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Can I Use My Insurance for Sleep Apnea Treatment?

September 26, 2018

Filed under: Uncategorized — drmogell @ 7:06 pm

piggy bank surrounded by question marks More and more patients are turning to oral appliance therapy for sleep apnea treatment in Ocala because it’s an easy way to drastically increase their quality of sleep, protect their long-term health, and stop snoring. It’s also a more conservative and comfortable option compared to traditional CPAP therapy. Of course, cost is always a factor that is on people’s minds when it comes to any kind of medical treatment, bringing on the all-important question, “Will my insurance cover this?” Today, we’re going to answer that question and more so you can know how to save money while getting the sleep care you need.

Does insurance cover oral appliance therapy for sleep apnea?

Oral appliance therapy uses a custom-made mouthguard to prevent the breathing cessations associated with sleep apnea. It’s usually provided by a dentist, but it’s intended to treat a medical condition. So, will it be covered by medical or dental insurance?

Oral appliance therapy is typically covered by medical insurance because it’s designed to help with a medical issue, not a dental one. Of course, everyone’s specific plan is different from one another, so to make sure you’ll be covered for a sleep appliance, be sure to talk to your insurance provider.

Will insurance cover an oral appliance for snoring?

If an oral appliance is solely intended to help a patient stop snoring, then most medical insurance plans will NOT offer coverage because it will not be considered “medically necessary.” It’s still advisable to get a custom-made oral appliance from a dentist for this purpose as a “one-size-fits-all” appliance may not be effective and can even cause other issues (such as jaw soreness).

What is the deductible like for a sleep appliance?

A sleep oral appliance is considered DME (Durable Medical Equipment), and the deductible for it will probably differ from your plan’s yearly deductible. This is just speaking generally, however, and you should look at the details of your policy to see how it covers DME.

Can Medicare be used to cover a sleep apnea appliance?

Yes, Medicare can be used to cover oral appliance therapy for patients suffering from sleep apnea. A patient must make sure that the dentist providing their appliance is enrolled as a Medicare Supplier, however. As always, there is a bit of an application process to use Medicare benefits, but most dental offices will have teams who will walk you through it to make things nice and simple.

Will insurance cover a sleep study?

Before a patient can get a sleep appliance, they first need to be officially diagnosed with sleep apnea. In order for that to happen, they must undergo a sleep study. Most medical insurance plans will reimburse for a sleep study if it’s intended to determine if a patient has sleep apnea.

Have More Questions?

If you’re considering a sleep appliance, a great place to get information is from a sleep dentist in your area. They and their team will be very familiar with how medical insurance can be used to cover oral appliances, and they’ll likely be able to check your benefits for you so you have a more concrete idea of what you’ll be expected to pay out of pocket.

In the end, yes, medical insurance can be used to help offset the cost of a sleep oral appliance, ensuring that even more people can get the care they need so they (and others around them) can finally rest easy.

About the Author

Dr. Kenneth Mogell is a sleep dentist who has been helping patients rest better for more than 30 years. At his practice, he provides custom-made oral appliances for patients dealing with snoring and sleep apnea in Ocala. To learn more about your treatment options and how your insurance can be used to offset the cost, he can be contacted through his website for questions.

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