Does Medicare Cover Inspire Sleep Apnea Treatment?

Are you habitually suffering from obstructive sleep apnea (OSA) and looking for a solution? If so, you may be considering the Inspire system.

The Inspire system is a more recent treatment for obstructive sleep apnea. Inspire attempts to cure the fundamental cause of sleep apnea, not simply its symptoms, by activating the tongue and airway muscles.

If this treatment could help you, you might ask, “Does Medicare cover Inspire Sleep Apnea Treatment?”

In this article, we answer the question in clear, plain English. You will also find the average Inspire sleep apnea treatment costs for those without insurance coverage and some other helpful info.

Does Medicare Cover Inspire Sleep Apnea Treatment?

The short answer is yes; Medicare will cover the cost of Inspire sleep apnea treatment. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your Inspire sleep apnea treatment. Below we look at what these are so you know what to expect.

Original Medicare Coverage of Inspire Sleep Apnea Treatment

Original Medicare (Medicare Part A and Part B) provides coverage for Inspire sleep apnea treatment if it is considered medically necessary.

Your healthcare provider must first order the operation for Original Medicare to provide coverage.

Although Original Medicare has no specifications for eligibility for providing coverage for the Inspire sleep apnea treatment, according to the company’s website, you are eligible for Inspire sleep apnea treatment if you meet the following conditions:

You have Obstructive Sleep Apnea (also known as OSA)
You are unable to or cannot benefit from CPAP
You are not significantly obese
You are 18 years old or above

Medicare Advantage Coverage of Inspire Sleep Apnea Treatment

Medicare Advantage plans (Medicare Part C) also provide coverage for Inspire sleep apnea treatment. They cover everything Original Medicare covers, as well as some additional benefits.

What it covers and how much the out-of-pocket costs vary depending on your plan’s specifics.

Other Medicare Coverage for OSA Diagnosis

What about the diagnosis of OSA?

Well, Original Medicare also provides coverage for a home sleep study. Of course, you’ll get this coverage if it is considered medically necessary by your healthcare provider. However, Medicare will only cover Type 1 sleep studies if they take place in a sleep lab facility.

Is OSA Diagnosis Covered by Part A or Part B?

Coverage for a home sleep study is provided by Medicare Part B. Part B provides coverage for all types of sleep studies from type 1 to type 4.

However, type 1 sleep studies must take place in a sleep lab facility for Medicare Part B to provide coverage. Medicare Part B considers a home sleep study as medically necessary if it will be for diagnosing or treating sleep conditions like OSA.

In previous years, Medicare Part B only provided coverage for a sleep study if it took place in a sleep lab facility. However, nowadays, they also provide coverage for home sleep studies.

That is because home sleep studies are said to be more effective than being done in a sleep lab facility. If you are diagnosed with OSA, Medicare Part B will provide coverage for CPAP therapy or any other treatment.

Medicare Part B covers 80 percent of the costs of a home sleep study. You will pay for the remaining 20 percent as a copayment.

How Much Does Inspire Sleep Apnea Treatment Cost?

For both the surgery and the Inspire sleep apnea device, the overall cost may range from $30,000 to $40,000.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always be sure to double-check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.