Rest assured, most U.S. insurers cover Inspire® therapy
Don’t let concerns about insurance coverage keep you from getting better sleep.1
How much does Inspire® therapy cost?
Different plans can result in varying out-of-pocket expenses. Inspire does not verify benefits or quote out of pocket costs. Review the below examples shared by Inspire Patient Ambassadors on how much they paid out-of-pocket for Inspire® therapy.
Suzanne H.
Insurance type: Blue Cross Blue Shield
Out-of-pocket cost: Less than $1000 out-of-pocket for Inspire therapy.
Age: 51
BMI: 34
State: California
Comments: When I got Inspire therapy I had a basic Blue Cross Blue Shield plan as well as Federal Employee Health Benefits. Once I paid my $1000 deductible, my outpatient expenses were all covered. Before I began the Inspire therapy process, I looked on the BCBC website and made sure my Inspire-trained doctor was in-network for my plan.
Lisa G
Insurance type: Blue Cross Blue Shield
Out-of-pocket cost: $0 out of pocket cost for Inspire therapy.
Age: 59
BMI: 28
State: Arizona
Comments: When I got Inspire therapy, I had a low deductible plan with a low out of pocket maximum. Before I had my procedure, I met my out-of-pocket maximum, so my Inspire® implant procedure and follow up appointments were covered.
Nathan U.
Insurance type: Tricare Veteran Insurance
Out-of-pocket cost: $0 out of pocket cost for Inspire therapy.
Age: 39
BMI: 36
State: Tennessee
Comments: Tricare paid for every dollar of the Inspire therapy cost from my initial consult appointment, implant procedure, and follow up appointments.
Nancy H.
Insurance type: Medicare supplement part G
Out-of-pocket cost: $0 out of pocket cost for Inspire therapy.
Age: 66
BMI: 27
State: Florida
Comments: My doctor had a wonderful nurse who handled everything. Insurance approval was never an issue I had to deal with during the Inspire therapy process.
Suzanne H.
Insurance type: Blue Cross Blue Shield
Out-of-pocket cost: Less than $1000 out-of-pocket for Inspire therapy.
Age: 51
BMI: 34
State: California
Comments: When I got Inspire therapy I had a basic Blue Cross Blue Shield plan as well as Federal Employee Health Benefits. Once I paid my $1000 deductible, my outpatient expenses were all covered. Before I began the Inspire therapy process, I looked on the BCBC website and made sure my Inspire-trained doctor was in-network for my plan.
Lisa G
Insurance type: Blue Cross Blue Shield
Out-of-pocket cost: $0 out of pocket cost for Inspire therapy.
Age: 59
BMI: 28
State: Arizona
Comments: When I got Inspire therapy, I had a low deductible plan with a low out of pocket maximum. Before I had my procedure, I met my out-of-pocket maximum, so my Inspire® implant procedure and follow up appointments were covered.
The patient testimonials & sleep apnea treatment reviews above relate to accounts of an individual’s response to treatment. The accounts are genuine, typical & documented. Responses to the treatment can & do vary. Insurance coverage and costs vary with each insurance plan. Inspire does not guarantee any third-party coverage or payment for our products or reimburse customers for claims that are denied by third party payors. Always talk with your doctor about diagnosis and treatment information.
Coverage: What to expect
The vast majority of U.S. insurance providers – including Medicare, Veterans Affairs (VA) and major commercial carriers – cover Inspire therapy for those who have tried and struggle with CPAP.
Talking to your insurance agent
If you have U.S. commercial insurance or Medicare Advantage, it’s best to check directly with your insurance company to confirm your coverage information for Inspire therapy. Here’s a suggested way you may ask your insurance agent:
“I am considering Inspire therapy to help treat my sleep apnea. I would like to understand if my health insurance plan would cover the procedure and if my clinic is in network. The code for the procedure is 64582 (existing Inspire implant) or 64568 (Inspire V (five) implant), and it would be billed with a diagnosis code of G47.33. My clinic is [state your clinic here]."
Your Inspire-trained provider can answer implant-related questions, including which version of the implant you’ll receive. Inspire Medical Systems, Inc. is currently working with payers to navigate the transition to Inspire VTM within their policies. If you have questions about coverage for your specific Inspire® implant version, please work with your Inspire-trained provider, contact your insurance company, or contact us at [email protected].
See if you qualify.
Take a few minutes and find out if you qualify for Inspire® therapy. Fill out the questionnaire and get your results immediately.
Have you been diagnosed with obstructive sleep apnea (OSA)?
This questionnaire will ask for personal and health-related information. View our privacy policy.
Eligibility requirements
To be a candidate for Inspire therapy, you must meet the following FDA indications:
Age 18 or older
Diagnosed with moderate to severe obstructive sleep apnea
Have tried and struggle with CPAP
Inspire Therapy has been clinically tested for people with a body mass index (BMI) up to 40. Over 90%1 of U.S. adults are within this range. Most insurance policies have a BMI policy in place for Inspire therapy coverage. Talk to your provider or Inspire therapy-trained doctor for more information.
Inspire therapy is FDA-approved for use in pediatric patients with Down syndrome. Learn more about specific qualifications here.
BMI
If you meet the FDA indications for Inspire therapy and your BMI is 40* or less, it's likely your insurance will cover Inspire therapy. This may or may not require a prior authorization process that your clinic and/or the Inspire team can conveniently manage for you.
* Medicare plans require a BMI less than 35
Don't know your body mass index?
Take a simple 5-question quiz to find out if you qualify and calculate your BMI.
* Please note: Our Inspire Medical Systems, Inc. team is actively pursuing updates to coverage policies. Inspire therapy has been clinically tested for people with a BMI up to 40 – the vast majority2 of U.S. adults are within this range.
Learn more about your specific plan
Talk to your insurance provider for more information about your policy and to get an estimate of what your out-of-pocket costs may be.
An Inspire therapy-trained doctor also can talk to you about insurance coverage during your initial Inspire therapy consultation appointment.