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Does Medicare Cover Oral Devices for Sleep Apnea?

When you suffer from sleep apnea, you know relief is of the utmost importance. It is not only a matter of getting a better night’s sleep, but also a matter of improving your health. Obstructive sleep apnea, or OSA, is known to increase blood pressure. It has also been linked to a number of other cardiovascular problems. That is why finding appropriate and effective OSA treatment is so important.

As with any medical piece of equipment, paying for devices to treat sleep apnea can get pricey. It’s important to know what your insurance may or may not cover so you can be prepared to pay the balance. Let’s take a look at sleep apnea, the treatments for it and whether Medicare covers some equipment.

What is OSA?

Obstructive sleep apnea is a chronic condition that happens when the muscles in the throat relax when someone is sleeping. This blocks the flow of air and the sleeper can stop breathing for periods of ten seconds or longer as oxygen levels drop. As you can imagine, this is not only dangerous because it affects breathing patterns as well as interrupts sleep.

How is OSA diagnosed?

While some people may suspect they have sleep apnea, a proper diagnosis is necessary for insurance to cover any treatment. In order to be diagnosed, patients must undergo a sleep study. During the sleep study, the patient spends the night at a sleep laboratory where they are monitored. Blood oxygen levels, respiration rate, brain-wave activity, leg movements, and how many partial inhalations are taken each hour are all tested.

If the sleep study determines a patient does have sleep apnea, a doctor will either recommend a CPAP machine or an oral device to offer relief. Some patients don’t have success with a CPAP machine because it requires them to wear a mask while they are sleeping and the machine to be plugged into an outlet all night. That’s why they use mouthpieces instead. The mouthpieces work basically the same way as a CPAP machine, just without the mask and need for an outlet.

These custom-made mouthpieces are worn while the patient is sleeping. They help to move the lower jaw back to a comfortable position, allowing the tissues at the back of t of the throat to relax. This ensures the base of the tongue doesn’t collapse and block the airway. This helps to give the patient a safe and quiet sleep. Mouthpieces have been found to be most effective in patients who suffer from mild to moderate cases of sleep apnea.

How much do mouthpieces for sleep apnea cost?

Costs can vary depending on the type of mouthpiece that is needed. Generally speaking they cost between $1,800-$2,000. Some insurance companies may cover these devices or part of the cost. It’s important to check with your company to see what benefits you have for oral devices for sleep apnea.

Does Medicare cover sleep apnea mouthpieces?

Oral appliances are a viable treatment option for OSA, but does Medicare Cover Oral Devices for Sleep Apnea?

Medicare will cover oral devices for obstructive sleep apnea, if they meet certain criteria and are deemed “Medicare approved”. In order to qualify for coverage:

  • The patient must visit a doctor before seeking coverage for the device and the device must be ordered by the dentist.
  • The patient must undergo a Medicare approved sleep test to determine a sleep apnea diagnosis.
  • In order to get reimbursement, the dentist must be a Medicare DME Supplier.
  • The oral device itself must fulfill all criteria specified in the durable medical equipment definition.
  • Oral appliance therapy must be necessary and reasonable for the treatment of obstructive sleep apnea.
  • The patient is not able to tolerate a positive airway pressure device or the doctor determines the using the CPAP machine will not work in that specific case.
  • All other billing, coding, and documentation requirements must also be met.

It’s important that all vital criteria is met in order for Medicare to cover your oral device. In some cases, coverage is granted at a certain percentage, with the patient responsible for the balance.

If you do have sleep apnea and begin doing your own research about mouthpieces, you will find that many are sold online. If you are looking for Medicare to cover your oral device, you need to go through your dentist. Even if you are paying out of pocket or going through insurance, you should be wary of these mouthpieces as they can harm your teeth and be ineffective if you choose to buy one blindly. A licensed physician can make sure the mouth guard is tailored to fit your mouth, which will make it work much better.

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

A consultation with a dentist can help determine if an oral device is the right course of treatment for your sleep apnea. People who have used an oral device to treat sleep apnea have found them to be effective. Many patients report improvement after using an oral device after just the first night. They also enjoy the fact that unlike CPAP machines, oral devices do not make noise and don’t need to be plugged in to function. You can easily take them with you if you are traveling as they fit right in your pocket.

Where can I get an oral appliance for sleep apnea?

If you suffer from obstructive sleep apnea and are looking for relief other than a CPAP machine, contact Dr. Mark Levy. Dr. Levy has been using oral appliance therapy and mouthpieces to treat sleep apnea since 2005. He is a member of the American Academy of Dental Sleep Medicine as well as the Academy of Clinical Sleep Disorders Disciplines. Dr. Levy has completed hundreds of hours of continuing education and is highly experienced in his field.

Contact Dr. Levy today at (614) 777-7350 for a better night’s sleep to learn more about treating your sleep apnea with a mouthpiece.