Does Medicare Cover Insomnia Treatment?

Have you ever had one of those nights where no matter what you do, you couldn’t fall asleep? You lay in bed staring at the ceiling hoping to drift off, but you just can’t? Not to mention all of this is followed by inevitable exhaustion. Now imagine feeling like this most nights. This is the reality for up to a quarter of Americans every year who develop chronic insomnia.

Figuring out why you’re having trouble sleeping, treating the root causes and dealing with insomnia can get expensive. If you’re enrolled in Medicare, do you have any coverage for both insomnia diagnosis and treatment?

What is Insomnia?

Simply put, insomnia is the inability to fall asleep or stay asleep. It can be acute, meaning a single night or short-term sleep issues, to chronic or long-term. Generally, for insomnia to be chronic, it needs to be consistent for up to three nights a week for at least three months or more. Insomnia may also be primary or secondary, depending on if it’s linked to another health condition or not.

You could even notice that you’re having sleep issues, but if you find yourself not feeling well rested in the morning, tired throughout the day, or generally irritable, depressed, or anxious, those are signs you should seek a doctor’s help.

General symptoms of insomnia can include trouble falling asleep or anxiety about not being able to fall asleep. You may also find yourself waking up in the middle of the night and struggling to fall back asleep. You could even notice that you’re having sleep issues, but if you find yourself not feeling well rested in the morning, tired throughout the day, or generally irritable, depressed, or anxious, those are signs you should seek a doctor’s help.

Medicare and Insomnia Testing

Determining what type of insomnia you have is critical to preventing or treating it. The causes of insomnia can be varied from sleep environment and stress to secondary health concerns. Each of these require a different avenue of treatment. If you’re experiencing signs of insomnia, we encourage you to talk to your doctor during your Annual Wellness Visit or schedule an appointment. They may help you figure out the cause then and there or refer you to a sleep specialist to find answers.

If you’re experiencing signs of insomnia, we encourage you to talk to your doctor during your Annual Wellness Visit or schedule an appointment.

If you show the clinical signs of sleep apnea, insomnia being one, you may also qualify for coverage for a Type 1 sleep study through Medicare. Your doctor must order the test. A sleep study, also called a polysomnography, will check for signs of a sleep disorder and the severity of it. While you must show signs of sleep apnea to have the test covered, they may find you have a different sleep disorder, like narcolepsy or unexplained chronic insomnia. Either way, you may get answers.

Medicare Coverage of Insomnia Treatment

Once you figure out what’s causing your insomnia, you can find a treatment plan with your doctor. You’ll likely be instructed to create a healthier sleep environment in your bedroom, making it easier to drift off. Beyond that, you’ll have a number of cause-specific routes to try.

CPAP

If your insomnia is part of an overall sleep apnea diagnosis, you’ll likely qualify for Medicare coverage of a CPAP machine. These machines keep your airways open and help you get a more restful sleep.

Therapy

Another common cause of insomnia is mental health issues from anxiety to depression and beyond. If this is you, your best course of action will be to talk with a mental health professional or therapist to begin working through these issues. Luckily, Medicare can help pay for mental health costs through Medicare Part B for outpatient mental health services or Part A for inpatient stays at a mental health care facility.

Medication

While it’s usually not the first option when it comes to insomnia care, you may be instructed to try a sleep aid or medication. This may include over-the-counter options like melatonin or an antihistamine. You may also be prescribed  zaleplon (Sonata) or zolpidem (Ambien). If you’re enrolled in Medicare Part D or a Medicare Advantage plan with prescription drug coverage, you may have coverage depending on your plan’s formulary. If it’s not covered, you may be able to file an exception to request coverage of the drug.

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A bad night’s sleep can ruin the next day, leaving you groggy, uncomfortable, and grumpy at the best of times. When this issue has been going on for days, weeks, months, or even longer, the risks are multiplied. If you’re struggling to sleep at night or to have restful sleep, don’t wait. Talk to your doctor to figure out what’s going on so you can solve the issues and get a good night’s rest.