Health insurance for sleep apnoea
You can find some benefits for sleep apnoea starting in bronze hospital policies, sometimes referred to as "sleep studies".
What different scores mean
9+
Excellent
These products offer a balance between low pricing and more features.
7+
Great
Competitive products within their group.
5+
Standard
Usually these products would either have fewer treatments covered or higher pricing.
0+
Basic
Offering basic cover with limited features or higher pricing.
Key takeaways
- Sleep apnoea is a disorder that affects up to 2.5 million Australians.
- Sleep studies, used to diagnose sleep apnoea, are only guaranteed on Gold hospital policies, though some lower-tier policies include them.
- Alternatively, Medicare also covers sleep apnoea diagnosis and treatments, including sleep tests and CPAP therapy.
What is sleep apnoea?
Sleep apnoea is a disorder that occurs when a person's breathing is repeatedly interrupted during sleep. It can be a serious affliction as it restricts the body of its regular oxygen levels, and can impact long-term health in some cases. According to Rosedale Medical Practice, approximately 2.5 million Australians have been diagnosed.
What are the symptoms of sleep apnoea?
An 'apnoea' is the time when your breathing stops, and it can last anything from 10-90 seconds. While it is often hard to distinguish sleep apnoea from other sleeping problems, there are a few recognisable symptoms that you will feel consistently:
- Waking up choking or gasping
- Waking up with a sore or dry throat
- Loud snoring
- Sleepiness or lack of energy during the day
- Headaches, especially in the morning
- Forgetfulness and mood changes.
If you suspect you may have sleep apnoea, it's important to speak with your GP. They may refer you to a sleep physician for a test, known as a sleep study. This can confirm if you have sleep apnoea, or another sleep problem such as insomnia or narcolepsy.
Did you know?
80% of sleep apnoea cases go undiagnosed. If you've noticed any of the above symptoms or would say you're a "bad sleeper," it may be worth booking an appointment with your GP.
How does Medicare cover sleep apnoea?
Before you can receive a Medicare rebate for a sleep study test, your doctor will need to make sure you are eligible by asking a series of approved screening questions. This is in order to make sure you definitely have a sleep disorder and are not being misdiagnosed.
Medicare may also cover Continuous Positive Airway Pressure (CPAP) therapy if you've been diagnosed with sleep apnoea. Your doctor will determine if you are eligible for CPAP based on how effective they feel the therapy may be in your situation.
Although Medicare will cover some of the costs, you'll still have out-of-pocket expenses. These can add up each time you receive care.
How does private health insurance cover sleep apnoea?
Treatment options vary depending on your insurer, but generally private health cover can help with the following:
Basic, Bronze or Silver policies
- Taking part in an overnight sleep study at a hospital or clinic, in order to properly diagnose sleep apnoea, if your policy includes the Sleep studies clinical category. Only Gold policies must include it.
- As well as diagnosis, you'll get to choose your own doctor and hospital.
- Some policies will pay a benefit towards the high cost of purchasing a CPAP machine and masks, if your doctor recommends CPAP therapy.
Silver Plus or Gold policies
- Taking part in an overnight sleep study at a hospital or clinic, in order to properly diagnose sleep apnoea, if your policy includes the Sleep studies clinical category. Only Gold policies must include it.
- As well as diagnosis, you'll get to choose your own doctor and hospital.
- Some policies will pay a benefit towards the high cost of purchasing a CPAP machine and masks, if your doctor recommends CPAP therapy.
- More comprehensive cover could help with alternative treatment, such as nasal surgery or a tonsillectomy.
Some policies may cover a home sleep test. According to SleepFoundation.org, the accuracy of home sleep tests for apnoea can range from 68% to 91%.
It's also worth remembering you should always get the Medicare Benefits Schedule (MBS) number from your doctor. This lets you know exactly what you'll pay, so you are able to budget well in advance of treatment.
Compare health insurance with sleep apnoea coverage
We crunched through the policies and here are some policies from Finder partners that offer a benefit for sleep apnoea or sleep studies. To compare even more funds, use the free tool below the table. All prices are based on a single individual with less than $105,000 income and living in Sydney.
Finder Score - Hospital cover health insurance
Each month we analyse our hospital insurance products and rate each one on price and features. What we end up with is a nice round number out of 10 that helps you compare hospital cover a bit faster.
Before we start scoring, we need to make sure we're comparing like-for-like. Just as it doesn't make sense to compare a bicycle with a Ferrari, it doesn't make sense to compare basic hospital policies to top-tier Gold policies. Each policy is given a price score and feature score. These are then combined to determine each policies's Finder Score.
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