Medicare Authorizes Funding for Home Sleep Studies

Medicare decisions about funding are important for everyone, not just for those on Medicare. Medicare's decisions about what to fund and what not to fund are seen as important evidence about what private insurance companies must fund as "necessary treatments" as opposed to elective procedures which insurance companies can opt against funding. When state regulating boards are considering decisions about coverage mandates for insurance companies, they look at Medicare decisions to decide what should be on the list.

Now, as part of its program to ensure that all sleep apnea sufferers over the age of 65 receive treatment for this serious condition that can lead to premature death, Medicare has decided to fund home sleep apnea tests, and prescriptions for sleep apnea treatments (including CPAP and oral appliance therapy) based on those home tests. This makes Medicare the first insurer to back diagnosis of sleep apnea using home test methods.

The use of home tests to diagnose sleep apnea is controversial among sleep scientists. Although some do not believe they are as accurate as lab-based tests, others argue that home sleep data, taken over a longer period of time under normal sleeping conditions, are actually more accurate. And recent research also supports the repeatability of home sleep apnea tests, which lends considerable credibility to their results.

Sleep apnea poses a serious health threat partly because it so often goes undiagnosed and untreated, we hope that this change will help people get the diagnosis and treatment necessary to avoid the dangers of sleep apnea. Home sleep studies come at a considerable cost saving to patients, costing about $200 with a $35 copay for Medicare, as opposed to a $1000 procedure with a $150 copay for laboratory sleep study. With reduced cost, people are more likely to get diagnosed. In addition, home sleep tests allow patients to be diagnosed more quickly than at sleep centers, which may have long waiting lists for sleep studies. We can only hope that more insurers will pick up this policy.

If you have been diagnosed with sleep apnea, we can help you get the best treatment for you. To learn more about your treatment options, schedule a sleep apnea treatment consultation at the Snoring & Sleep Apnea Treatment Center in Gurnee, Illinois today.