Does Medicare Cover Inspire for Sleep Apnea?
Fair Square Medicare

Does Medicare Cover Inspire for Sleep Apnea?

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By Daniel Petkevich

Dec 27, 2022

See if you might qualify

A critical part of a long and healthy life is restful sleep. This is easier said than done with sleep apnea. Luckily, if your doctor deems the Inspire implant to be medically necessary, you can get coverage through Medicare. But how does it work? Let's find out.

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What is Sleep Apnea and How Is It Treated?

Sleep apnea is a sleep disorder where your breathing repeatedly stops and starts while you are sleeping. It is caused by the muscles in the throat becoming too relaxed, which can cause your airway to collapse. Sleep apnea can be treated with a mouth guard or CPAP machine. Another option is the Inspire implant. Inspire therapy helps people with obstructive sleep apnea (OSA) breathe more easily during sleep by stimulating the hypoglossal nerve. This nerve helps to keep the airway open.

Does Medicare Cover the Cost of an Inspire Implant?

Yes, Medicare Part B covers the cost of an Inspire implant if your doctor deems it medically necessary. If you have Medicare Part B and meet all other coverage requirements, you may qualify for coverage of Inspire therapy. Coverage includes the device itself and any related procedures performed by your doctor.

While you'll have coverage, there might still be out-of-pocket expenses such as deductibles, copays, and coinsurance up to 80% of the total cost. With the Inspire implant priced around $30,000 to $40,000, this can be a huge bill. The best way to limit out-of-pocket exposure is with Medicare Supplement Plan G.

What Types of Tests Are Required to Determine Eligibility for Medicare Coverage?

To be eligible for coverage, your doctor must complete a series of tests and provide the results to Medicare. These tests include a sleep study, an airflow evaluation, and a physical examination. Your doctor will also review your medical history and assess whether Inspire therapy is medically necessary for improving your quality of life.

What Is the Process for Obtaining an Inspire Implant Through Medicare?

Once your doctor has determined that you are eligible for coverage under Medicare, they will submit all the necessary documentation to Medicare. The process typically takes a few weeks and may involve getting pre-approval from your local Medicare office. After approval is obtained, your doctor will schedule an appointment to have the device implanted.

Other Considerations When Deciding Whether or Not to Get an Inspire Implant?

Getting an Inspire implant is a big decision, and it’s important to weigh all the pros and cons before proceeding. Make sure you understand the risks of undergoing this procedure, as well as any potential side effects or complications that may arise from having the implant. Your doctor should be able to answer any questions you have about the procedure and help you make an informed decision.

Benefits of Getting an Inspire Implant Through Medicare

Getting an Inspire implant through Medicare will save you money on the cost of the device and any related procedures. It can also help improve your quality of life by reducing snoring, daytime sleepiness, and other symptoms associated with OSA. Additionally, since Medicare is covering your procedure, you’ll have access to high-quality healthcare

Tips on Making Sure You Receive Proper Treatment With Your Insurance Provider

When working with your insurance provider for coverage of an Inspire implant, it’s important to make sure you are getting the care and treatment that you need. Have all of your questions ready before any appointments, and make sure you understand what is covered by your policy. Be prepared to present evidence from your doctor that shows the procedure is medically necessary. Additionally, be aware of any coverage limitations and exclusions in your policy before treatment. With the proper preparation, you can ensure you receive the best care possible from your insurance provider.

Takeaway

There is no substitute for a good night's sleep. If Inspire is the right sleep apnea treatment for you, Medicare might cover it if your doctor considers it medically necessary. Be sure to talk with your doctor before pursuing any treatment. This content is for informational purposes only. If you have any Medicare questions, Fair Square Medicare has a team of experts ready to help you. Call us now.

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Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.


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