Does TRICARE Cover Oral Appliance Therapy?

Quick answer: Yes — TRICARE can cover a custom oral appliance for obstructive sleep apnea when it is medically necessary and you have a diagnosis from a sleep study. TRICARE Prime members usually need a referral from their primary care manager; TRICARE Select members generally have more flexibility. Smiles for Life Dental Group works with TRICARE and checks your plan's requirements first.

How TRICARE Coverage Typically Works

TRICARE covers durable medical equipment that is medically necessary, and a custom oral appliance for diagnosed obstructive sleep apnea can qualify. It is billed through TRICARE as a medical treatment, not through a dental plan.

What you need depends on your plan. TRICARE Prime members usually need a referral from their primary care manager, and some services require prior authorization. TRICARE Select members can usually see an authorized provider without a referral, though cost-shares differ. We confirm your plan's requirements before treatment begins.

What We Handle for You

• Benefit verification — we confirm what your TRICARE plan covers for oral appliance therapy before treatment starts.
• Referrals and authorizations — we check whether your plan needs a referral or prior authorization, and help get it in place.
• Sleep study coordination — if you have not been diagnosed, we coordinate testing with a sleep physician.
• Medical billing — oral appliance therapy is billed with medical codes, which we handle directly.

Why a Dental Sleep Medicine Diplomate Matters

Billing a medical plan for an oral appliance is a different process from routine dental care. As a Diplomate of the American Board of Dental Sleep Medicine, Dr. Pooja Goel has the training — and the experience with medical documentation — that this treatment requires.

Other plans we work with: Aetna, UnitedHealthcare, Medicare, Kaiser Permanente, plus Sutter Health and the local IPAs PMG and SCCIPA.

Frequently Asked Questions