Does Insurance Cover Sleep Apnea Dental Appliance?

In many, if not all, circumstances, health insurance will pay all or part of the price of a dental appliance for sleep apnea therapy. Granted, this varies from one health plan to the next, as well as from state to state, so you should check with your insurance provider to see if this treatment is covered. Simply call the sleep doctors at Koala Center for Sleep and TMJ Disorders if you don’t know how to contact them or how to find out. We’ll work with you to figure it out together.

Other insurance companies will cover the entire cost, while others may only cover a portion of it, and on the other end of the spectrum, some insurers may not cover any of the costs at all. Whatever the case may be, the dental/sleep doctors are here to assist you. For people who are uninsured, we have a variety of self-pay choices as well as discounts and financial possibilities. We want to make sure that everyone who needs therapy gets it as soon as possible.

How much do sleep apnea dental appliances cost?

Costs of Oral Appliances Mouthpieces and other oral appliances can be used to treat sleep apnea and snoring in those who have mild to moderate sleep apnea. A sleep apnea mouth guard can cost anywhere between $1,800 and $2,000. The appliance, dentist checkups, and follow-ups are all included. A lot of health insurance companies will pay for it.

Is a mandibular advancement device covered by insurance?

Mandibular advancement devices (MAD) and other mouth appliances may have different insurance coverage than CPAP machines. Some insurers will cover the entire amount, while others will just cover a portion of it. Some insurance companies may refuse to reimburse any of the costs.

What is the most effective oral appliance for sleep apnea?

The following devices, which must be fitted by a dentist or orthodontist and worn at night, are available:

Advancement device for the mandible (MAD). MADs, the most often used mouth device for sleep apnea, resemble a sports mouth guard. The devices are metal hinged and snap over the upper and lower dental arches, allowing the lower jaw to be eased forward. Some, like the Thornton Adjustable Positioner (TAP), let you choose how far forward you want to go.

Retaining device for the tongue. This device, which is less popular than MAD, is a splint that keeps the tongue in position to keep the airway open.

Dental devices may help persons with mild to severe sleep apnea sleep better and snore less frequently and loudly, especially if they sleep on their backs or stomachs. People are also more likely to use their dental appliances on a regular basis than they are to use CPAP.

In comparison to uvulopalatopharyngoplasty (UPPP), the conventional surgical approach for apnea, in which the surgeon removes soft tissue from the back of the throat, dental devices have been found to control sleep apnea over time. Dental gadgets, on the other hand, have certain possible downsides, including changed bites, tooth movement, discomfort, temporomandibular joint (TMJ) arthritis, dry lips, and excessive salivation.

If you have a dental device, you should have a checkup right away to see if it’s working, as well as periodic checkups to see if it needs to be adjusted or replaced. If you have pain or changes in your bite, the dentist or orthodontist who fitted your device may be able to make adjustments to help you.

The optimum treatment for obstructive sleep apnea is determined by a variety of criteria, including the severity of your condition, the physical anatomy of your upper airway, any other medical conditions you may have, and your personal preferences. Selecting the appropriate treatment choice for you should be done in consultation with your doctor or a sleep specialist.

Can a dentist prescribe a CPAP machine?

Sleep apnea may devastate your quality of life; not only does it leave you fatigued even after a full night’s sleep, but it can also lead to serious, long-term health concerns if left untreated.

The problem could be solved by your doctor using loud, heavy machines or even surgery. However, depending on your situation, your dentist may be able to recommend a less invasive alternative.

What is Sleep Apnea?

The symptoms of sleep apnea are more well-known than the disorder itself: weariness, snoring, headaches, irritability, and even melancholy. Rather than not getting enough sleep, the body stops breathing intermittently while sleeping, which causes these symptoms.

  • The most prevalent type of sleep apnea is obstructive sleep apnea (OSA), which is caused by inadequate or restricted airflow.
  • When the brain fails to provide correct instructions to the breathing muscles, central sleep apnea develops.

What Causes Sleep Apnea?

When the soft tissues of the throat collapse owing to muscle relaxation, it blocks the airway, causing obstructive sleep apnea. The body’s oxygen levels are lowered, and you wake up briefly throughout the night (some people fear they are suffocating).

Swollen tonsils and glands, swelling or misalignment of the jawbone, obesity, alcohol consumption before sleeping, or nasal disorders such as a deviated septum or allergies can all restrict the airways.

How Merion Village Dental Diagnoses and Treats Sleep Apnea

If the test indicates that you may have obstructive sleep apnea, you will be given a take-home sleep study, which records the biochemical parameters of your body while you sleep. Our dentists will discuss the study’s findings with you, and if they show that you have OSA, we will create a dental appliance for you to wear.

To treat obstructive sleep apnea, some dentists or doctors recommend a CPAP machine, which pumps air through the mouth and nasal passageways to keep soft tissues from contracting. CPAP machines can be noisy, big, and inconvenient, which might interfere with your sleep. Instead, our dentists will create a bespoke mouth appliance to assist you open your airways more easily.

The soft tissues in your airways (tongue, soft palate, tonsils, and back of the mouth) are individually formed to guide your jaw forward while sleeping, preventing them from blocking airflow. Starting with the initial use, you should get a decent night’s sleep with an unobstructed airway.

How long does an oral appliance for sleep apnea last?

With regular use, sleep apnea dental appliances can last up to two years. Some people may require a replacement as soon as six months, however this is uncommon. The mouth guard may become worn down and less effective after two years. We can examine for signs of wear and produce a replacement mouth guard if you bring your dental appliance in for regular checks.

Does Medicare cover sleep apnea appliances?

Oral appliances are a potential therapy option for OSA, but can oral devices for sleep apnea fall under Medicare coverage?

