The National Council On Aging Has A New Guide That Can Help
About 30% of Americans experience poor sleep due to sleep apnea which often causes those affected to feel like a tired - all - the - time zombie. The most frequently recommended sleep apnea treatment — a CPAP machine — offers a restful and healthy night’s sleep, but many people struggle to use it. In fact, studies (https://www.ncbi.nlm.nih.gov/books/NBK535538/) suggest that from one third to half of patients either stop using their machines or never bother to fill their prescription.
But untreated sleep apnea can be dangerous for your health. With this disorder, breathing stops and starts frequently during sleep and it can lead to, or exacerbate, health problems. There’s an increased risk of high blood pressure, stroke, and heart attacks. Continuous positive airway pressure therapy (CPAP) machines blow a stream of air into the back of the throat to allow people to breath easier.
Finding the right CPAP machine with a mask that fits comfortably through the night can feel overwhelming when also trying to navigate treatment options and paying for it all. Costs for a CPAP can be $1,000 or more in the first year. Fortunately, the team at the National Council on Aging (NCOA) has released a guide (https://ncoa.org/adviser/oxygen-machines/does-medicare-cover-cpap-machines/ ) that explains Medicare coverage of CPAP machines and supplies.
Here are key takeaways from their guide:
- Medicare covers the cost of CPAP machines and supplies.
- The out-of-pocket costs that you’ll be responsible for paying will vary based on your insurance provider, your plan and, whether you choose an enrolled (or in-network) doctor and supplier.
- If you are an Original Medicare beneficiary (not enrolled in a Medicare Advantage plan) going through an enrolled doctor and supplier (providers who participate in Medicare), you can expect to pay 20% of the Medicare approved amount for the CPAP machine and supplies.
- After you’ve confirmed that your doctor and the supplier are enrolled and you’ve paid a deductible, Medicare Part B typically covers a three - month trial of CPAP therapy.
- For Medicare coverage, you’ll need a diagnosis of Obstructive Sleep Apnea from a sleep study.
Medicare requires patients to start with a three - month trial. After that trial period, Medicare will likely require confirmation from your doctor that you use the machine nightly as prescribed, and that CPAP therapy is helping your condition.
To get the National Council On Aging’s full Guide to Medicare Coverage of CPAP Machines and Supplies in 2023 visit: https://www.ncoa.org/adviser/oxygen-machines/does-medicare-cover-cpap-machines/.
