Does Insurance Cover At-Home Sleep Apnea Tests?

If you are one of the millions of people who have recently discovered that you are at risk for sleep apnea, you likely have questions about the cost of testing and treating this condition. The good news is that health officials have fought to make it easier and cheaper to diagnose sleep apnea, especially through the expanded use of the Home Sleep Apnea Test (HSAT).

But as most of us know, convenience doesn’t mean much if your health insurance doesn’t cover it. So, the question is, is an at-home sleep study covered by insurance? In short, the answer is usually yes, but the process can sometimes be a bit complicated.

If you want to know more about health insurance coverage for at-home sleep apnea testing, you’ve come to the right place! Today, we’ll discuss your options for insurance-approved home sleep apnea studies and provide a step-by-step guide to getting insurance approval for a Home Sleep Apnea Test. We will also examine the most common insurance providers and discuss their coverage eligibility requirements. And lastly, we’ll discuss the benefits and drawbacks of home sleep apnea testing with insurance.

Health insurance will usually cover a Home Sleep Apnea Test if medically needed. However, coverage may vary depending on your policy. Many insurance providers will only approve in-home sleep studies for suspected cases of Obstructive Sleep Apnea.

You should contact your insurance provider to review your coverage details and potential out-of-pocket costs if you are considering undergoing an at-home study.

There are four tests that diagnose sleep apnea. Three can be performed at home. As long as you can prove that you need to be tested for sleep apnea, your health insurance company will most likely cover an at-home sleep study. However, some companies do prefer that you undergo testing at a sleep clinic.

Your health insurance provider may ask that you undergo a specific type of in-home sleep apnea study, depending on the following factors:

• Your Insurance Policy
• Likelihood of a Positive Diagnosis
• Type of Sleep Apnea Suspected
• Presence of Other Conditions
• Possible Severity of Your Condition

Related Reading: How to Complete a Home Sleep Apnea Test

• What Does It Measure? An in-lab sleep study examines at least seven factors related to sleep data: brain waves, eye movements, blood oxygen levels, cardiac activity, breathing effort/movement, airflow, and limb movements.
• What Does It Diagnose? Obstructive Sleep Apnea, Central Sleep Apnea, and other sleep disorders.
• Where Is It Performed? At an overnight sleep center while being monitored by an in-person sleep technologist.
• Does Insurance Cover It? While some insurance companies prefer to cover Level I sleep studies, others will only agree to cover an in-lab sleep study in certain circumstances, like if Central Sleep Apnea is suspected. If your doctor suspects you have moderate or severe sleep apnea, your insurance may ask you to undergo an at-home sleep study first.

Related Reading: A First-Person Account of An In-Lab Sleep Study

• What Does It Measure? These tests are designed to track your breathing patterns by recording at least four types of information, such as respiratory movement/effort, airflow, cardiac activity, and blood oxygen levels. This test does not measure brain waves or track sleep stages.
• What Does It Diagnose? Obstructive Sleep Apnea, Central Sleep Apnea, and other sleep disorders.
• Where Is It Performed? At home or a sleep clinic with an overnight sleep technologist.
• Does Insurance Cover It? Many insurance policies will cover Level II testing for OSA. However, in-home Level II tests may not be covered if CSA is suspected.

• What Does It Measure? These tests track your breathing patterns by recording at least four types of information, such as respiratory movement/effort, airflow, cardiac activity, and blood oxygen levels.
• What Does It Diagnose? This test detects Obstructive Sleep Apnea. Some versions may detect Central Sleep Apnea, but most providers recommend running a polysomnogram if CSA is suspected.
• Where Is It Performed? At home.
• Does Insurance Cover It? Level III HSATs are the most likely to be approved by insurance if you have signs of sleep apnea, like excessive sleepiness, and no other sleep disorder or sleep-disordered breathing condition is suspected. Most insurance policies will not cover in-home testing if CSA is suspected.

• What Does It Measure? These tests check for sleep apnea events by monitoring your airflow, heart rate, and blood oxygen saturation.
• What Does It Diagnose? This study should only be used if you have a high likelihood of Obstructive Sleep Apnea. Level IV testing cannot be used to diagnose any other sleep disorder.
• Where Is It Performed? At home.
• Does Insurance Cover It? Level IV studies are popular because they are the least invasive. However, they are also considered less accurate than other overnight sleep studies, so some insurance companies ask that you undergo a Level II or III sleep study instead.

