Home sleep studies have seen a recent rise in popularity after many sleep labs experienced long wait times and lengthy turnarounds at the height of the pandemic. With the rise of technology, they’ve also become more capable, and can accurately diagnose Obstructive Sleep Apnea from the comfort of your home. Compared to a sleep study in a lab—especially from a financial perspective—more and more people are interested in the idea of an at-home sleep study covered by insurance.
The question is, though, will insurance even cover a home sleep test?
At-home sleep studies can be covered by insurance, though the extent of your coverage depends on your specific insurance policy and carrier. Some insurance providers might only cover in-lab sleep studies, while others may actually require a home sleep apnea test (HSAT) before they’ll pay for a clinical sleep study (if one is required). Furthermore, some HSAT providers don’t actually accept insurance, so you may need to directly submit your claim to your insurance for reimbursement if possible.
Even without insurance, though, a home sleep study is an accurate way to test, is relatively affordable, and typically costs between $150 and $500 out of pocket.
There are many variables when insurance gets involved, especially when it comes to Medicaid and Medicare, so keep reading to learn how you might be able to get your home sleep test covered by insurance.
HSAT and The Affordable Care Act
The Affordable Care Act states that health insurance must cover costs for sleep apnea tests. The law states that if a physician prescribes the sleep apnea test, the affiliated health insurance will cover everything for the patient outside of the deductible and the co-pay, which are the patient’s monetary responsibility.
Ideally, that means that your insurance will pay for a home sleep apnea study if it is prescribed by an appropriately-licensed physician and billed using HCPCS codes. In reality, your insurance may only cover an HST from a provider that is in their network, so your best first step is to get very clear with your insurance carrier about what they will or won’t cover.
Does Health Insurance Cover Sleep Studies?
Health insurance can cover your home sleep study, and some Medicaid and Medicare plans will do so as well.
Medicare can cover Type I, II, III, and IV sleep apnea tests if your doctor states that you exhibit symptoms of the condition. Medicaid will primarily cover in-lab sleep apnea tests at centers accredited via the American Academy of Sleep Medicine and other approved locations, meaning an HSAT won’t be covered under Medicaid.
If you receive CPAP therapy under different insurance and then attempt to switch to Medicaid for coverage, the Affordable Care Act protects you from discrimination on the basis of a preexisting condition. You will still likely need to provide whatever proof of diagnosis or treatment you’ve already had in order to receive coverage from the government.
Why Do People Prefer an At-Home Sleep Apnea Test?
People prefer home sleep apnea tests because they are more comfortable and less stressful than traditional in-lab sleep studies. Typically, sleep labs try to be as inviting and comfortable as possible, and generally look more like hotel rooms than laboratories. Monitoring equipment is much more invasive and can be overwhelming for some people, making it more difficult for them to fall asleep. While these sensors may be uncomfortable at times, they make the lab sleep study much more capable of diagnosing a variety of sleep disorders outside of sleep apnea compared to an HSAT.
Alternatively, a home sleep test requires only a small device wrapped around your finger, which monitors you for apneas throughout the night. Sleeping in a familiar environment under normal circumstances produces the most accurate results, though HSATs aren’t for everybody. Only patients suspected to have Obstructive Sleep Apnea can be diagnosed by a home sleep test. It can indicate whether you should have a clinical sleep study after, but it is limited in capability; this is why a prescription is required. The difference between home and lab sleep studies is worth understanding, and those with more complex health histories are better suited to lab sleep studies for the best results.
If sleeping in your own bed during your sleep apnea test sounds like the best option and you haven’t experienced any other kind of sleep-disordered breathing, you may want to try SleepMedRx. This sleep apnea test is the size of your fingertip and monitors your sleep via the NightOwl phone app. After you sleep, a sleep physician analyzes your results and gives recommendations. If you’re diagnosed with Obstructive Sleep Apnea, you’ll get a prescription for an APAP machine.
What Is the Cost of a Sleep Study With Health Insurance?
An at-home sleep apnea test (HSAT) is much cheaper than the in-lab alternative. Even if you pay without insurance, an at-home test may range from $200 to $450. With insurance coverage, you’re more likely to pay even less than this range depending on your deductible and copay amount.
If your health insurance only covers in-lab sleep studies, you may pay hundreds or thousands of dollars depending on your insurance plan. For example, Medicare reimburses the company conducting the in-lab sleep apnea test $650. Other health insurance companies reimburse up to $1,200.
Overall, an in-lab sleep test can be up to $5,000 before insurance contributes to the cost. Hence, an sleep apnea test at home with insurance is much more cost-effective and less hassle than the in-lab alternative.
How to Have Health Insurance Cover a Sleep Study
First, you’ll want to get with your insurance provider to find options in-network that they can cover the cost of. After that, you’ll need to get a prescription for the home sleep test. However, if your at-home sleep test is covered by insurance, it will likely include a consultation with a medical professional. You won’t need to go to your primary care provider because this initial consultation will also include the prescription for a home sleep test that your insurance will require. Once you have the prescription, go back to your insurance for clearance, or order your sleep test device and file a claim with them after the fact.
Since every insurance carrier is a bit different, we recommend getting extremely clear with your insurance agent about what is covered and what isn’t, as they’ll be able to give you the best answers.
If your insurance doesn’t have any in-network options for home sleep tests, we recommend SleepMedRx, which includes a consultation, test device, follow-up report, and, if necessary, a prescription for an APAP machine—all for $175.
What Treatments Can I Receive for Sleep Apnea?
Living with sleep apnea is not the end all be all. While you cannot cure the condition, the symptoms can lessen with approved treatments. Many treatments are available for sleep apnea, such as:
- CPAP Therapy
- EPAP Therapy
- Dental Appliances Such as MyTAP
- Using Supplemental Oxygen
- Surgery, Such As Radiofrequency Volumetric Tissue Reduction, Maxillomandibular Advancement, Uvulopalatopharyngoplasty or UPPP Surgery, and More
Besides these medical treatments, there are also some lifestyle changes that one can make if applicable. Losing weight, reducing your alcohol intake, and quitting smoking are all helpful in reducing sleep apnea symptoms. Sleeping on one of your sides instead of your back may also help prevent tissue from blocking your airway.
Final Thoughts About Sleep Apnea Tests Covered Under Insurance
Suspecting that you have sleep apnea can be a scary feeling. Do not delay petitioning for a sleep apnea test so you can discover the next steps in looking out for your health while you sleep. If taking a sleep apnea test at home sounds like the best setup, then SleepMedRx may be right for you.
If you’re looking for a home sleep apnea test that is covered by insurance, the first place to start is with your insurance provider. Get very clear with them about what will or won’t be covered, what HSAT providers are in their network, and what the process is like for submitting a claim if necessary.
Living with sleep apnea is possible, but taking the first step in diagnosis is needed so you can find a treatment that is right for you! Connect with your health care provider and insurance company today to get started.
