Does insurance cover beds for sleep apnea?
SHARE: If you have been or might be diagnosed with sleep apnea, you're probably wondering if your insurance will cover the cost of your treatment. The answer is yes in most cases.
The SSA does not recognize sleep apnea as a disability. Conversely, if your sleep disorder is severe enough, you may meet eligibility standards based on other symptoms that result. To qualify for benefits, you must meet SSD's definition of disabled.
Insurance companies sometimes cover the cost of an adjustable bed when sleep apnea is a diagnosis and a doctors prescribes it. An adjustable bed can be a lifesaver for sleep apnea sufferers. They come in many sizes and are available with several options from massage and heat to split frame and memory foam mattresses.
Since CPAP is the most common form of sleep apnea therapy, it's generally covered by most insurance policies. CPAP is “considered to be durable medical equipment,” writes Dr. Helene A. Emsellem, director of the Center for Sleep and Wake Disorders.
In general, chronic conditions like sleep apnea will result in higher life insurance quotes. But if you're taking active steps to treat your condition and your diagnosis is mild, you should be able to get insured at an affordable price.
If you suffer from sleep apnoea, you may be eligible to claim Personal Independence Payments (PIP).
Life Expectancy of People Sleep Apnea
People with severe sleep apnea under 50 can expect to live between eight to 18 years if they receive treatment with oral appliance therapy or the CPAP machine.
For a person to be eligible for an adjustable bed that qualifies as DME, their doctor must write a prescription stating that the bed is medically necessary. According to the eligibility requirements, the bed is a medical necessity if a person needs: positioning to relieve pain or promote body alignment.
You may even be able to qualify for a CPAP system for free. Two organizations that assist with sleep apnea treatment for uninsured patients are ASAA CPAP Assistance Program and The Reggie White Foundation.
Original Medicare does offer coverage for adjustable beds as part of a beneficiary's Part B benefits. Part B offers coverage on durable medical equipment (DME), which includes adjustable beds. Medicare will pay for 80% of the cost of an adjustable bed after you have met your Part B deductible.
What happens if I don't use my CPAP for a week?
Taking a week-long break from your CPAP can lead to a recurrence of your sleep apnea symptoms at the same intensity as before you started treatment. Although the most noticeable effect might be fatigue due to the return of sleep apnea, underlying damage to your body starts accumulating.
All health care card holders receive government subsidised CPAP equipment with a complete set of consumables inclusive of mask at first prescription. The patients pay an ongoing annual $50 'rental' fee and are responsible for the costs of replacement masks/tubing etc.
In easier to understand terms, you have a full 90 day (or 3-month period) to wear your CPAP for a minimum of 4 hours each night for 70% of the time. To break it down further, 70% usage is the same as 21 days out of 30 consecutive days.
The VA rates sleep apnea on a range of 0% for a documented sleep disorder that is asymptomatic, 30% for persistent day-time sleepiness, 50% with the required use of a breathing device such as a CPAP machine, or 100% with chronic respiratory failure with carbon dioxide retention or cor pulmonale (abnormal enlargement of ...
50%: A 50% disability rating is assigned for sleep apnea when the veteran requires the use of a breathing assistance device such as a CPAP machine. With a 50% rating, the veteran will be entitled to partial disability payments (in 2023, $1,041.82/month) and other benefits, including broader healthcare coverage.
Sleep apnea is a serious medical condition. Complications of OSA can include: Daytime fatigue. The repeated awakenings associated with sleep apnea make typical, restorative sleep impossible, in turn making severe daytime drowsiness, fatigue and irritability likely.
Under the VA Ratings Schedule, a veteran with sleep apnea may be entitled to between 0% and 100% benefits based on their condition.
Sleep apnea is a long-term, chronic condition. For some people, it's possible to resolve it by reducing their weight or undergoing certain treatments. For others, it may be a lifelong condition.
Abnormal heart rhythms: Also known as heart arrhythmias, abnormal heart rhythms can be a result of the low oxygen levels that happen in people with sleep apnea. Experts believe that heart arrhythmias may be one of the main reasons behind sudden death in those with sleep apnea.
Undiagnosed and untreated obstructive sleep apnea syndrome can lead to abnormal physiology that can have serious implications including increased cardiovascular disease, stroke, metabolic disease, excessive daytime sleepiness, work-place errors, traffic accidents and death.
What happens if sleep apnea goes untreated?
Several studies have shown an association between sleep apnea and problems like type 2 diabetes , strokes , heart attacks and even a shortened lifespan, says Jun.
Patients with medical conditions like paraplegia or a broken hip can get Medicaid coverage for an adjustable bed if it is necessary to provide greater comfort and limit injury risk.
Adjustable beds are not ideal for stomach sleepers or side sleepers because they can put extra pressure on the stomach, which can cause GERD or acid reflux. For side sleepers, alterable beds can also put extra pressure on the hips and shoulders, which can cause pain.
- Consult a Doctor: Get a diagnosis and prescription for a medically necessary mattress.
- Find a Supplier: Locate a Medicare-approved supplier that offers the required mattress.
- Submit Documentation: Provide Medicare with the necessary documentation and prescription.
Insurance Compliance and Prescription Requirements
First, you must have a prescription for CPAP therapy from your healthcare provider. Second, you must successfully complete a compliance period with the CPAP machine, to demonstrate that you are using the treatment regularly.
References
- https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631
- https://www.quaggadesigns.com/post/advantages-disadvantages-of-adjustable-beds-worth-it
- https://www.veteranslaw.com/blog/can-i-receive-va-disability-for-sleep-apnea/
- https://www.sleepfoundation.org/cpap/does-insurance-cover-cpap
- https://www.streetdirectory.com/travel_guide/42852/medical_conditions/adjustable_beds_may_improve_sleep_apnea_symptoms.html
- https://www.policygenius.com/life-insurance/sleep-apnea/
- https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-dangers-of-uncontrolled-sleep-apnea
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- https://cleancpap.net/no-insurance-heres-how-to-get-sleep-apnea-treatment/
- https://mairagency.com/does-medicare-cover-adjustable-beds/
- https://www.upstate.edu/sleep-center/pap/adherence.php
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- https://www.sleepapnea.org/can-you-die-from-sleep-apnea/
- https://www.medicalnewstoday.com/articles/adjustable-beds-covered-by-medicare
- https://puffy.com/blogs/best-sleep/medicare-mattress-guide
- https://www.plushbeds.com/blogs/green-sleep/can-a-mattress-purchase-be-covered-by-insurance
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5698527/
- https://www.standard.co.uk/news/health/sleep-apnoea-symptoms-causes-benefit-payments-b1126507.html
- https://www.resmed.com/en-us/sleep-apnea/sleep-blog/does-insurance-cover-sleep-apnea-therapy/
- https://my.clevelandclinic.org/health/diseases/8718-sleep-apnea
- https://brossfrankel.com/2020/05/02/how-sleep-apnea-affects-your-va-rating/
- https://veteranshelpgroup.com/sleep-apnea-va-ratings/
- https://parmelelawfirm.com/blog/social-security/is-sleep-apnea-a-disability/
- https://toothopiadental.com/what-is-the-life-expectancy-of-someone-with-sleep-apnea/
