Does Medical Insurance Cover Sleep Apnea Treatment?

Some people hesitate to pursue sleep apnea treatment because they are concerned about cost. If you are among them, you may be happy to know that your medical insurance will likely help you pay for your oral appliance! This blog post explores how your coverage might apply and how you can get started on your path to a better night’s sleep.

Medical Insurance and Sleep Apnea

Most major medical insurance plans recognize obstructive sleep apnea (OSA) as a serious condition that requires treatment, so they are willing to pay for at least a portion of the cost of an oral appliance or CPAP machine. They also commonly cover the cost of sleep testing, which determines whether you have OSA and how severe it is.

Using Medical Insurance for Sleep Apnea

The details of medical insurance can be confusing at times, especially since plans can vary so widely in their coverage. The best way to navigate your benefits is to visit a treatment provider who is used to dealing with the ins and outs of insurance; they will be happy to help you understand your coverage and file your claims.

Here are a few additional notes to keep in mind about medical insurance and sleep apnea:

• You might have to pay a deductible. A deductible is the amount you must pay out of pocket before your insurance kicks in. If you have already paid your deductible for 2021, you won’t have to worry about this. If you wait until 2022 to start treatment, your deductible is likely to reset, so you will have to pay it all over again. It would be in your best financial interests to seek treatment sooner rather than later!
• A copay or coinsurance may apply. A copay is a flat free that you must pay for certain services. Coinsurance is a percentage of the cost of treatment that you are be responsible for.
• You might need pre-authorization from your insurance company before it will cover sleep apnea testing and treatment. It is difficult to predict how long this might take, so again, starting the process sooner rather than later would be the wise course of action.

What About Medicare and Medicaid?

Medicare covers sleep apnea testing and treatment under part B. However, keep in mind that it might limit your choice of oral appliances. Visiting a practice that is used to dealing with Medicare can help you stay within the boundaries established by your plan. Medicaid may also help to lower your out-of-pocket obligation for sleep apnea services.

You probably won’t have to pay the entire cost of sleep apnea therapy! Your medical insurance may save you a significant amount of money!

Meet Dr. Mogell

Dr. Kenneth Mogell, a board-certified specialist in sleep medicine with over 10 years of experience treating sleep breathing disorders is the practice’s founder and primary practitioner. The practice has three South Florida locations: Melbourne, Vero Beach, and Boca Raton. To learn more about Florida Dental Sleep Disorders and Dr. Kenneth Mogell, contact our team at 844-294-7559. We accept Medicare, Tricare and most medical insurance!