Does Medicare Cover Oral Devices for Sleep Apnea?

A close of up a sheet of lined paper with the title "Diagnosis" across the top with the words "Sleep Apnea" handwritten on the top line.

When you have sleep apnea, the need for rapid relief is obvious. It’s not simply a question of obtaining a better night’s sleep; it’s also about your health. Obstructive sleep apnea, also known as OSA, is associated with increased blood pressure. It’s also been linked to a number of other heart issues. That is why finding the correct and efficient treatment for OSA is so crucial.

Paying for medical equipment to treat sleep apnea can get pricey, as with any other medical piece of equipment. It’s vital to understand what your insurance will and will not cover so you can plan ahead of time. Let’s take a look at sleep apnea, the treatments available for it, and whether Medicare covers some devices.

What is OSA?

Obstructive sleep apnea is a chronic disease in which the muscles in the throat relax while someone sleeps, causing air to be blocked from flowing. This obstructs the flow of air and causes oxygen levels to plummet, forcing the sleeper to stop breathing for periods of ten seconds or more. Obviously, this isn’t just dangerous because it affects breathing patterns; it can also lead to other health problems.

OSA is a common problem; according to the National Sleep Foundation, it affects up to 30% of all men and 20% of women in the United States. It can be especially dangerous for pregnant women and those who are overweight. Left untreated, OSA can lead to heart disease, stroke, and diabetes.

How is OSA diagnosed?

A normal breathing problem that causes mild symptoms can go undiagnosed for years. Although some people may believe they have sleep apnea, a thorough diagnosis is required in order to receive coverage for any treatments. Patients must participate in a sleep study in order to be diagnosed. The patient spends the night at a sleep laboratory for monitoring during the sleep study. Blood oxygen levels, breathing rate, brain-wave activity, leg movements, and how many partial inhalations are taken each hour are all examined.

If a patient’s sleep study shows that he or she has sleep apnea, a doctor will either recommend using a CPAP machine or an oral apparatus to help them get some rest. Because a CPAP machine requires users to wear a mask while sleeping and requires them to plug the equipment into an outlet all night, not everyone is successful with it. That’s why people resort to mouthpieces instead. Mouthpieces are intended to provide a similar therapy as a CPAP machine, with the exception of the mask and requirement for an outlet.

Patients wear these custom-made mouthpieces while sleeping. Mouthpieces are used to help the lower jaw move forward and relax the tissues at the back of the throat. This ensures that the base of the tongue does not collapse, preventing airway obstruction. Patients who have mild to severe instances of sleep apnea benefit from mouthpieces.

How much do sleep apnea mouthpieces cost?

The expense of a mouthpiece varies depending on the kind of mouthpiece required. The typical cost is between $1,800 and $2,000. These devices may be covered by certain insurance companies or portions of the cost may be reimbursed. It’s critical to discuss this with your insurance company to discover whether you’re eligible for any discounts on oral devices.

Is Medicare willing to pay for sleep apnea mouthpieces?

Oral appliances are a fantastic treatment option for obstructive sleep apnea, but does Medicare Cover Oral Devices for Sleep Apnea?

Oral appliances for obstructive sleep apnea are covered under Medicare if they fulfill specific criteria and are determined to be “Medicare-approved.” To qualify for coverage:

  • The patient must see a doctor prior to seeking coverage and a dentist must order the device.
  • To establish a sleep apnea diagnosis, the patient must have a Medicare-approved sleep test.
  • The dentist must be a Medicare DME Supplier in order to receive payment.
  • All requirements of the durable medical equipment definition must be fulfilled by the oral device.
  • For the treatment of obstructive sleep apnea, oral appliance therapy must be both necessary and appropriate.
  • The patient is not able to tolerate a positive airway pressure device, or the doctor determines that using the CPAP machine would be ineffective in that situation.
  • All other billing, coding, and documentation necessities must also be completed.

It’s critical that all important criteria are fulfilled in order for Medicare to reimburse your oral device. In certain situations, coverage is given at a specific proportion, with the patient on the hook for the difference.

If you have sleep apnea and begin conducting your own research about mouthpieces, you’ll find that many are available online. If you want Medicare to cover your dental device, you must see your dentist. Even if you pay for it yourself or take out a policy, you should be cautious of these mouthpieces since they might harm your teeth and be ineffective if you buy one on a whim. A qualified dentist can ensure that the mouth guard is properly fitted to your mouth, ensuring greater effectiveness.

How do I know if an oral device is right for me?

A dentist may be able to recommend whether an oral device is a proper treatment for your sleep apnea during a consultation. People who have used an oral device to treat sleep apnea report that it worked. After the first night, many patients report improvements in their sleep. They also appreciate the fact that oral devices do not produce noise or require to be plugged in to function, unlike CPAP machines. If you are going on a trip, they may easily fit into your pocket since they can slip right into your handbag.

Where can I get an oral appliance for sleep apnea?

Contact Dr. Jeffrey W. Cross, D.D.S., F.A.G.D., for more information about obstructive sleep apnea treatment that goes beyond a CPAP machine. Since 2005, Dr. Cross has utilized oral appliance therapy and mouthpieces to treat sleep apnea patients. He is a member of the American Academy of Dental Sleep Medicine as well as the Academy of Clinical Sleep Disorders Disciplines. Dr. Cross has completed hundreds of hours of continuing education and is highly experienced in his field.

Contact Dr. Cross today at (301) 662-0300 for a better night’s sleep to learn more about treating your sleep apnea with a mouthpiece.

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