Medicare covers sleep apnea testing, but the route and what you pay depends on which type of test your doctor orders
Medicare Part B covers sleep apnea testing when your doctor refers you for it. The coverage includes both in-lab sleep studies (polysomnography) and home sleep apnea tests (HSAT). You typically pay 20% of the Medicare-approved amount after you meet your Part B deductible. The exact cost varies by location and the testing facility, so calling ahead to ask what your out-of-pocket share will be is worth doing before the test.
The type of test your doctor orders matters. An in-lab test at a sleep center costs more but gives more detailed information. A home test is less expensive and often more convenient — you wear a small device at home overnight and return it the next day. Medicare covers both, though your doctor has to determine which one is appropriate for your situation.
Key Takeaways
- Medicare Part B covers both in-lab sleep studies and home sleep apnea tests when ordered by your doctor.
- You pay 20% of the Medicare-approved amount after meeting your Part B deductible, though the actual dollar amount varies by location and facility.
- Your doctor decides which type of test is right for you based on your symptoms and medical history.
- If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower than the standard 20%.
- Medicare also covers CPAP machines and other sleep apnea treatments once you have a diagnosis.
In-Lab Sleep Studies and What They Cost
An in-lab sleep study, called polysomnography, happens at a certified sleep center. You spend the night there while technicians monitor your brain waves, heart rate, breathing, oxygen levels, and leg movements. The test takes about 7 to 8 hours and produces detailed information about how many times you stop breathing and how low your oxygen drops.
Medicare Part B covers the full technical cost of the test. You pay 20% of what Medicare approves after your deductible. In-lab tests typically cost between $1,500 and $3,000 before insurance, though this varies widely by region and facility. After Medicare's 80% payment, your 20% share usually falls between $300 and $600, depending on the facility and your deductible status.
If you have already met your Part B deductible for the year, you pay only the 20% coinsurance. If you have not met it yet, you pay the full deductible first, then 20% of the approved amount. Your deductible for 2024 is $240, though this amount can change each year.
Home Sleep Apnea Tests and Lower Out-of-Pocket Costs
A home sleep apnea test (HSAT) is a smaller, portable device you wear while sleeping in your own bed. It measures breathing, oxygen levels, and heart rate — fewer measurements than an in-lab test, but enough to diagnose most cases of sleep apnea. You pick up the device from your doctor's office or a testing company, use it for one or two nights, and return it.
Medicare Part B covers home tests at the same 80/20 split as in-lab tests. Home tests typically cost $300 to $800 before insurance, making your 20% share much smaller — often $60 to $160. Because the equipment is simpler and no overnight facility is needed, home tests are usually the less expensive option.
Your doctor decides whether a home test is appropriate for you. If you have severe symptoms, other medical conditions, or if a home test does not give clear results, your doctor may order an in-lab study instead. Medicare will cover whichever your doctor determines is medically necessary.
When Your Medigap or Medicare Advantage Plan Affects Your Cost
If you have a Medigap (supplemental insurance) plan, your out-of-pocket cost may be lower. Some Medigap plans cover the 20% coinsurance, meaning you pay little or nothing. Check your plan documents or call your Medigap insurer to confirm what they cover for sleep apnea testing.
If you have a Medicare Advantage plan (Part C), your costs work differently. Advantage plans set their own copays and coinsurance amounts, which may be higher or lower than the standard 20%. Some Advantage plans cover sleep apnea testing with a small copay; others charge coinsurance. Call your plan to find out what you will owe before scheduling a test.
Medicare Coverage for CPAP Machines and Other Treatments
Once you have a sleep apnea diagnosis, Medicare Part B covers CPAP (continuous positive airway pressure) machines and other breathing devices. You pay 20% of the approved amount after your deductible. Medicare also covers the mask, tubing, and filters you need to use the machine.
For the first month, you rent the equipment. If you use it regularly (at least 4 hours per night on 21 of 30 days), Medicare will then cover the purchase of the machine after three months of rental. You pay 20% of the purchase price, and Medicare pays 80%.
Sleep apnea treatments also include oral appliances (devices that reposition your jaw) and, in some cases, surgery. Medicare covers these when medically necessary and when your doctor documents that you have tried CPAP first or that CPAP is not suitable for you.
How to Schedule a Sleep Apnea Test Through Medicare
Start by talking to your primary care doctor about your symptoms — loud snoring, pauses in breathing during sleep, daytime sleepiness, or waking up gasping. Your doctor can refer you to a sleep specialist or directly to a sleep center for testing.
Once your doctor writes a referral, contact a Medicare-approved sleep center or testing facility. Ask them to confirm that they accept Medicare and what your out-of-pocket cost will be. If you are using a home test, the facility or your doctor's office will give you the device and instructions.
Bring your Medicare card to your appointment. The facility will verify your coverage and let you know your estimated cost before the test. If you have questions about what Medicare will cover, you can also call Medicare directly at 1-800-MEDICARE (1-800-633-4227).
What Medicare Does Not Cover for Sleep Apnea
Medicare does not cover sleep apnea testing ordered by someone other than a doctor — for example, testing ordered by a sleep coach or wellness program. The test must be medically necessary and ordered by a licensed physician.
Medicare also does not cover certain types of devices or treatments that are not standard for sleep apnea, such as positional devices (special pillows or belts that keep you on your side) or unproven alternative treatments. If your doctor recommends something unusual, ask whether Medicare covers it before you pay out of pocket.
Routine follow-up sleep studies are covered if medically necessary — for example, if your doctor needs to adjust your CPAP pressure or check whether treatment is working. However, testing done purely for monitoring without a medical reason may not be covered.
Frequently Asked Questions
Do I need a referral from my doctor to get a sleep apnea test?
Yes. Medicare requires that a doctor order the test. You cannot schedule a sleep study on your own. Call your primary care doctor and describe your symptoms — snoring, daytime tiredness, or pauses in breathing — and ask for a referral to a sleep specialist or sleep center.
Will Medicare cover a home sleep test if my doctor orders an in-lab test instead?
Not automatically. Your doctor decides which test is medically appropriate. If your doctor orders an in-lab test and you want a home test instead, talk to your doctor about whether a home test would work for your situation. Some doctors will switch the order; others will not.
What if I have not met my Part B deductible yet?
You will pay the full deductible amount first, then 20% of the Medicare-approved cost of the test. For 2024, the Part B deductible is $240. Once you meet it, you pay only 20% coinsurance for the rest of the year. Ask the sleep center what the total approved cost is so you can estimate your out-of-pocket share.
Does Medicare cover sleep apnea testing if I have a Medicare Advantage plan?
Yes, but your costs are different. Medicare Advantage plans must cover sleep apnea testing, but they set their own copays and coinsurance. Call your plan before scheduling to find out what you will owe. Some plans charge a small copay; others charge coinsurance similar to Original Medicare.
If my home sleep test is inconclusive, will Medicare cover an in-lab test?
Yes. If a home test does not give clear results, your doctor can order an in-lab study, and Medicare will cover it. You will pay the standard 20% coinsurance (after your deductible if you have not met it). This is considered medically necessary follow-up.