Inspire Medical Systems, Inc. (INSP) · Nov 2, 2026 · Earnings

Inspire Medical earnings beat, but 2026 growth still stalls

Beat — Adj. EPS $0.14 vs ~$0.09 consensus; FY revenue midpoint unchanged at $855M

Inspire Medical’s Q3 earnings beat consensus and its adjusted EPS outlook improved, but revenue remains below last year as reimbursement issues persist.

Inspire is trying to navigate a coding-and-reimbursement slowdown in obstructive sleep apnea while using Project Horizon to redirect roughly $30 million of annual capacity into growth initiatives; management has been targeting a return to growth in 2027. The Q3 release shows early stabilization, not a full recovery.

The quarter beat a low bar, but the underlying business is still contracting. Revenue of $206.7 million exceeded the roughly $204.3 million consensus, and adjusted EPS of $0.14 topped the approximately $0.09 expectation. But revenue was down nearly 8% year over year, while adjusted EBITDA fell to $37.9 million from $44.0 million. Management said U.S. performance came in ahead of expectations and that physician comfort with the coding environment is improving, but the company is still operating below last year’s demand level. “We are pleased to have delivered sequential growth in the third quarter, with U.S. performance coming in ahead of our expectations.” 〔0〕

The outlook is more controlled, not meaningfully more bullish. Inspire narrowed its revenue range to $850 million–$860 million from $835 million–$875 million, leaving the midpoint unchanged at $855 million. It raised the midpoint of adjusted EPS guidance to $1.30 from $1.25, but the improvement is partly offset by a lower GAAP loss range and the continued burden of restructuring and legal costs. “The Company is narrowing its previously announced revenue outlook to be in the range of $850million to $860million, compared to the previous range of $835million to $875million.”

Project Horizon is producing cost capacity, but also confirms the transition is expensive. The quarter included $24.1 million of restructuring charges and a $7.0 million legal settlement, pushing GAAP operating income to a $28.7 million loss even though adjusted operating income was $1.9 million. Operating cash flow remained positive at $46.4 million, and the balance sheet held roughly $453 million in cash and investments at quarter-end, so the company has room to fund the transition. Still, adjusted EBITDA for the first nine months fell to $112.6 million from $121.3 million, meaning the cost reset has not yet translated into better operating performance.

The longer-term reimbursement setup improved, but the benefit is distant. The new dedicated CPT code for single-lead HGNS devices, including Inspire V, is scheduled to take effect in January 2028, which should reduce coding ambiguity for physicians and hospitals. That supports the eventual access story, but it does not solve the current reimbursement friction or restore growth in 2026. “When this takes effect in January 2028, a dedicated code set will give physicians and hospitals enhanced clarity around coding and reimbursement and, in turn, further enable patient access to Inspire therapy.” 〔1〕

Bottom line: This is a modestly better quarter than expected and the adjusted outlook is slightly improved, but the core story remains a company managing through a revenue decline rather than returning to growth already. The filing advances the stabilization narrative without rewriting it.

What to watch next

2027 return-to-growth plan and January 2028 CPT code launch

Original filing on SEC EDGAR