Two of the most common treatments for obstructive sleep apnea or OSA are CPAPs and mouth guards. Though we already know that Medicare covers CPAP therapy, many people also want to know if they cover mouth guards for sleep apnea.
So a common question many people have is, “does Medicare cover mouth guards for sleep apnea?” In this article, we answer the question in clear, plain English. You will also find the average costs of mouth guards for sleep apnea, as well as other helpful info.
Does Medicare Cover Mouth Guards For Sleep Apnea?
The short answer is yes; Medicare will cover the cost of mouth guards for sleep apnea. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your mouth guards for sleep apnea. Below we look at what these are so you know what to expect.
Original Medicare covers mouth guards for sleep apnea because they are considered Durable Medical Equipment. Medicare Part B provides coverage for DME.
However, they will only cover them under certain conditions. First, the mouth guard should be “medically necessary”. To confirm if you are diagnosed with obstructive sleep apnea, a physician-approved sleep study will be performed on you. Your dentist must also be a Medicare-approved supplier for Medicare to cover mouth guards.
Medicare Advantage plans also cover mouth guards for sleep apnea as they are required to cover anything Original Medicare covers. They also offer additional benefits.
Once Medicare provides coverage for mouth guards for sleep apnea, they will cover 80% of the costs, and you will pay 20%.
How Much Do Mouth Guards For Sleep Apnea Cost?
Oral devices for sleep apnea may cost between $1,800 to $2,000. The costs also include dentist appointments, adjustments, follow-ups, and modifications.
About Mouth Guards For Sleep Apnea
Oral devices are used for treating several sleep issues, including OSA. They can be an alternative to CPAP machines. Mouth guards can help treat sleep apnea by moving the jaw forward. Having the jaw moved forward results in an increase in the size of the upper airway.
The air resistance that causes snoring is reduced. They are mostly used to treat mild to moderate sleep apnea cases, but they can also serve as an alternative against severe sleep apnea if the patient cannot tolerate CPAP machines.
It is important to know that they may not be 100% effective. And some doctors request a sleep study to measure how effective they are to the patient. Follow-up care is also conducted to determine if they are effective or not. But even so, most patients find them effective.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. 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.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover needle aponeurotomy?