Obstructive Sleep Apnea (OSA) is a medical disease that falls under your medical health insurance plan, not dental. Below you will find answers to common questions about insurance coverage for oral appliances used to treat OSA.
Medical Insurance Covers What Types of Oral Appliances?
Insurance coverage for obstructive sleep apnea varies.
Many healthcare plans cover oral appliances for OSA only when the devices are FDA approved, custom-made, and inserted and monitored by a qualified dentist. Over 100 FDA-approved custom oral appliances are available. Your Snoring Isn’t Sexy™ dentist is qualified to recommend the oral appliance that is right for you.
How do I know if my insurance covers oral appliances and will they tell me how much they cover the devices for?
Medical plans can be verified in advance for coverage of oral appliances. Medical plans do vary, so it’s a great idea to check with your Snoring Isn’t Sexy™ dentist for assistance in how to find out if your medical policy covers oral appliances.
An insurance representative is a “benefit estimator.” This representative will help you gauge coverage under your policy. (Or they should). However, the insurance representative may not be able to determine your exact reimbursement in advance. But this representative indicates if your plan includes coverage.
How does the Affordable Care Act (ACA) affect my insurance coverage for oral appliances?
Under the ACA (also known as Obamacare), coverage for oral appliances or other types of devices has improved. “Oral appliances are considered Durable Medical Equipment,” writes Rose Nierman, CEO of Nierman Practice Management. “It’s good to know that coverage of Durable Medical Equipment is one of the Essential Health Benefits in the Affordable Care Act (ACA), commonly known as Obamacare. Most states have adopted some form of this insurance mandate.”
What about Medicare?
Only licensed dentists bill for custom Oral Appliance Therapy for a Medicare beneficiary. Medicare covers certain oral appliances, as long as it meets the requirements. Medicare provides reimbursement for oral appliances under the Durable Medical Equipment (DME) benefit. This means that, in order to bill Medicare for these items, a dentist must enroll as a Medicare DME Supplier.
Does medical insurance cover mouthpieces for just snoring?
No. Medical insurance considers custom mouthpieces as the only type of oral appliances that are “medically necessary”. It’s important that your physician and dentist work together to manage sleep apnea in addition to the snoring. That snore could be something more! Even though snoring may stop, you or your bed partner still could be having sleep apnea episodes. For this reason, and to ensure that you receive the best possible care, medical insurance only covers custom mouthpieces fitted and inserted by a dentist.
This Insurance Guide for Oral Mouthpiece Coverage for Obstructive Sleep Apnea is a courtesy of Snoring Isn’t Sexy. This is not a guarantee of insurance benefits. Deductibles and copayments may apply.