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Does Medicare Cover a Sleep Apnea Mouthpiece?

Perhaps you find yourself waking up at night gasping for air out of a deep sleep. You wake up not just once, but multiple times every night. You’re drowsy and fatigued the next day and have trouble functioning. You have begun to suspect you suffer from sleep apnea and are wondering if an oral appliance may be the solution. Of course cost is always a factor. Now you need to know if sleep apnea medicare coverage exists. Before we delve into whether Medicare covers mouthpieces (also known as oral appliances) for sleep apnea, it is crucial to understand what sleep apnea is and if you may be one of its sufferers.

What is Sleep Apnea?

Sleep Apnea is a disruptive condition that millions of people suffer from and have to deal with on a daily basis. If you were not aware, sleep apnea is a dysfunction that affects breathing while a sufferer sleeps by constricting airways and robs their body of oxygen. The two leading causes of sleep apnea are an obstructed airway or a problem with the brain sending a signal to muscles in the throat to relax.  An airway becomes obstructed when both tongue and jaw are fully relaxed while a sleep apnea sufferer falls into a state of deep REM sleep. When this happens for people without sleep apnea, their airways stay unobstructed. But for sleep apnea suffers, when their airway muscles relax, the back of the throat becomes obstructed and stops respiration.

An automatic response occurs when you stop breathing, your brain jogs you into consciousness, sometimes, you will be harshly thrust into consciousness, at other times you will barely awaken. These interruptions in sleep have a can have a range of effects on a person. It can be just annoyances like fatigue from broken sleep, snoring, or a sore throat. If you have more serious health conditions in addition to sleep apnea, it can bring about heart attacks, strokes, and makes you more likely to have diabetes or hypertension.  These conditions are why sleep apnea should not be taken lightly.

Does Medicare Cover Sleep Apnea Dental Appliance Costs?

Does sleep apnea Medicare coverage include oral appliances to relieve sleep apnea? The short answer is yes, but it is a complex issue. Medical insurance regularly reimburses dentists for dental devices that treat sleep apnea. However, you must follow a specific process in order to be reimbursed.

The sleep apnea sufferer has to make an appointment to see a qualified medical professional who can diagnose if they have sleep apnea. If there is substantial evidence of sleep apnea being present, a sleep test will have to be performed. A sleep test is usually takes place at a hospital in a special room to monitor sleep habits. In most cases, a sleep test will only require one overnight stay, but more than one night stay is possible. To be eligible for Medicare reimbursement of an oral appliance the sleep test must be a Medicare-approved sleep test. Medical apparatus will confirm or disprove the diagnosis of sleep apnea.

It must also be determined that the sleep apnea patient cannot use a CPAP machine for legitimate reasons such as discomfort leading to insomnia. This confirmation of the patient’s intolerance to a CPAP machine must occur within 90 days of the initial diagnosis. At that time the qualified medical professional who made the diagnosis will decline to sign a certification letter for CPAP treatment. When this occurs, the sleep apnea sufferer becomes eligible for an oral appliance that will be covered by Medicare. Even if Medicaid initially denies your case, there is an appeals process that can bring positive results. If you have a physical abnormality that is the source of your sleep apnea, Medicare automatically covers the cost of an oral appliance.

Why Use a Mouthpiece for Sleep Apnea?

Dental devices can be very useful in treating sleep apnea. This fact is especially true in cases where a patient cannot tolerate the use of a CPAP machine. Mouthpieces for sleep apnea are FDA approved and with good reason. Oral appliances enable sleep apnea sufferers to utilize a device that in most cases is more comfortable and doesn’t produce the discomfort that a  CPAP machine does.

The function of an oral appliance is simplicity itself; they work by forcing your airway open. There is nothing more to it, no hoses or cords to deal with as you try and sleep.  Because the mouthpiece keeps the airway from collapsing, the patient can breathe normally throughout the night. This method is a simple and safe way to keep your airway unobstructed.  For some, CPAP is somewhat more effective than dental devices for sleep apnea treatment. However, a CPAP only works if you use it on a nightly basis. If you don’t tolerate your CPAP treatment well and skip nights, then it isn’t an effective treatment option for you.

In cases where a sleep apnea sufferer has an abnormality in their throat, it can be highly effective to use an oral appliance in conjunction with a CPAP machine. This combination would allow them to receive the maximum benefit from the CPAP treatment.

Some other benefits of using an oral appliance for sleep apnea are:

  • Oral appliances for sleep apnea cost less than CPAP machines.
  • You don’t get tangled in hoses or cords as you try to sleep.
  • Oral appliance for sleep apnea are portable and can be easy to use on camping trips or long flights on an airplane.
  • Oral appliances are not bulky and much easier to transport.
  • You don’t ever need to plug in or charge an oral appliance for sleep apnea.
  • Cleaning an oral appliance for sleep apnea is much easier than cleaning out hoses and attachments on a CPAP machine.
  • There is no noise from an oral appliance that will keep you or your significant other awake.

Get a Medicare Approved Oral Appliance Right Away

If you have been struggling with sleep apnea or a CPAP machine to treat sleep apnea, you don’t have to any longer. Mark Levy DDS and his staff are here to help you with your sleep apnea issues. Reach out to us and one of our knowledgeable and understanding staff members will contact you and set up a time to discuss a Medicare-approved oral appliance for sleep apnea.

Call Mark Levy DDS at 614-777-7350 or fill out our free online contact form today to learn more about sleep apnea and sleep apnea medicare coverage for treatment.