Does Medicare Cover Narcolepsy?

Pamela Cannaday by Pamela Cannaday | Licensed since 2011
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This article was updated on: 10/06/2018

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If you’ve been diagnosed with narcolepsy, you probably know firsthand that this chronic sleep condition can disrupt your life and well-being. Learn more about narcolepsy and whether Medicare covers this condition.

What is narcolepsy?

According to the National Institute of Neurological Disorders and Stroke (NINDS), narcolepsy is a chronic sleep condition where your brain’s ability to manage sleep-wake cycles is disrupted. People with narcolepsy experience extreme drowsiness during most of the day, no matter how much sleep they get, and might accidentally fall asleep during everyday activities like eating or driving.

According to the Mayo Clinic, narcolepsy symptoms may include:

  • Extreme sleepiness during the day
  • Temporary inability to move (sleep paralysis)
  • Uncontrolled, sudden muscle weakness (cataplexy)
  • Insomnia (inability to fall or stay asleep when you want to)

How do doctors diagnose narcolepsy?

According to the Mayo Clinic, a narcolepsy diagnosis usually starts with a physical exam by a doctor; you may also be asked to keep a sleep diary recording sleep patterns over a few weeks.

According to the National Institute of Neurological Disorders and Stroke (NINDS), a narcolepsy diagnosis may also involve certain sleep tests:

  • Polysomnogram (PSG): measures factors like breathing patterns, brain activity, and muscle movements during sleep.
  • Multiple sleep latency test (MSLT): measures how quickly you fall asleep and enter rapid eye movement (REM) sleep. People with narcolepsy tend to enter REM sleep more quickly than other people.

How do doctors treat narcolepsy?

Although there is currently no cure for narcolepsy, symptoms may be managed with prescription drugs, according to the Mayo Clinic. Your doctor may prescribe stimulants to help you fight daytime drowsiness. Selective serotonin reuptake inhibitors (SSRIs) are also often prescribed for narcolepsy to treat hallucinations and muscle weakness.

According to the Mayo Clinic, some people also find lifestyle changes help their narcolepsy, such as avoiding alcohol and nicotine and exercising regularly. If possible, try to wake up and sleep at consistent times every day, the Mayo Clinic advises.

Alternative therapies may be another treatment option for narcolepsy. According to the Narcolepsy Network, some people with narcolepsy have treated symptoms with acupuncture, massage, herbal remedies, or meditation.

Does Medicare cover narcolepsy treatment?

Medicare Part B covers sleep studies if your doctor thinks you may have obstructive sleep apnea; however, these sleep tests are generally not covered to diagnose other sleep conditions, including narcolepsy. For more information on what Medicare covers for diagnosis of narcolepsy, contact Medicare at 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users, call 1-877-486-2048.

If you’re diagnosed with narcolepsy, Medicare Part D offers prescription drug coverage. You can get this coverage through either a stand-alone Medicare Prescription Drug Plan or a Medicare Advantage Prescription Drug plan. Before enrolling in a plan, it’s a good idea to check the plan’s formulary (or list of covered drugs) to make sure your narcolepsy medications are covered. The formulary may change at any time. You will receive notice from your plan when necessary.

Medicare doesn’t generally cover alternative therapy such as acupuncture, massage, or herbal remedies.

Would you like help finding Medicare plan options that cover narcolepsy or other health conditions? I can show you choices that may fit your situation. To get started, use the links below to either set up a phone appointment with me or request a personalized email with plan information. If you’d rather browse on your own, simply click the Compare Plans button to view plan options in your service area.

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