Sleep apnea doesn’t just disrupt your sleep—it can disrupt your life. From daytime exhaustion and poor concentration to serious health risks like high blood pressure and heart disease, untreated sleep apnea has far-reaching consequences.
If you’ve been exploring treatment options and your provider has recommended orthodontic intervention—like MARPE, oral appliances, or braces—you may be asking:
“Will my insurance help cover the cost?”
The short answer is: possibly—especially if your treatment is considered medically necessary and supported by proper documentation.
In this post, we’ll walk you through how insurance coverage works for orthodontic sleep apnea treatments, what steps you should take, and how Bergen Orthodontics can help guide you through the process.
How Orthodontics Plays a Role in Sleep Apnea Treatment
Sleep apnea is most commonly caused by a blockage in the airway during sleep—this is known as Obstructive Sleep Apnea (OSA). While CPAP machines are the standard solution, they don't fix the root cause for many patients. In children, teens, and adults with narrow jaws, high palates, or jaw misalignments, the physical structure of the mouth can be a major contributor to airway obstruction.
Orthodontic treatments such as the following can create lasting improvements by widening the airway, enhancing nasal breathing, and preventing soft tissue collapse during sleep:
- MARPE (Minimally Invasive Rapid Palatal Expansion)
- Braces or Invisalign to align the jaw and improve bite positioning
- Custom oral appliances designed to hold the lower jaw slightly forward during sleep
These treatment options address the root structural causes of obstructive sleep apnea, offering a more natural and long-term path to better breathing and improved sleep quality.
Will Insurance Cover Orthodontics for Sleep Apnea In New Jersey?
The Answer: It Depends on the Type of Insurance and the Documentation
There are two main types of insurance that may come into play:
Medical Insurance
Medical insurance is more likely to cover orthodontic treatment when it’s prescribed to treat a medically diagnosed condition like OSA. This is especially true if the treatment is:
- A non-surgical alternative to CPAP, such as MARPE or oral appliance therapy
- Prescribed by or in collaboration with a sleep physician, ENT, or pulmonologist
- Accompanied by proof of medical necessity, such as a sleep study report and a referral letter
In many cases, insurance providers will cover part or all of the cost when:
- You’ve had a diagnostic sleep study
- Your physician recommends orthodontic intervention
- Your treatment is not for cosmetic reasons
Pro Tip: The more documentation you can provide, the better your chances of getting approved.
Dental Insurance
Traditional dental plans usually cover orthodontics only for cosmetic or functional dental alignment issues. That said, if your plan includes orthodontic benefits, you may still be eligible for partial reimbursement, especially if devices like braces or retainers are included as part of your sleep apnea treatment plan.
However, most dental insurance providers do not cover treatments labeled as “medical,” such as oral appliances or airway expanders—those fall under your medical policy.
Steps to Take for Insurance Approval
Getting insurance coverage for orthodontic sleep apnea treatment is possible, but it takes the right strategy. Here’s how to get started:
Step 1: Get a Sleep Apnea Diagnosis
You’ll need a formal diagnosis of Obstructive Sleep Apnea from a sleep physician or pulmonologist. This typically requires a sleep study (polysomnography) conducted at a certified sleep center or through an at-home test.
Step 2: Request a Letter of Medical Necessity
Ask your physician or sleep specialist to write a detailed letter stating:
- Your diagnosis
- The severity of your OSA
- Why the proposed orthodontic treatment is necessary to improve your airway
- That non-invasive orthodontics is being considered as an alternative or complement to CPAP therapy
Step 3: Work With Your Orthodontist to Coordinate Care
An experienced orthodontic provider will often work closely with referring physicians to ensure all necessary medical records, imaging, and supporting documentation are in place. This collaborative approach helps strengthen your insurance claim and ensures that the orthodontic treatment is clearly tied to your diagnosed medical need—especially when addressing sleep apnea.
Step 4: Contact Your Insurance Provider
Speak directly with your insurance representative and ask the following:
- Is orthodontic treatment covered when used to treat obstructive sleep apnea?
- Are MARPE or oral appliances covered under medical benefits?
- What codes or forms are required for pre-authorization or reimbursement?
- Does the policy include out-of-network coverage if needed?
What If Insurance Doesn’t Cover It All?
Even with partial insurance coverage, there may still be out-of-pocket costs for orthodontic sleep apnea treatment. Fortunately, many orthodontic practices offer flexible financing options to help make care more affordable and accessible.
Depending on the provider, you may be able to:
- Break treatment costs into interest-free or low-interest monthly payments
- Use Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA) to cover eligible medical expenses
- Explore third-party financing options to fit your budget and timeline
The goal is to eliminate financial barriers so you can move forward with treatment confidently—without unnecessary stress or delay.
Why Choose Bergen Orthodontics for Sleep Apnea Treatment?
At Bergen Orthodontics, we take a comprehensive and compassionate approach to treating sleep apnea through orthodontics. Our focus isn’t just on straightening teeth—it’s on helping you breathe easier, sleep better, and live healthier. Whether you're exploring alternatives to CPAP or looking for a long-term, non-surgical solution, we’re here to guide you every step of the way.
Here’s why so many patients across New Jersey trust us for their airway-focused care:
Flexible Financial Options That Fit Your Budget
We believe that cost should never stand in the way of better health. That’s why we offer affordable, flexible payment plans to make treatment accessible for every patient. Whether you’re using medical insurance, HSA/FSA funds, or prefer low monthly payments, our team will help you find the best financial path forward.
Our knowledgeable staff is also happy to assist with insurance coordination, including providing supporting documentation and helping you navigate coverage for medically necessary orthodontic care.
Expertise in Airway-Focused Orthodontics
We specialize in identifying and treating the structural issues that contribute to obstructive sleep apnea. From MARPE to jaw alignment, our treatments are backed by clinical expertise and a deep understanding of how jaw development and airway function are connected.
Advanced Technology for Precision Diagnosis
Using 3D imaging, digital airway scans, and bite analysis, we provide a complete picture of your breathing and jaw anatomy. This allows us to design a truly customized treatment plan tailored to your unique needs and goals.
Coordinated Care With Medical Professionals
We work closely with sleep physicians, ENTs, and other healthcare providers to ensure your orthodontic treatment aligns with your overall sleep apnea management plan. This team-based approach helps deliver more effective, long-term results.
Proven Results, Trusted Reputation
We’ve helped countless patients in Bergen County and across New Jersey reduce snoring, improve sleep quality, and eliminate their dependence on CPAP—thanks to non-invasive, orthodontic treatment options that address the root of the problem.
Let Us Help You Navigate Insurance and Get the Care You Deserve
If you’ve been diagnosed with sleep apnea and are exploring orthodontic solutions like MARPE or oral appliances, you don’t have to navigate insurance and treatment planning alone.
At Bergen Orthodontics, we’ll guide you from diagnosis to documentation, helping you get the most from your insurance benefits while ensuring you receive the best possible care.
Schedule a consultation today to discuss your treatment options, insurance coverage, and next steps for better sleep and a healthier life.
