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Does Medicare Cover Mouth Guards for Sleep Apnea?

Mouth guard used to help treat sleep apnea
By Daniel Petkevich
Dec 8, 2022

You'll get coverage if it's medically necessary

There is no substitute for a good night's sleep. For those with sleep apnea, not getting enough sleep can bleed into other areas and impact your health negatively. Finding the right sleep apnea treatment can change your life. Medicare will cover mouth guards for sleep apnea as DME (durable medical equipment) if your doctor considers it medically necessary. Although, some other treatments might get preferential treatment on Medicare. Read on to find out what your options are for Medicare coverage of sleep apnea.

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What are mouth guards for sleep apnea?

Mouth guards for sleep apnea are plastic devices that fit over the teeth. Also known as mandibular advancement devices, they work by holding your jaw forward, helping to open the airway and reduce snoring and/or improving sleep apnea-related breathing issues. Mouth guards can help people with mild to moderate sleep apnea get a better night's rest without resorting to CPAP or other breathing devices.
If your doctor has diagnosed you with sleep apnea, they will likely recommend a mouth guard as part of the treatment plan. Your doctor may also order a sleep study to determine if a mouth guard is necessary.

What are the benefits of using a mouth guard for sleep apnea?

Using a mouth guard for sleep apnea can help you enjoy a better night's rest, as it helps keep your airways open during the night. In addition to improved sleep quality, using a mouth guard can also lead to less daytime drowsiness and fatigue, improved cognitive performance, reduced risk of heart attack or stroke, and improved overall health.

How to get Medicare coverage for a mouth guard for sleep apnea?

Your doctor will need to determine if a mouth guard is medically necessary for you, and you may require an overnight sleep study before they can do so. If the test shows that your sleep apnea is severe enough that it could cause serious health issues, then your doctor may prescribe a mouth guard as part of your treatment plan. Medicare will then cover the cost of the mouth guard. CPAP machines might be seen as the more reliable option when treating sleep apnea, so you need to try that first before getting Medicare approval for a mouth guard or other oral devices.
Finally, it's important to note that even if you have Medicare coverage for a mouth guard for sleep apnea, you may still need to pay out-of-pocket costs such as copays or coinsurance when purchasing one. You could pay up to 20% of the Medicare-approved amount through Medicare Part B.

What risks are associated with not using a mouth guard for sleep apnea?

Not using a mouth guard for sleep apnea can have serious consequences. Without proper treatment, your sleep apnea can worsen and lead to more severe health problems such as high blood pressure, stroke, heart attack, and diabetes. In addition, untreated sleep apnea can also lead to daytime drowsiness and fatigue.

Conclusion

In conclusion, Medicare will cover mouth guards for sleep apnea if they are deemed medically necessary by your doctor. Using a mouth guard for sleep apnea can help improve your sleep quality, reduce daytime fatigue, and may even lower your risk of stroke or heart attack. If you are experiencing any symptoms associated with sleep apnea, it is important to speak to your doctor to help find the right treatment for you. This content is for informational purposes only. Call an expert at Fair Square Medicare to answer any Medicare-related questions.

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