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Is sleep apnea a pre-existing condition for life insurance?

Filed in
  • Sleep apnea
  • oral appliance therapy
  • CPAP

By Chris Acker, CLU, ChFC  |  May 16, 2019
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ManwithCPAP

When most obstructive sleep apnea patients think about “insurance,” they typically ask questions like, “Are my CPAP supplies covered by insurance?” or, “Will my sleep study be covered by insurance?” or, “Is my durable medical equipment provider in-network with my PPO?”  

Of course, these are all important questions, but with the Affordable Care Act in full swing since 2014, almost all Silver level plans and above cover sleep apnea testing and supplies much more liberally than before.  

And that’s a good thing!  Sleep studies and CPAP equipment and supplies used to be subject to your deductible first, then co-insurance. 

Now all the ACA-compliant plans cover the study as an office visit with co-pay, and the equipment is not subject to the deductible.

Life Insurance for People with Sleep Apnea

One vital insurance area that is often overlooked by the sleep apnea patient is life insurance. It is arguably the central piece of most families’ financial plans, as this coverage protects mortgages, college plans, and overall standard of living.

Life insurance is especially important to the sleep apnea patient because sleep apnea is considered a pre-existing condition for life insurance. Companies that provide life insurance were, at one time, reluctant to even consider a life insurance application from someone who has sleep apnea.  

Today, the industry has good experience with the condition and will view an applicant favorably if he or she meets certain criteria. However, since sleep apnea affects the life insurance rates you will end up paying, it’s important to know what the insurance companies are looking for before you even apply.

Life Insurance Criteria for Sleep Apnea

  1. You must be completely open and honest about your condition. This goes for any chronic medical condition, but people often forget to disclose sleep apnea, even when prompted. Companies will want a date of diagnosis and treatment information. If you don’t disclose your condition, the carrier will most likely find out and possibly decline you for non-disclosure. At the very least, it creates confusion and will take time to clear up.

  2. Adhere to your sleep apnea therapy, whether it’s an oral appliance or CPAP machine. Use your machine! Most new CPAP machines have built-in Wi-Fi technology that communicates your sleep data to your medical insurance company so they can confirm that you’re using the treatment.

  3. Lose weight if you are overweight. This is a big one. Sleep apnea can be accompanied by many co-morbidities like obesity, high blood pressure, heart conditions, diabetes, depression, and more. Life insurance companies want to see an applicant who has made a major effort to control their condition. Losing weight is an excellent indication of your commitment to better health.

  4. Always attend follow-up sleep medicine appointments. Your sleep medicine specialist is an extremely valuable resource and can guide you and your treatment. Life insurance underwriters will want to see your medical records, especially sleep apnea treatment comments from your doctor.

  5. Insurance carriers want to see an apnea-hypopnea index (AHI) of 5 or less per hour. Some life insurance companies will offer preferred rates at this level. They don’t care which treatment you are using. They are simply looking at statistics, and most clinicians consider an AHI of less than 5 to be an indicator of effective treatment.

  6. Normal oxygen saturation levels of 95-100 should be easily attainable with treatment adherence. The life insurance underwriter will expect your results to be in this range if you have mild to moderate sleep apnea.

  7. Get a follow-up sleep study! If you’ve gone for your first study, now it’s time for the titration study, which will help the sleep doctor set the pressure on your CPAP machine. Don’t miss this appointment; otherwise, you won’t be able to get the equipment, and the life insurance company will not offer good rates until they see that you’ve complied with the study.
So, when you’ve finished adding up your costs for your equipment and medical care for sleep apnea, make sure you add a line item for life insurance. You should have some room in your budget for a life insurance policy since the Affordable Care Act saved you some money on your new medical equipment.

Remember, with excellent treatment adherence comes much lower rates on your premiums. Also, make sure you wait to apply for life insurance until after you've done your homework and gotten a handle on your condition.

Once you’ve adapted to your treatment (if you’re newly diagnosed), then you can discuss your life insurance with an independent life insurance broker who has experience in helping consumers with this type of health condition. A broker will be able to help you find the best rates for you given your sleep apnea history.

Chris is an independent life insurance broker located in Palo Alto, California. He started helping families and businesses build strong financial safety nets in 1985.

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