Is Sleep Apnea Surgery Covered by Insurance? Complete 2026 Guide

Most health insurance plans, including Medicare, generally cover sleep apnea surgery, but coverage is not guaranteed and is subject to specific requirements. The primary condition for coverage is typically the failure of less invasive treatments. Insurers require patients to have tried and failed conservative therapies like Continuous Positive Airway Pressure (CPAP) before they will approve surgical procedures. This 'CPAP first' policy ensures that surgery is reserved for those with moderate to severe obstructive sleep apnea who have not found relief from other methods.

The extent of coverage depends heavily on the individual's insurance plan, including their provider, annual deductible, copayments, and out-of-pocket maximums. Specific surgical procedures have different levels of acceptance by insurance companies. For instance, procedures like Uvulopalatopharyngoplasty (UPPP) and Hypoglossal Nerve Stimulation (e.g., Inspire Therapy) are often covered if the prerequisite conditions are met. However, treatments considered experimental or less effective, such as laser-assisted uvulopalatoplasty and palatal implants, are often not covered by Medicare and many private insurers. Patients should always obtain pre-authorization from their insurance provider to understand the specific costs and coverage details before undergoing surgery.