If oral devices for obstructive sleep apnea meet certain criteria and are certified “Medicare approved,” Medicare will cover them. To be eligible for coverage, you must:

  • Before obtaining coverage for the device, the patient must see a doctor, and the gadget must be ordered by the dentist.
  • To diagnose sleep apnea, the patient must undergo a Medicare-approved sleep test.
  • The oral device must meet all of the criteria outlined in the definition of durable medical equipment.
  • For the treatment of obstructive sleep apnea, oral appliance therapy must be both required and appropriate.
  • The patient cannot tolerate a positive airway pressure device, or the doctor thinks that utilizing a CPAP machine will not be effective in that situation.

In order for Medicare to cover your oral device, you must meet all essential criteria. In other circumstances, only a portion of the cost is covered, and the patient is responsible for the remainder.

If you have sleep apnea and want to learn more about mouthpieces, you’ll discover that many are available online. You must go through your dentist if you want Medicare to pay for your oral equipment. Even if you’re paying cash or using insurance, you should be aware of these mouthpieces because they might hurt your teeth and be ineffective if you buy one on impulse. A competent physician may ensure that the mouth guard is custom-made to fit your mouth, making it far more effective.

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

A dentist visit can help you evaluate if an oral device is the best treatment option for your sleep apnea. Oral devices for sleep apnea have been reported to be effective by those who have tried them. Many people claim improvement after just one night of utilizing an oral device. They also appreciate the fact that, unlike CPAP machines, oral devices do not produce noise and do not require electricity to operate. If you’re traveling, you can easily take them with you because they fit in your pocket.

Where can I get an oral appliance for sleep apnea?

Contact Dr. Jeffrey W. Cross, D.D.S., F.A.G.D., if you suffer from obstructive sleep apnea and are looking for an alternative to a CPAP machine. Since 2005, Dr. Cross has been treating sleep apnea with dental appliance therapy and mouthpieces. He is a member of the Academy of Clinical Sleep Disorders Disciplines and the American Academy of Dental Sleep Medicine. Dr. Cross has hundreds of hours of continuing education under his belt and is an expert in his profession.

Are snore guards covered by insurance?

Many health insurance policies will cover custom-made dental appliances for obstructive sleep apnea (OSA) provided they are installed by a trained dentist and are FDA approved. There are more than a hundred FDA-approved custom oral appliances on the market. Your Snoring Isn’t SexyTM dentist is equipped to make a recommendation for the best oral appliance for you.

How do I know if my insurance policy covers oral appliances?

Almost all medical plans cover oral appliances, which can be checked ahead of time. Because medical plans differ, it’s a good idea to ask your Snoring Isn’t SexyTM dentist for help determining whether or not your policy covers oral appliances.

Will my medical insurance tell me how much they cover for a mouthpiece or appliance?

The good news is that a “benefit estimator,” a type of insurance representative, should be able to calculate your policy’s coverage. Although the insurance person may not be able to estimate your exact reimbursement ahead of time, he or she can tell you if your plan includes coverage.

What about deductibles?

Because most carriers classify oral appliances for obstructive sleep apnea as Durable Medical Equipment, your deductible may differ from your typical insurance deductible. Check your deductible for medical DME benefits, as equipment like mouth appliances or even CPAP may have a different deductible. It’s crucial to remember this!

Does the Affordable Care Act (ACA) affect my insurance coverage for oral appliances?

Yes, coverage for dental appliances and other sorts of equipment has improved as a result of the Affordable Care Act (ACA, commonly known as Obamacare). Deductibles or copayments, depending on your plan, will be among your variables.

“According to Rose Nierman, CEO of Nierman Practice Management, “oral appliances are considered durable medical equipment.”

“It’s good to know that the Affordable Care Act (ACA), also known as Obamacare, includes Durable Medical Equipment coverage as one of the Essential Health Benefits.

The majority of states have enacted some type of insurance compulsion.”

Does medical insurance cover snoring mouthpieces?

No. Custom mouthpieces are the only type of oral appliance that medical insurance considers “medically required.” It’s critical that your doctor and dentist collaborate to treat sleep apnea as well as snoring. That snoring has the potential to be more! Even if your snoring has stopped, you or your bed partner may still be suffering from sleep apnea. Medical insurance only covers custom mouthpieces fitted and placed by a dentist for this reason, and to ensure that you receive the best possible treatment.

I’m a senior and have Medicare. Does Medicare pay for sleep apnea oral appliances?

Certain mouth appliances used to treat obstructive sleep apnea are covered by Medicare if certain Medicare-approved conditions are met. Oral appliances are covered by Medicare under the Durable Medical Equipment (DME) program. This means that a dentist must become a Medicare DME Supplier in order to charge Medicare for these things. For a Medicare beneficiary, only a licensed dentist is allowed to bill for bespoke oral appliance therapy.

Snoring Isn’t Sexy has provided this Insurance Guide for Oral Mouthpiece Coverage for Obstructive Sleep Apnea. This does not imply that you will receive insurance benefits. There may be deductibles and copayments.

Nierman Practice Management, which provides materials and training to dentists for medical billing of oral appliances, includes Snoring Isn’t Sexy. Dentists educated by Nierman Practice Management have assisted more patients than any other group in obtaining payment for oral appliances.

How Much Does Medicare pay for CPAP machines?

CPAP and BiPAP equipment are commonly covered by Medicare at 80% of the recommended cost. Some supplies, like as tubing and masks, are also covered in part. To be eligible for a Medicare-covered CPAP machine, you may need to undertake a doctor-supervised sleep study.

What are the bad side effects of the using the CPAP machine?

Side Effects of Continuous Positive Airway Pressure (CPAP) and Solutions

  • Nasal congestion is a common problem. Congestion or inflammation of the nasal passages is one of the most prevalent side effects of CPAP therapy.