Does Medicare Cover Home Sleep Study?

If you are experiencing difficulty sleeping, you are all too aware at how much it affects your life. And you may be wondering why you’re not sleeping well and what you can do to get a good night’s sleep.

So how can you figure out why you’re having problems when sleeping? One common way is by doing a sleep study. With a sleep study your healthcare provider can learn if you are suffering from a sleep condition such as obstructive sleep apnea, or OSA.

If this is something you may need, a common question that comes up is, “does Medicare cover home sleep study?” In this article, we answer that question in clear, plain English. You’ll also get information about sleep study costs and more.

Does Medicare Cover Home Sleep Study?

The short answer is yes. Medicare will cover the cost of your home sleep study. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your home sleep study. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for a home sleep study. Original Medicare provides coverage for a home sleep study if it is considered medically necessary by your healthcare provider. Medicare Part B considers a home sleep study as medically necessary if it will be for diagnosing or treating sleep conditions like OSA.

Coverage for a home sleep study is provided by Medicare Part B. Medicare Part B provides coverage for all types of sleep studies from Type 1 to Type 4. However, Type 1 sleep studies must take place in a sleep lab facility for Medicare Part B to provide coverage.

In the past, Medicare Part B provided coverage for a sleep study if it took place in a sleep lab facility. However, nowadays they also provide coverage for home sleep studies. That is because home sleep studies are said to be more effective.

If you are diagnosed with OSA, Medicare Part B will provide coverage for CPAP therapy or any other treatment.

Medicare Part B covers 80 percent of the costs of a home sleep study. You will pay for the remaining 20 percent as a copayment.

Part C Coverage for Home Sleep Study

Medicare Advantage plans (Medicare Part C) also provide coverage for a home sleep study. These plans have to cover all the same treatments and services that Original Medicare covers. They will also offer members additional benefits that Parts A & B do not cover. Each Part C plan differs though on what additional benefits they provide and what the costs are.

How Much Does A Home Sleep Study Cost?

A home sleep study may cost somewhere from $150 to $500. Sleep studies done in the patient’s home are also less expensive than those done in a sleep study lab. The average cost of a sleep study in a sleep study lab ranges from $600 to $3,000.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.