Does Medicare Cover Inspire for Sleep Apnea?

While CPAP therapy is the gold-standard treatment for obstructive sleep apnea (OSA), many patients struggle with mask discomfort, dry mouth, air leaks, or claustrophobia, which can lead to poor adherence or intolerance to CPAP therapy.

Inspire for sleep apnea is an FDA-approved OSA treatment that’s an alternative to CPAP for some people with OSA Trusted Source U.S. Food and Drug Administration (FDA) The FDA is responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices; and by ensuring the safety of our nation's food supply, cosmetics, and products that emit radiation. View Source .This therapy focuses on nerve stimulation rather than air pressure. 

“It is like a pacemaker for the tongue,” says sleep medicine specialist Lulu Guo, MD. “It responds to each breath and helps keep the airways open.”

Below, we’ll explain what it is, how it works, and who’s a good candidate for the procedure. We’ll also detail what it takes to get Medicare coverage for Inspire and how much it can cost. 

What Is Inspire for Sleep Apnea?

In obstructive sleep apnea, breathing disturbances occur because of a physical blockage in the upper airway. Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source . CPAP therapy pushes pressurized air into your breathing passages to prevent upper airway collapse. Slightly different from CPAP machines, mandibular advancement devices (MADs) are another way to treat OSA via mouthguards that reposition the  jaw or tongue forward to open your airway. 

Inspire for sleep apnea is an OSA treatment that’s intended for people who have already unsuccessfully tried CPAP therapy or a MAD. It’s a hypoglossal nerve stimulation treatment that activates a nerve controlling tongue movement to open your breathing passages and improve OSA symptoms. Inspire has three main components that work together: a nerve stimulator, a monitor, and a remote.

Inspire candidates undergo a procedure to test how their airways collapse to determine if they are a good candidate for Inspire. If they are a good candidate, they will then undergo an outpatient surgical procedure that places two connected implants. The procedure is generally done under anesthesia and takes about 90 minutes. A monitor is implanted under the skin near your collarbone. It has a connected wire that runs toward your jawline. The end of the wire has a nerve stimulator that’s placed with a second incision so that it’s situated near the hypoglossal nerve, which is the nerve that controls your tongue. 

The implant near your collarbone monitors your breathing and directs the nerve stimulator to move your tongue forward while you take a breath, leaving your airway clear and unobstructed. Patients often feel mild stimulation, but it shouldn’t be painful. Treatment starts when you place the remote over your chest near the monitor. Sleep data is also transmitted to a phone app for tracking and follow-up care.   

Does Medicare Cover Inspire for Sleep Apnea?

Medicare covers Inspire under Medicare Part B coverage in specific cases. Medicare Part B covers outpatient procedures, preventative care, and medically necessary services Trusted Source Medicare.gov Medicare.gov provides essential information about signing up for and using Medicare, which is health insurance for people 65 or older. View Source . People with OSA must meet specific criteria in order to get Medicare coverage. 

Medicare will not cover Inspire if a high percentage of your breathing issues stem from central sleep apnea (CSA) or mixed sleep apnea (MSA) rather than OSA. You also can’t get Inspire treatment without first trying CPAP or another non-invasive OSA treatment.  Medicare requires proof that CPAP was attempted and not tolerated before approving Inspire.

How to Get Medicare to Cover Inspire

In order to get Medicare to cover Inspire, you must first be diagnosed with OSA. Medicare covers all four types of sleep tests including in-person polysomnographies and at-home sleep tests. After being diagnosed with OSA, a physician will prescribe a treatment plan that will most likely involve CPAP therapy, since it’s one of the most effective treatment methods.

However, some people don’t tolerate CPAP therapy well, whether it’s because of discomfort wearing a mask, problems with dry mouth, or anatomical restrictions. If CPAP therapy fails or you can’t adhere to it even after a doctor’s interventions, you may qualify for Inspire treatment. 

It’s important to note that you can’t make this decision on your own. To get coverage, your doctor must be documented as a shared decision maker stating that you need an alternative to CPAP therapy. 

Medicare Requirements for Inspire Coverage

There are strict requirements to get Medicare coverage for Inspire. A person seeking coverage must meet all of the following criteria Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source . 

• At least 18 years old
• Generally, a BMI of 35 or less
• Have completed a polysomnography (sleep study) within 24 months of your first Inspire consultation
• More than 75% of breathing events caused by OSA rather than CSA or MSA
• Apnea-hypopnea index (AHI) of 15 to 65 
• Documentation from a healthcare provider that there is CPAP failure or intolerance 
• No complete concentric collapse of the soft palate, which can be determined by drug-induced sleep endoscopy (DISE)

To get Medicare coverage, you also need to have the procedure performed by a board-certified physician who meets specific qualifications Trusted Source ERJ Open Research View Source . 

How Much Does Inspire Cost With Medicare?

Your exact cost for Inspire will vary depending on where you get the procedure done. However, you can estimate a ballpark figure with Medicare’s coverage data. First, you must meet Medicare’s Part B deductible, which is $283 in 2026 Trusted Source Centers for Medicare and Medicaid View Source . Medicare will cover 80% of the procedure cost, while beneficiaries are responsible for the remaining 20%. 

On average, patients getting Inspire for sleep apnea at an outpatient surgical center will pay about $5,330 out of pocket. Hospitals are generally less expensive, costing roughly $1,839 out of pocket. However, these aren’t fixed costs – they can vary and may not include facility or doctor’s fees. You should check with your provider, but you can generally expect to pay somewhere between $2,000 and $6,000 with Medicare coverage Trusted Source Centers for Medicare and Medicaid View Source . Costs vary by region, surgeon and facility type.

How to Check if Your Medicare Plan Covers Inspire

If you’re enrolled in Medicare Part B or a Medicare Advantage plan with Part B bundled, you should be able to get Inspire coverage (provided you meet the criteria). Most Advantage plans include Part B, but you can check your individual coverage by using your patient portal or calling customer service. Preauthorization is necessary before moving forward with the procedure.