep disorders. The sleep study can look for indications of narcolepsy, insomnia, sleep apnea, sleepwalking, and restless leg syndrome. Sleep studies involve measuring and recording certain readings over the course of a night to evaluate sleep quality and quantity, and any other clinical signs that could lead to the diagnosis of a sleeping disorder.

There are four main types of sleep studies available, and they are numbered one through four. All of these tests have the potential to be covered by Medicare.

Type I: Type I sleep tests are performed at a sleep lab facility and must be taken overnight.
Type II: Type II tests utilize seven different channels to regulate body and brain function, including heart rate, oxygen levels, and breathing rate. This type of test can be performed in a sleep lab facility or at home.
Type III: Type III sleep tests measure four different metrics: airflow, heart rate, oxygen levels, and respiratory effort. These tests can also be performed in or out of a sleep lab facility.
Type IV: Type IV sleep testing utilizes three or more channels that can look at activity and rest cycles, oxygen saturation in the blood, artery tone, and more. This test can also be done in or out of a facility.

What Do Medicare Insurance Plans Cover? 
In order for a sleep study to be covered by Medicare Part B (Medical Insurance), your care must be deemed medically necessary.  For instance, treating obstructive sleep apnea is considered medically necessary care. Sleep apnea is described as a condition that results in difficulty breathing while you sleep. It can result in snoring and gasping for air during the night. It can also reduce sleep quality and cause fatigue, irritability, lack of concentration, and more.

In order for a sleep study to be covered, it must be requested by a licensed physician. In the past, all sleep studies had to take place in a Medicare-approved sleep lab facility. However, more at-home studies are being approved for coverage by Medicare. These studies are much more convenient, and their results can lead to a diagnosis when combined with a physician’s visit.

If you are diagnosed with sleep apnea, treatment using a CPAP machine is also covered by Medicare insurance plans. CPAP stands for Continuous Positive Airway Pressure, and these devices work to maintain the pressure in your throat to prevent it from collapsing when you breathe in. These machines also help to improve breathing ability and regularity.

If you suffer from sleeping problems and believe that you may have a sleeping disorder, consult your doctor about participating in a sleep study. Medicare Part B offers coverage for all four types of studies and the necessary treatments afterwards given a diagnosis. Medicare Part B is responsible for covering healthcare costs for medically necessary procedures, services, and supplies that are administered at a doctor’s office or in an outpatient setting.

If you have Original Medicare, you will likely pay 20% of the Medicare-approved amount for your sleep study, and the Part B deductible will apply. If you are enrolled in a Medicare Advantage (MA) plan, you will have at least the same coverage as Original Medicare Part A and Part B, but many MA plans offer additional coverage. Check with your plan to find out your exact costs of participating in a sleep study.

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