Does OHIP cover CPAP machines? Find out using our free online tool
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Good to know
OHIP is Ontario's public health insurance plan. It covers many emergency and preventative medical care costs. The basics, such as doctor visits and emergency health care, are usually covered by OHIP, but not everything is. This tool will help you determine what's covered and for how much. The remaining costs can be paid out-of-pocket, or with supplemental private health insurance.
Is CPAP covered by OHIP?
Yes, OHIP does offer partial coverage for CPAP (Continuous Positive Airway Pressure) machines in Ontario, but it comes with specific eligibility criteria.
Here’s how it works: OHIP, through the ADP, generally covers 75% of the cost of a basic CPAP machine, leaving you responsible for the remaining 25%. This coverage is available once a sleep specialist has confirmed your diagnosis and submitted the necessary paperwork.
Who is eligible for OHIP CPAP coverage?
To be eligible for OHIP coverage of a CPAP machine under the Assistive Devices Program (ADP), you must meet specific criteria:
- Diagnosis of Obstructive Sleep Apnea (OSA): You need a formal diagnosis of OSA, confirmed through a sleep study. This diagnosis must be made by a qualified sleep specialist or healthcare provider.
- Prescription Requirement: A prescription from your doctor or sleep specialist is necessary to qualify for ADP funding. They will provide the documentation required by OHIP to prove your need for a CPAP machine.
- ADP Authorized Vendor: The CPAP machine must be purchased from an ADP-authorized vendor, ensuring it meets specific standards and eligibility for funding.
If you meet these criteria, OHIP coverage will take care of 75% of the cost of a basic CPAP machine.
What parts of a CPAP machine are covered by OHIP?
Under ADP, OHIP coverage includes 75% of the cost of a basic CPAP machine for eligible individuals diagnosed with obstructive sleep apnea. This coverage applies to the main device itself, which delivers continuous airflow to help maintain open airways during sleep. However, this assistance is limited to the machine and generally does not include essential accessories such as:
- Masks
- Headgear
- Hoses and tubing
- Filters
These accessories are vital for the machine’s effectiveness but typically need to be purchased separately. If you have private health insurance, it may help cover some or all of these additional costs. Checking with your provider can help ensure you’re fully prepared for the expenses associated with CPAP therapy.
You can use our free tool below to explore the best private health insurance plans in Canada that offer CPAP coverage. Get multiple quotes online in seconds.
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How much does a CPAP machine cost without OHIP Coverage?
Without OHIP coverage, a CPAP machine can cost between $500 and $3,000 in Ontario, depending on the type, brand, and features. Basic CPAP machines typically range from $500 to $1,000, while more advanced models with additional settings, data tracking, or automatic pressure adjustment can cost between $1,200 and $3,000.
In addition to the machine itself, you’ll need to factor in ongoing costs for essential accessories, which include:
- Masks: $100 to $300
- Tubing and hoses: $20 to $60
- Filters: $5 to $30 each, depending on type and frequency of replacement
These costs add up, especially considering that masks and filters often require regular replacement. For those paying out-of-pocket, private health insurance might help offset some of these expenses. If you need CPAP coverage, compare the best health insurance plans in Canada using our free tool below. It's completely online and gives you instant quotes.
Compare The Best Health Insurance Plans in Seconds
How to apply for CPAP coverage through OHIP?
To apply for OHIP coverage for a CPAP machine under the Assistive Devices Program (ADP), follow these steps:
- Get a Diagnosis: First, you need a formal diagnosis of obstructive sleep apnea (OSA) from a sleep specialist or a qualified healthcare provider, confirmed through a sleep study.
- Obtain a Prescription: Your doctor or specialist will write a prescription for a CPAP machine, detailing the medical necessity of the device.
- Visit an ADP-Authorized Vendor: Select an ADP-approved vendor for your CPAP machine. These vendors are certified by ADP and will guide you through the application process to ensure compliance with OHIP requirements.
- Complete the Application: The ADP-authorized vendor will assist in filling out and submitting the necessary forms to ADP. This includes both your personal information and your doctor's confirmation of medical need.
- Approval and Payment: Once approved, OHIP, through ADP, will cover 75% of the cost of a basic CPAP machine. You’ll be responsible for the remaining 25%, plus any additional costs for accessories or upgraded features if chosen.
If you have questions about eligibility or the application process, your sleep specialist or vendor can offer guidance on navigating ADP’s requirements and the next steps to ensure timely coverage.
