Inspire is an implanted hypoglossal nerve stimulator (the clinical name is HGNS). A small device, placed under the skin, senses your breathing and gently moves the tongue forward during sleep to keep the airway open. It's an alternative for people with obstructive sleep apnea who can't tolerate a CPAP machine. Because it's surgery, every insurer requires prior authorization — and the approval turns on a handful of specific numbers.
Here's the part most people don't realize: the clinical bar is not the same across insurers. Two of those numbers — your apnea-hypopnea index (AHI) and your body mass index (BMI) — are where insurers diverge, and the gap is wide enough to flip the answer.
Every insurer below requires the same foundation (we'll cover that next). What differs is the AHI range, the BMI ceiling, and the minimum age:
| Insurer | AHI range | BMI ceiling | Min. age | Source policy (2026) |
|---|---|---|---|---|
| Aetna | 15–100 | under 40 | 18 | CPB — Obstructive Sleep Apnea in Adults |
| Cigna | 15–100 | 40 or under | 18 | Coverage Policy mm_0158 / eviCore SDB |
| UnitedHealthcare | 15–100 | 40 or under | 18 | Policy 2026T0525UU (OSA Treatment) |
| Anthem / Elevance | 15–65 | 32 or under | 18 | Carelon Sleep Disorder Management |
| Medicare | 15–65 | under 35 | 22 | CMS LCD L38276 (HGNS) |
| Medicaid | Varies by state — check your state's DME / OSA policy | State Medicaid manual | ||
Read that BMI column again. Anthem stops at 32. Medicare stops just under 35. Cigna, Aetna, and UnitedHealthcare go all the way to 40. That single difference is the most common reason an Inspire request is approved by one insurer and denied by another.
Before any of the numbers above matter, every insurer requires this foundation. Miss one of these and the request is denied no matter your AHI or BMI:
This is where the insurer differences stop being abstract. Take a patient who has failed CPAP, has predominantly obstructive apnea, and a clean DISE:
If you're near a BMI cutoff, this is worth knowing before you schedule the surgery. It can be the difference between an approval and a months-long appeal.
Enter your insurer, your AHI, and your height and weight, and see exactly where you stand against that insurer's real Inspire criteria — plus what to document if you're close.
Check my Inspire coverageIt depends on the insurer. Anthem covers Inspire only at a BMI of 32 or under, Medicare at under 35, and Cigna, Aetna, and UnitedHealthcare at 40 or under. There's no single national number — the BMI ceiling is set by each insurer's policy, and it's the most common reason the same patient is approved by one and denied by another.
Your apnea-hypopnea index generally has to be 15 or higher. Cigna, Aetna, and UnitedHealthcare cover an AHI up to 100; Anthem and Medicare cap it at 65. An AHI above your insurer's ceiling, or below 15, falls outside coverage. The reading must come from an attended (in-lab) sleep study for the Inspire workup.
Yes, always. Inspire is never approved as a first treatment. You must have documented CPAP failure (your sleep apnea stayed inadequately treated despite using it) or genuine CPAP intolerance. This documentation is one of the most frequently missing pieces in denied requests.
A drug-induced sleep endoscopy (DISE) is a procedure where an ENT examines your airway while you're under light sedation, to see how it collapses during sleep. Inspire is only covered if the airway does not show a complete concentric collapse at the soft-palate level — that specific pattern means the device is less likely to work, so it disqualifies coverage even when every other criterion is met.
Yes, under a national coverage determination (LCD L38276), but with the strictest numeric limits of the major payers: an AHI of 15 to 65, a BMI under 35, age 22 or older, predominantly obstructive apnea, documented CPAP failure, and a qualifying DISE. A patient with a higher BMI or AHI who would qualify under a commercial plan may not qualify under Medicare.
The most common reasons are a BMI or AHI outside your specific insurer's window, missing CPAP-failure documentation, a DISE that wasn't done (or showed a complete concentric collapse), or too high a proportion of central apneas. Almost all of these are fixable — by documenting the missing piece, optimizing weight to get under a BMI ceiling, or appealing with the DISE and CPAP records attached.
All three do, and with the most generous limits: an AHI of 15 to 100 and a BMI up to 40, for adults 18 and older, after CPAP failure and a qualifying DISE. Among the major commercial insurers, these three give the widest window for Inspire approval.
No. Inspire treats obstructive sleep apnea by moving the tongue forward to open the airway; it does nothing for central sleep apnea, where the brain isn't signaling the breathing muscles. Every insurer requires that central and mixed apneas make up less than 25% of your total AHI.
When it's covered, you pay your plan's surgical cost-sharing — typically your deductible plus coinsurance for an outpatient surgery, which varies widely by plan. The key to keeping costs predictable is getting prior authorization approved before the procedure, so the implant is billed as a covered benefit rather than denied after the fact.
Related: Sleep apnea coverage checker · Why prior authorizations get denied · all coverage tools