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Rest assured, most U.S. insurers cover Inspire® therapy

Don’t let concerns about insurance coverage keep you from getting better sleep.1

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.

Man talking on the phone
Man talking on the phone

General requirements

In general, insurance providers require you to meet the FDA indications for Inspire therapy:

  • Age 18 or older

  • Diagnosed with moderate to severe obstructive sleep apnea

  • Have tried and struggle with CPAP

Coverage varies depending on your plan and policy. If you qualify, you typically can expect to pay any unmet deductible for the year, along with any copay or coinsurance fee your insurance plan requires.

Body mass index (BMI) is another important factor in determining coverage for Inspire therapy. Some basic BMI related qualification considerations are as follows.

The image shows a simple icon of a gauge with an indicator pointing to the left side, along with the text "<32" below it.

BMI below 32

If you meet the FDA indications for Inspire therapy and you have a BMI below 32, your insurance company is very likely to pay for Inspire therapy.

Between 32 and 35 BMI scale

BMI 32-35

If you meet the FDA indications for Inspire therapy and your BMI is between 32-35, it’s likely your insurance will pay for 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.

Above 35 BMI scale

BMI above 35*

If you meet the FDA indications for Inspire therapy and your BMI is above 35, getting coverage for Inspire from your insurance provider may be more difficult, but there may be options. Talk to your insurance provider or Inspire therapy-trained doctor to learn more.

The image shows a man completing the Do I Qualify Form
The image shows a man completing the Do I Qualify Form

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.

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1 Woodson BT, Strohl KP, Soose RJ, et al. Upper Airway Stimulation for Obstructive Sleep Apnea: 5-Year Outcomes. Otolaryngology Head Neck Surgery 2018; 159(1):194-202
2 “Overweight & Obesity Statistics - Niddk.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, Sept. 2021.