Sleep Apnea & Oral Appliance FAQ
The short answer
Medicare covers custom oral appliances for obstructive sleep apnea when its requirements are met, and we bill Medicare directly. You need a sleep apnea diagnosis first, which our home sleep test can provide. You don't need a referral to book, and most patients with a diagnosis are wearing their appliance in about 2-3 weeks.
Does Medicare cover oral appliances for sleep apnea?
Yes. Medicare covers a custom oral appliance for obstructive sleep apnea (OSA) under its durable medical equipment benefit when certain requirements are met. A physician, nurse practitioner or physician assistant must evaluate you in person before your sleep test. The sleep test must show OSA at a level Medicare covers: moderate or worse, or mild with symptoms such as daytime sleepiness or conditions such as high blood pressure. For severe sleep apnea, Medicare covers an oral appliance when you can't tolerate CPAP or CPAP isn't appropriate for you. The appliance must be custom-made and provided by a licensed dentist. Complete Health Sleep SoCal is a Medicare provider and bills Medicare directly. Your Part B deductible and coinsurance usually apply.
Do I need a sleep study before getting an oral appliance?
Yes. You need a sleep apnea diagnosis from a physician, based on a sleep test, before treatment, and Medicare and most insurance plans require it. If you haven't been tested, our home sleep test is simple: you wear a small wrist device and a finger ring in your own bed, and a physician reads the results. If you already had a sleep study, bring the report to your consultation.
Do I need a referral to see Dr. Rappaport?
No. You can call or request an appointment without a referral, whether or not you have Medicare. Before Medicare pays for an appliance, your physician (or a physician we coordinate with) must evaluate you, review your sleep test and sign a written order. We help with those steps. Referrals from physicians, chiropractors, naturopaths and other providers are always welcome.
How long does it take to get an oral appliance?
Most patients are wearing their custom appliance about 2-3 weeks after their consultation, if they already have a sleep apnea diagnosis. The steps are a consultation, a diagnosis (a home sleep test if needed), impressions or a scan of your teeth, then fitting the appliance. Follow-up visits fine-tune the fit and position for comfort and results.
Will my insurance cover an oral appliance?
Often, yes. Oral appliances for sleep apnea are usually billed to medical insurance, not dental insurance. Medicare covers them when its requirements are met, and many medical plans do too. We check your benefits and explain expected costs before treatment begins.
Who is a good candidate for an oral appliance?
Adults with snoring or obstructive sleep apnea, especially mild to moderate OSA, and people who can't tolerate CPAP. The American Academy of Sleep Medicine recognizes oral appliance therapy as a treatment option for adults with OSA who prefer it or can't use CPAP. Dr. Rappaport, a Diplomate of the American Board of Dental Sleep Medicine, checks your teeth, jaw and airway to confirm it's right for you.
What is a home sleep test like?
It's an overnight test you take in your own bed. You wear a small wrist device and a ring on your finger while you sleep, then return them. A physician reads the results and diagnoses whether you have sleep apnea and how severe it is.
Have another question?
Call our Poway office or request an appointment, and we'll help you understand your options, your coverage and your next step.
Request an AppointmentCall (858) 956-7928
This page is for informational purposes only and does not constitute medical advice. Coverage depends on your plan and Medicare's requirements; we confirm your benefits before treatment.