Sleep Apnea
Oral Appliance vs CPAP: Which Sleep Apnea Treatment Fits You?
Can't tolerate CPAP? How a custom oral appliance compares, and who it suits.
4 min readBy Hiral Desai, DDS, MDS, D. ABDSM
Does Insurance or Medicare Cover a Sleep Apnea Mouthguard?
Many people are surprised to learn that a sleep apnea appliance is usually billed to medical insurance, not dental. Here is how coverage works and how our office helps.
The short answer
Because sleep apnea is a medical condition, a custom oral appliance is usually billed to medical insurance, including Medicare, rather than dental insurance. Coverage typically needs a diagnosed sleep study and a doctor's prescription. Our team checks your benefits before you start.
Key takeaways
- It's billed to medical, not dental, insurance
- You need a sleep study and prescription
- FDA-cleared, PDAC-verified appliances are covered
- Store-bought snoring guards are not covered
- We check your benefits first
Why medical, not dental, insurance?
Sleep apnea is a medical condition that affects breathing and overall health. A custom oral appliance treats that condition, so it is generally billed as medical equipment rather than dental care.
What does Medicare usually require?
Medicare can cover oral appliances for obstructive sleep apnea as durable medical equipment when certain conditions are met. These usually include:
- A sleep test that confirms the diagnosis.
- An order from your doctor.
- A custom-made appliance that is FDA-cleared and PDAC-verified, from an enrolled supplier.
What about private PPO medical plans?
Many private PPO medical plans cover oral appliances too, often with similar requirements and sometimes a pre-approval step. Your deductible and coinsurance apply.
Want us to check your coverage? Call (714) 505-9462.
Book a consultationWhat if I'm not covered?
Cash payers are welcome, and monthly payments are available through several third-party financing vendors. Store-bought snoring guards aren't covered, and they aren't a substitute for a custom appliance for diagnosed sleep apnea.
How does our office help?
Our insurance coordinator checks your benefits, gathers the paperwork from your sleep study and physician, and explains your full cost before your appliance is ordered.
Sleep apnea coverage help in Tustin
Our office is at 604 E 1st St in the Larwin Square Shopping Center in Tustin. Bring your insurance cards and sleep study results to your consultation. Call (714) 505-9462.
Questions patients ask
Do you accept Medicare, PPO and HMO plans?
Yes. We accept Medicare and all PPO plans. Your deductible and coinsurance still apply. If you have an HMO plan, talk to our front desk. They will verify your benefits and let you know if your insurance will cover the device.
How much does an oral appliance cost?
If you're using insurance, your costs depend on your plan, copay and deductible, but we'll verify everything with your insurance and let you know what to expect. We believe in 100% payment transparency and will let you know what to expect even before we start treatment.
Do you have self-pay options?
We do. If you're not using insurance, you can still access care with clear, flat-rate pricing.
Can I use an HSA or FSA card?
Yes. HSA and FSA funds may cover oral appliances as eligible expenses. If you have any questions about eligibility, our team is happy to help.
Can I trust the cost estimate?
We believe in 100% financial clarity with all our patients before we start treatment. We base your estimate on information received directly from your insurance plan. If those details aren't fully up to date, the estimate may not be exact. Even after prior authorization, we can never guarantee how your claim pays. Every plan processes claims a little differently, so while we do our best to give you an accurate estimate, we recommend double-checking your coverage with your insurer.
What is a prior authorization?
Oral appliances generally do not need prior authorization when they are medically necessary, but some plans need insurer approval before they are covered. We'll handle that if needed.
What is a copay?
A fixed fee for a visit, depending on your plan.
What is coinsurance?
The percentage of the cost you pay after meeting your deductible.
What is a deductible?
The amount you pay out of pocket each year for healthcare services before your insurance plan begins to pay.
Do I need a referral?
You need a sleep apnea diagnosis and usually an order from your doctor. We can help coordinate this.
Is a snoring guard covered?
Over-the-counter snoring guards are not covered. Coverage applies to custom appliances for diagnosed sleep apnea.
How long does approval take?
It varies by plan. We'll tell you what to expect once we check your benefits.
Can I use financing?
Yes. Monthly payments through several third-party financing vendors are available for any amount your plan doesn't cover, based on approval.
Know your cost before you start
We check your coverage and explain your costs before anything is ordered, so there are no surprises.
Sources: Medicare.gov: Durable medical equipment coverage · Medicare.gov: Sleep studies
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This guide is general information, not a diagnosis. Book a visit for advice about your own teeth.