Managing a Sleep Disorder Long-Term: Will Insurance Cover Your Expenses?

Insurance coverage for sleep disorders is a mixed bag. If you have obstructive sleep apnea, you're in luck. For other disorders which require medication—or even more complicated behavioral therapy—approval can get iffy.

Sleep studies
If you have symptoms of a sleep disorder and your doctor refers you to a sleep study, almost all insurance programs will cover all or most of the cost. Several plans, including Medicare and Medicaid, also recently agreed to cover home sleep tests, a secondary option for sleep apnea diagnosis.

Deciding between a sleep lab study and home test may be a matter of financial choice; often, you'll be covered for a lab study but not for a home test. But if your plan has a high deductible, the pricier lab study may cost more anyway. In-lab studies are more comprehensive, however, and should be your first choice, so talk to your doctor about payment options.

Sleep apnea treatment
Both private and public insurance programs cover CPAP (continuous positive airway pressure) machines, which force air into your lungs and keep you breathing, uninterrupted, while you sleep. Depending on the machine's life expectancy, insurance will also cover replacement of masks, tubing, pads, and most accessories at least twice a year. And more sophisticated machines—such as a BiPAP (bi-level positive airway pressure) or APAP (autotitrating positive airway pressure)—are typically covered if you've tried and can't tolerate the less expensive CPAP.

If you opt for surgery, you may be required to provide documentation of your sleep apnea score and time spent on a CPAP machine. (Since CPAP is the recommended first option, companies want to make sure that you've at least tried that first.) Not all procedures are covered, according to the American Sleep Apnea Association; but an appeal that demonstrates your need for a specific operation may change your provider's mind.

Surgery for snoring—without proof of sleep apnea—is usually considered a cosmetic procedure and not covered by most insurance plans.