Sleep Apnea Oral Appliance Coverage Calculator

Forecast what you will pay for an oral appliance to treat obstructive sleep apnea once deductibles, coinsurance, and plan allowance limits are applied. Enter the provider quote, your remaining deductible, and coinsurance share, then optionally add the insurer's allowed amount or your remaining out-of-pocket maximum to see the true cash requirement.

Total price quoted by your dentist or sleep center for the custom mandibular advancement device.
Amount of deductible you still owe before coinsurance applies to durable medical equipment.
Portion of the allowed amount you pay once the deductible has been met.
Optional. Defaults to the provider quote. Enter the insurer's negotiated allowance if it is lower than the billed cost.
Optional. Defaults to unlimited. Use the amount left before you hit the annual out-of-pocket maximum.

Coverage varies by carrier and medical necessity requirements. Confirm benefits with your insurer and provider before ordering an oral appliance.

Examples

  • $3,800 quote, $1,200 deductible remaining, 20% coinsurance, $2,900 allowance, $3,500 OOP cap ⇒ Patient out-of-pocket: $2,120.00 USD (capped by remaining out-of-pocket maximum) • Deductible applied: $1,200.00 USD • Coinsurance owed: $340.00 USD • Plan payment: $1,540.00 USD • Uncovered balance (above allowance): $900.00 USD • Coinsurance rate applied: 20.00%
  • $2,750 quote, $600 deductible remaining, 10% coinsurance, allowance blank, OOP cap blank ⇒ Patient out-of-pocket: $865.00 USD • Deductible applied: $600.00 USD • Coinsurance owed: $215.00 USD • Plan payment: $1,885.00 USD • Uncovered balance (above allowance): $0.00 USD • Coinsurance rate applied: 10.00%

FAQ

Does this calculation apply to Medicare claims?

Yes, but only if Medicare recognises the appliance as durable medical equipment. Enter the Medicare-approved amount in the allowed amount field to reflect their fee schedule.

How should I handle balance billing?

Any amount above the allowed charge is captured as uncovered balance. If your dentist is out of network, include the full billed amount so the model highlights the balance you may need to negotiate or finance.

Can I include HSA or FSA funds?

Track those outside the calculator—apply HSA or FSA balances to the patient out-of-pocket figure to see how much cash you need beyond tax-advantaged accounts.

What if I have already met my deductible?

Enter $0 in the deductible remaining field so the tool applies only coinsurance to the allowed amount.

Additional Information

  • Allowed amount defaults to the billed charge when the plan does not discount the appliance, mirroring how many PPO dental plans coordinate with medical coverage.
  • If the plan allowance is lower than the provider quote, the difference is treated as an uncovered balance that you must pay regardless of deductibles or coinsurance.
  • Applying the out-of-pocket maximum lets you confirm whether this purchase will trigger 100% coverage for additional care the same year.

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