At a glance
Inspire Medical Systems Inc is worth $2.06B, about 15 times its fiscal 2025 earnings. Revenue grew 13.6% to $912.0M in fiscal 2025, with 15.9% kept as profit; over 5 years it has grown 51.2% a year. It pays no dividend; it spent $175.0M buying back its shares over FY2021–FY2025. The stock returned −8.0% over the past year with dividends reinvested and −22.9% a year over five years, against +11.5% and +11.7% for the S&P 500. At its worst it fell 53.7% in the 2020 crash (S&P 500: 33.7%) and 44.7% in the 2022 bear market (S&P 500: 24.5%), and was back at its earlier high 3 months and 9 months after the lows.
The business in plain English
Inspire Medical Systems makes one main product: the Inspire system, an implanted device for obstructive sleep apnea (OSA). In OSA, the airway keeps narrowing or closing during sleep, which interrupts breathing. The device tracks each breath and sends mild pulses to the nerve that controls the tongue, nudging it forward to keep the airway open. It is meant for people with moderate to severe OSA who can't use or don't benefit from CPAP, the standard mask-and-air-pump treatment. Doctors have treated more than 125,000 patients with it.
Its customers are hospitals and outpatient surgery centers. Inspire reaches them with its own sales force in the U.S. and parts of Europe, and through distributors in Japan and Singapore. It also advertises directly to patients. Insurers and Medicare generally reimburse U.S. customers, so coverage matters. Inspire says insurers with policies covering the therapy reach over 300 million people in the U.S., and all seven regional Medicare contractors pay when medical criteria are met.
Revenue for the year ended December 31, 2025, rose 13.6% to $912 million, and Inspire system sales made up almost all of it. Gross margin, the share of sales left after production costs, was 85.4%. Its sales effort is centered on the U.S.: as of December 31, 2025, it had 295 sales territories there and 21 elsewhere.
Price history
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INSP -8.0% over the year to Oct 28, 2026, total return with dividends reinvested.
Latest results
- In Q3 FY2026 (ended Sep 30, 2026), revenue was $206.7M, down 7.9% from a year earlier, and net income was $-24.4M (-345.6%).
- For fiscal 2025, revenue was $912.0M (+13.6% year over year; +51.2% a year from FY2020 to FY2025) with a 15.9% net margin.
Financial health check
| Revenue growth a year (FY2020–FY2025) | +51.2% good |
|---|---|
| Operating margin | 5.6% watch |
| Free cash flow margin | 8.6% watch |
| Return on equity (FY2025) | 18.6% good |
| Return on assets (FY2025) | 16% good |
| Cash and investments | $453.1M (no borrowings found in the filings) good |
| Fiscal year | Revenue | Net income | Free cash flow |
|---|---|---|---|
| FY2020 | $115.4M | $-57.2M | $-55.5M |
| FY2021 | $233.4M | $-42.0M | $-24.8M |
| FY2022 | $407.9M | $-44.9M | $2.5M |
| FY2023 | $624.8M | $-21.2M | $1.0M |
| FY2024 | $802.8M | $53.5M | $91.1M |
| FY2025 | $912.0M | $145.4M | $78.5M |
Valuation snapshot
| Market value | $2.06B |
|---|---|
| P/E ratio | 14.5 |
| Dividend yield | None |
Rank among 1514 US companies
Market value at each year end
Inspire Medical Systems’s market value went from $904.2M at the end of 2018 to $2.06B on Oct 28, 2026, about 2.3 times as much; since the end of 2025 it is down 23%.
