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.
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 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.
BMI 32-40
If you meet the FDA indications for Inspire therapy and your BMI is between 32-40*, 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.
*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.
Find a doctor1 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.