While the specific steps may vary depending on your health insurance provider, there are general guidelines that you can follow to increase the chances of getting your at-home sleep test covered.

Keep in mind that your doctor's office will do a lot of these steps for you, but it’s always good to educate yourself on the insurance approval process so that you can help it along when needed.

Review your health insurance policy to understand what services and medical equipment are covered, including available at-home sleep studies. Look for any specific criteria or limitations stated in your policy so that you can discuss them with your doctor.

The more you can show your life is impacted by potentially having sleep apnea, the more likely you are to have your sleep apnea diagnosis and treatment covered by insurance. We suggest keeping a diary of any physical complaints, cognitive changes, and mental health concerns.

Schedule an appointment with your doctor to discuss your concerns regarding sleep apnea. Based on your physical exam, medical history, and current complaints, your doctor will decide whether or not a home-based sleep apnea test is appropriate for you.

In some cases, your primary care doctor or insurance provider may ask that you first see a sleep specialist to confirm that you are showing signs of sleep apnea. Seeing a specialist can make receiving an official sleep apnea diagnosis a little easier.

If your healthcare provider believes that there is a high likelihood that you have sleep apnea, they will refer you for a sleep study and inform your insurance company. Orders for sleep studies are typically sent electronically, but you can ask that your referral be sent to a specific sleep apnea test provider.

You and/or your doctor’s office will need to contact your health insurance provider and ask if any specific requirements or documentation are needed for an overnight sleep study. Most insurance providers require that you first prove that you have a high likelihood of having sleep apnea to qualify for an at-home sleep apnea test.

Before asking for a home sleep apnea test, it may be helpful to check whether or not your insurance company requires pre-authorization or prior approval for at-home sleep testing. If your insurance requires this step, your doctor must complete additional paperwork explaining why you need a sleep apnea test. This step usually takes extra time, so knowing if it is required beforehand can be helpful.

Your insurance company will have a list of approved sleep study providers or at-home sleep apnea test suppliers. Your doctor’s office will usually make sure that a home sleep test supplier is in-network with your insurance plan, but it always helps to contact your insurance to double-check.

Contact your HSAT equipment provider for a cost estimate for your home sleep apnea test. Knowing the estimated cost can help you prepare for potential out-of-pocket expenses and negotiate with your insurance company if needed.

Getting approval from insurance can take time and a bit of effort. If your doctor’s request for an HSAT is initially denied, don’t get discouraged! Start by reviewing your insurance company’s “reason for denial.” In most cases, you have the right to appeal their decision, which should be explained in the Notice of Denial sent by your insurance.

Health insurance can be hard to navigate, and you want to avoid receiving an unexpected bill. Before undergoing any medical procedure or test, it is always a good idea to contact your doctor’s office and insurance company to double-check that your insurance policy will cover a particular step in diagnosing and treating sleep apnea.

A home sleep test is covered by Medicare, Medicaid, and private insurance. But coverage will largely depend on your insurance company, policy type, and whether or not you have met your deductible for the year. Let’s talk about how different health insurance carriers cover these tests.

Medicare covers all three levels of home sleep tests, but coverage may vary depending on the type of test and the state of your health. You should check directly with Medicare or consult a healthcare provider to determine the coverage requirements for at-home sleep testing.

Medicare Part B covers 80% of the total cost of in-home testing for Obstructive Sleep Apnea. After you have paid your annual deductible, you’ll cover 20% of the total cost of an at-home sleep study. So, if your HSAT costs $500, you pay $100.

• Medicare Eligibility: To check your Medicare eligibility, click here.
• Medicare Contact: For questions about Medicare’s coverage policies, call 1-800-633-4227 or click here.
• Sleep Apnea Testing Coverage: To double-check the details on Medicare’s sleep apnea testing coverage, click here.
• Sleep Apnea Treatment Coverage: For more information about Medicare’s coverage for sleep apnea treatment, read Does Medicare Cover CPAP?

