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Is CPAP Equipment Or Therapy Covered Under Healthcare Insurance?

June 26, 2020

One of the top questions Sleep Apnea patients often ask is whether CPAP equipment is covered by healthcare benefits or not. The good news is that there are some provincial regions across Canada that do offer coverage for a portion of the expenses that go towards buying CPAP equipment. Below, we detail the funding details that you will need to know for your province.

Need CPAP Equipment: Does My Insurance Benefits Cover It?

Millions of Canadians have or are at risk of developing Sleep Apnea on a yearly basis. With this discovery, comes a consultation with a sleep specialist and a polysomnogram test which will determine the severity of your Sleep Apnea. Based on these findings, you are then prescribed with PAP therapy, which in most cases will be CPAP therapy.

While the initial diagnosis may come as a surprise, many people then wonder how they will be able to afford the cost of CPAP equipment. Most Sleep Apnea patients will need equipment that consists of:

A CPAP machine
A heated humidifier
A CPAP mask
Tubing
CPAP filters and caps
A sanitizing device *optional

All of these elements can add up quickly especially if you weren’t factoring it into your budget. But can provincial health programs help to relieve some of the burdens? The answer is it depends on where you live.

CPAP Coverage By Province:

Once you have been diagnosed with Sleep Apnea, check with your private insurance company how much coverage they offer for CPAP equipment. Keep in mind that each insurance company and each province will be different in how much of the expenses they cover.

Below, we walk you through the funding and coverage options of the following provinces: Ontario, Alberta, British Columbia, Quebec and Nova Scotia.

Ontario

Under OHIP, all sleep studies and consultations with a sleep specialist are covered automatically with this provincial health program. Ontario residents can also gain access to funding programs such as the Assistive Devices Program (ADP) which covers up to 70% of the cost of CPAP equipment and is valid to all those who hold a valid Ontario health card and require the equipment for six months or longer.

The Ontario Disability Support Program (ODSP) also provides assistance to those who are seeking coverage for the cost of CPAP therapy equipment as does the Ontario Works Program (OW). They both cover 100% of therapy.

Alberta

For those who reside in Alberta, funding for CPAP therapy is only offered to those residents that require social assistance support such as through Income Support or Assured Income for the Severely Handicapped (AISH). Funding will only be provided to those who have received a sleep study and have been diagnosed with moderate to severe OSA.

Under Income Support, those who are found eligible will receive coverage of up to $1700 for CPAP machines and up to $2000 for APAP machines. If you do not meet these eligibility requirements, you will need to pay out of pocket or speak with your private insurance company regarding coverage.

British Columbia

In British Columbia, the provincial health program, the Medical Services Plan (MSP) will only provide coverage for CPAP therapy if you are also eligible under the Employment and Assistance Regulation or the Employment and Assistance for Persons with Disability Regulation.

Similar to other provinces, funding will be provided once all eligibility criteria have been met and diagnosis has been validated by a sleep study.

Quebec

Unfortunately, in Quebec, the provincial health program (RAMQ) does not provide any coverage or funding support for the purchase of CPAP equipment.

For most Sleep Apnea patients in Quebec, they rely heavily on private insurance companies to cover costs. Depending on your insurance company, the cost of treatment equipment can be covered at 80% - 100% and the cost of a sleep study can be covered at 50% - 100%. However, this is all dependent on who you are insured with.

Nova Scotia

In Nova Scotia, while a provincial health program does not provide insurance coverage for CPAP equipment expenses there is an organization which is providing local residents with access to affordable treatment equipment.

The Lung Association of Nova Scotia started the Sleep Apnea Refurbishment Program which collects gently-used and new models of essential CPAP equipment for those that can’t afford therapy expenses or have no private insurance coverage.

How Much Does CPAP Equipment Cost?

CPAP equipment can be expensive depending on the brand and type of CPAP machine or mask that you are purchasing. However, that shouldn’t stop you from buying the equipment that is necessary to treat your Sleep Apnea and improve your sleep quality.

Keep in mind that prices at local CPAP vendors can be 2-3 times higher than buying products online. However, local CPAP vendors also provide trial periods, aftercare and monitoring. Purchasing online offers monetary savings but each person needs to decide which is most important to them - cost savings or aftercare and monitoring services.

Here at CPAPMachines.ca, we are able to offer our loyal customers great savings due to the relationships that we have built with top CPAP manufacturers. We also offer a discount, in some cases, if you find a lower price elsewhere online with another Canadian CPAP vendor, we’ll match the price. However, we do not offer service or aftercare services which reflect the monetary services you receive.

For any questions that you have in relation to Sleep Apnea equipment or understanding insurance coverage for these devices, get in touch with our team of experts today.