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What is Sleep Apnea?
"Apnea" literally means without breath. People with OSA (obstructive sleep apnea) will stop breathing repeatedly during their sleep, sometimes hundreds of times during the night, and often for a minute or longer. This is generally caused by a blockage of airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. A that point, the brain briefly arouses people with sleep apnea in order for them to restore breathing. Consequently sleep is constantly interrupted leading to a very poor nights sleep. Untreated, several health issues can result, including but not limited to heart problems, weight gain, headaches, and memory loss. Fortunately, this condition can be treated with a CPAP machine.
Are CPAP Machines Covered by Medicare?
When use of the CPAP is certified by the prescribing physician, Medicare will cover the rental of a single level CPAP device, if during sleep, you temporarily stop breathing. Medicare covers rental of the CPAP for up to 3 months. If you require the CPAP beyond 3 months, it must again be certified by the prescribing physician.
How Do I Qualify?
Step one: You must have a face-to-face evaluation by the treating physician to be assessed for OSA, or sleep apnea. If sleep apnea is determined to be present, a prescription will be written for treatment.
Step two: The physician will refer you to a Medicare-covered sleep lab for a test that meets certain criteria. The lab will document the sleep patterns (number of times the patient wakes up). This information along with the physician's notes will determine if you are eligible for Medicare payment.
How Much Will This Cost Me?
Once the annual deductible of $162 (in 2011) is met for part B services, Medicare will pay 80% of the Medicare approved costs. Supplemental insurance may pick up the remaining 20%, depending on the individual policy. Without supplemental insurance, you would pay 20% of the total cost.
Where Do I Go To Get It?
Once you have been diagnosed with sleep apnea and have been prescribed CPAP therapy, you should choose a Medicare approved supplier to assist you in making the corrct choice. The CPAP machine is typically covered by insurance as durable medical equipment, and is most often rented or purchased. You should ask if the supplier is a participating supplier in the Medicare program. If the supplier is a participating supplier, they must accept assignment. This means they will bill Medicare for you. If the supplier is enrolled in Medicare, but isn't "participating", they have the option of billing Medicare or billing you. If the supplier is NOT enrolled in Medicare, Medicare will not pay your claim.
Are you active? Do you exercise? Do you travel away from home overnight? Do you go to higher altitudes? All these things should be considered when choosing a machine. Your Medicare approved supplier will help you decide which machine to use, based on your activities. Working together, you can choose a machine that works for you, and help alleviate the problems associated with sleep apnea.