Medicaid coverage for in-home sleep studies varies by state. That said, most Medicaid policies will cover at least one of the three levels of home sleep tests. This coverage only kicks in once you’ve paid your deductible, which is calculated based on your income.

At most, you could be responsible for up to 20% of the total cost of your sleep study. So, if the study costs $500, you pay $100. Medicaid out-of-pocket costs can vary depending on income, family size, and state.

• Medicaid Eligibility: To check your Medicaid eligibility, click here.
• Medicare Contact: To contact a Medicaid representative for questions, call 1-877-267-2323 or click here.
• State-Based Information: To check your state’s eligibility requirements or contact a local Medicaid office, start here.

Most health insurance companies will cover at least one form of in-home sleep study. However, diagnostic testing for sleep apnea varies depending on your insurance carrier and policy. Contact your insurance directly if you have questions about Home Sleep Apnea Testing.

Your total out-of-pocket costs will vary depending on your insurance plan and the type of sleep study you are undergoing. Most policies cover between 60 and 90% of the total cost of diagnostic testing. So, if your HSAT costs $500, you pay between $50 and $200.

• Contact Your Insurance Carrier: To contact your insurance provider, call the phone number on the back of your health insurance card.
• Coverage Information: To check your insurance’s coverage policies, read your program’s Summary of Benefits.
• Sleep Apnea Treatment Coverage: For more information about using insurance to cover the costs of CPAP therapy, check out Does Insurance Cover CPAP Therapy?

You do not have to use insurance to cover the cost of in-home sleep apnea testing, but it also doesn’t have to cost an arm and a leg! We offer a telehealth doctor’s visit and a sleep apnea test at home kit for just $174.99.

At-home tests usually cost between $200 and $600 without insurance. While these tests are often less expensive with insurance, in some cases, it may actually be cheaper and easier to purchase an HSAT without the help of insurance.

• Sleep Apnea Testing Without Insurance: For more information about testing for sleep apnea without insurance, check out Sleep Apnea Test at Home: Cost, Accuracy, Benefits, and Tips!
• Sleep Apnea Treatment Without Insurance: For more information on paying for CPAP therapy without the help of insurance, check out CPAP Machine Cost: Is it Cheaper Without Insurance?

Unfortunately, there aren’t many options for free sleep apnea diagnostic testing. Some in-lab sleep studies or universities will offer free testing to research participants. That said, there are free sleep apnea screening tools that can be useful in determining whether or not you should pursue an actual sleep apnea diagnosis.

Related Reading: Can’t Afford a New CPAP Machine

While some at-home sleep apnea tests can detect Central Sleep Apnea, most health insurance companies prefer that you undergo CSA testing at an overnight sleep lab.

Most health insurance companies will cover in-home testing if your doctor believes you are likely to have Obstructive Sleep Apnea. However, this coverage will depend on your policy agreement and whether or not you have met your deductible.

Home tests are usually more convenient and cost-effective for diagnosing sleep apnea. They also offer the comfort of sleeping in your own bed. However, the results may not be as detailed as traditional in-lab sleep studies, and there are no medical professionals to ensure everything is working correctly.

Related Reading: In-Home Versus Clinical Sleep Studies

You have other options if your insurance declines to cover an in-home sleep study. If you wish to still use insurance, you can request an in-lab study at an overnight sleep center. Or you can pay for a Home Sleep Apnea Test on your own, such as our HSAT kit, for under $200.

Some health insurance carriers require that your doctor submit pre-approval paperwork before undergoing a sleep apnea test. However, pre-authorization requirements differ from carrier to carrier. So, it’s best to contact your insurance provider for more information.

Many insurance companies, including Medicare, cover home sleep studies if they are considered medically necessary. However, the amount of coverage depends on the insurance company and the medical provider. Before undergoing any overnight sleep study, you should always check with your insurance company to confirm your coverage options.

To maximize the chances of having your in-home sleep apnea test covered by insurance, schedule an appointment with your doctor to discuss your sleep apnea signs and symptoms. Your doctor’s office will help you navigate the process of insurance approval, but it may help to stay in personal contact with your insurance company throughout the process.

And if going through insurance isn’t for you, keep in mind that you can order an in-home sleep apnea test through CPAP.com!