Show as a table
| Year end | Market value | Change |
|---|---|---|
| Oct 28, 2026 | $2.06B | -23.3% |
| 2025 | $2.68B | -51.8% |
| 2024 | $5.56B | -7.5% |
| 2023 | $6.01B | -17.5% |
| 2022 | $7.28B | +15.6% |
| 2021 | $6.29B | +24.2% |
| 2020 | $5.07B | +183.7% |
| 2019 | $1.79B | +97.5% |
| 2018 | $904.2M |
Price behavior
| YTD | 1 yr | 3 yr | 5 yr | 10 yr | |
|---|---|---|---|---|---|
| INSP price data to Oct 28, 2026 | -23.1% | -8.0% | -22.2% | -22.9% | — |
Show as a table
| Year | Price data |
|---|---|
| 2026 (to date) | -23.1% |
| 2025 | -50.3% |
| 2024 | -8.9% |
| 2023 | -19.2% |
| 2022 | +9.5% |
| 2021 | +22.3% |
| 2020 | +153.5% |
| 2019 | +75.6% |
| 2008 financial crisis stocks fell Oct 9, 2007 – Mar 9, 2009 | Before this security existed |
|---|---|
| 2020 COVID crash stocks fell Feb 19, 2020 – Mar 23, 2020 | Lost 49.2% over that stretch · deepest drop along the way 53.7%, back to its old high 2.8 months after the low |
| 2022 bear market stocks fell Jan 3, 2022 – Oct 12, 2022 | Lost 30% over that stretch · deepest drop along the way 44.7%, back to its old high 9 months after the low |
Insider activity
Form 4 filings from 2025-11-03 to 2026-11-03 (25 read): 0 open-market purchases and 4 sales ($233K), 1 of them under pre-arranged 10b5-1 trading plans.
| Date | Insider | Type | Value |
|---|---|---|---|
| May 15, 2026 | John Rondoni See Remarks | sell | $114K |
| Aug 7, 2026 | Jason P Kelly See Remarks | sell | $57K |
| May 8, 2026 | Shawn mcCormick Director | sell (plan) | $32K |
| May 14, 2026 | John Rondoni See Remarks | sell | $30K |
Who owns it
Large shareholders (13G filings)
| BlackRock, Inc. | 14.4% | Jun 30, 2026 |
| Wellington Management Group LLP | 8.8% | Mar 31, 2026 |
| Soleus Capital Master Fund, L.P. | 6.7% | Jun 30, 2026 |
| AQR Capital Management, LLC | 6.44% | Jun 30, 2026 |
| Vanguard Portfolio Management | 6.02% | Sep 30, 2026 |
| D. E. Shaw & Co., L.P. | 5.1% | Jun 25, 2026 |
| Vanguard Capital Management | 5.1% | Mar 31, 2026 |
| WASATCH ADVISORS LP | 5.1% | Mar 31, 2025 |
| Deerfield Mgmt, L.P. | 4.5% | May 14, 2026 |
| FMR LLC | 2.5% | Sep 30, 2025 |
| Citadel Advisors LLC | 1.8% | Dec 31, 2025 |
| Wasatch Advisors LP | 0.5% | Sep 30, 2025 |
ETFs with the most weight in INSP
| HEAL Global X HealthTech ETF | 3.58% |
| PSCH Invesco S&P SmallCap Health Care ETF | 3.21% |
| BKIV BNY Mellon Innovators ETF | 2.81% |
| EKG First Trust Nasdaq Lux Digital Health Solutions ETF | 1.93% |
| SIXS ETC 6 Meridian Small Cap Equity ETF | 1.03% |
| VIOG Vanguard S&P Small-Cap 600 Growth ETF | 0.82% |
| QMID WisdomTree U.S. MidCap Quality Growth Fund | 0.47% |
| XJR iShares ESG Select Screened S&P Small-Cap ETF | 0.43% |
What could go wrong
- Almost everything rides on one device. Inspire system sales made up almost all revenue from 2023 through 2025. If doctors or patients lose interest, or the device has a quality problem, there is no other product line to cushion the blow.
- Insurers and Medicare control access. U.S. hospitals generally rely on insurers and Medicare to pay for the procedure. Coverage changes, confusion about possible changes, or trouble getting prior authorization (insurer sign-off before surgery) can delay procedures and hurt sales.
- Bigger competitors could win patients. Inspire faces companies with longer histories, more established products or greater resources. It counts on being first to market, but rival devices or treatments could slow its growth and pressure prices.
- Profits are new and could slip. Inspire lost money from 2020 through 2023. Core operating profit was 5.6% of 2025 sales, and net income in the quarter ended June 30, 2026, was $0.3 million as revenue fell 7.6% year over year.
- Outside manufacturers and strict device rules. Inspire relies on a limited number of outside suppliers and contract manufacturers. A supplier failure, a breach of manufacturing regulations, or a recall could interrupt supply of its only major product.
- Big swings in results and share price. U.S. sales tend to peak in the fourth quarter and dip in the first, when insurance deductibles reset. As of October 28, 2026, the shares' deepest fall from a peak was 87.7%.
Recent events
- Quarterly results released; Investor presentation or announcement
- Quarterly results released; Investor presentation or announcement
- Executive or board change
- Investor presentation or announcement
- Executive or board change; Bylaws or fiscal year changed; Shareholder vote results
- Quarterly results released; Investor presentation or announcement
- Quarterly results released; Bylaws or fiscal year changed; Investor presentation or announcement
- Quarterly results released; Executive or board change; Investor presentation or announcement
- Other company announcement
- Quarterly results released; Investor presentation or announcement
For income and retirement investors
Inspire pays no dividend, and its annual report says it does not expect to pay one in the foreseeable future. For an income investor, that means no cash payouts to spend; any return depends on the share price. The company did spend $175 million repurchasing its own shares in 2025, after none from 2022 to 2024, but the share count still rose 5.7% between October 26, 2021, and July 30, 2026.
The stock has fallen hard in downturns. In the 2020 COVID crash it dropped 53.7% between March 2 and March 23, 2020, then regained its peak by June 17, 2020. In the 2022 bear market it fell 44.7% from April 1 to May 9, 2022, and took about nine months to recover. Its price history doesn't reach back to the 2008 financial crisis. As of October 28, 2026, the shares were down 73% over five years. A single stock like Inspire carries more risk than a diversified fund.
Questions investors ask
Does Inspire Medical Systems pay a dividend?
No. Inspire Medical Systems pays no dividend, and its annual report for the year ended December 31, 2025, says it does not expect to pay cash dividends in the foreseeable future. Any gain for shareholders has to come from a higher share price. The company did spend $175 million repurchasing its own shares in 2025, which can raise each remaining share's claim on profits, but that provides no regular cash to live on.
How does Inspire Medical Systems make money?
Almost entirely from the Inspire system, an implanted device for obstructive sleep apnea that stimulates the nerve controlling the tongue to keep the airway open during sleep. Hospitals and outpatient surgery centers pay Inspire for the device, and in the U.S. insurers and Medicare generally reimburse them for the procedure. Revenue was $912 million for the year ended December 31, 2025, up 13.6%. Gross margin, the share of sales left after production costs, was 85.4%.
Is Inspire Medical Systems profitable?
Yes, though profits are new and uneven. After losses every year from 2020 through 2023, Inspire earned $53.5 million in 2024 and $145.4 million in 2025, or $4.89 per share. Operating income, the profit from the core business, was smaller at $51.0 million, a 5.6% margin. In the quarter ended June 30, 2026, net income was $0.3 million as revenue fell 7.6% year over year. At the October 28, 2026, price, the shares traded at about 14.5 times 2025 earnings.
How much has Inspire Medical Systems stock fallen?
Sharply. As of October 28, 2026, the shares were down 73% over five years, 53% over three years and 23.1% year to date, after losing 50.3% in calendar 2025. The largest drop from a peak in its 8.5-year price history was 87.7%. The price has also jumped: the stock gained 36.6% in the three months to that date. The company's annual report lists factors that can move the price, including insurance coverage changes, prior authorization hurdles and patients delaying implants ahead of new product launches.
Does Inspire Medical Systems have debt?
Its financial filings show no borrowings. As of June 30, 2026, Inspire held $415.2 million in cash and investments, with total assets of $926.0 million and shareholders' equity (assets minus liabilities) of $825.6 million. That cash gives it room to absorb a weak stretch. Still, its annual report warns it may need substantial additional funding in the future and might not be able to raise it when needed, which could force it to delay or cut back commercial or product development work.