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Is CPAP Therapy covered under Healthcare Insurance?

on June 21, 2021

Wondering if your CPAP therapy is covered under healthcare insurance? You’re not alone. CPAP therapy and equipment is a vital part of many peoples’ health and wellness, but the cost can add up quickly. This can keep people who need treatment from getting it--but healthcare insurance may be able to step in and mitigate the costs.

Keep reading. We’re going to tell you everything you need to know about the cost of CPAP therapy, the healthcare coverage you’re entitled to, and how to qualify for it.

The Cost of CPAP Equipment

CPAP equipment is designed to ensure you have enough oxygen throughout the night for safe, deep sleep. The cost of this technology isn’t going to be super cheap, but it doesn’t have to be prohibitively expensive. The good news is that CPAP equipment comes in a wide range of options to suit both your sleep and budget.

The cost of CPAP equipment depends on a few factors. Not only does the brand and specific model affect the cost, but the accessories you choose can affect the overall cost. Where you buy your CPAP equipment will also affect the cost; you can often find better prices online, but local CPAP vendors offer many additional benefits like free trials, aftercare, and monitoring support.

These are all factors to consider when purchasing your machine.

Is CPAP Equipment Covered Under Healthcare Insurance?

This is one of the most frequent questions around CPAP therapy, and the good news is that healthcare coverage can help offset some, if not all, of the CPAP equipment costs. This makes CPAP therapy not only more affordable for you, but it might allow you to choose a better model for your needs.

If you’re wondering if CPAP equipment is covered under your insurance, your first step is to get confirmation that you do have sleep apnea and need CPAP therapy. This is done through a consultation with a sleep specialist and a polysomnogram test. If CPAP therapy is prescribed based off of that, you’ll likely need the following equipment:

  • CPAP machine & mask
  • Heated humidifier 
  • Tubing
  • CPAP filters & caps
  • Optional sanitizing device

As mentioned, CPAP equipment can often be covered under your healthcare insurance, but it depends on both the province you live in and your insurance plan. We’ll dive deeper into the specifics below.

Coverage by Province

Every insurance provider and plan is different, so your best bet is to find out from your private plan directly if CPAP therapy is covered or not. But in many provinces, CPAP therapy is also partially covered under the provincial healthcare plan.

  • Ontario: Any sleep studies and consultations with sleep specialists are covered under Ontario’s provincial healthcare. Other programs can help offset the costs of CPAP equipment, such as the Assistive Devices Program (ADP), Ontario Disability Support Program (ODSP) and the Ontario Works Program (OW).
  • Alberta: Only residents who require social assistance support and that are diagnosed with moderate to severe sleep apnea are eligible for CPAP equipment coverage.
  • British Columbia: the provincial health plan in BC only provides coverage for those who qualify for the Employment and Assistance Regulation or the Employment and Assistance for Persons with Disability Regulation and have been diagnosed through a sleep study.  
  • Quebec: There is no provincial health coverage for CPAP equipment in Quebec.
  • Nova Scotia: There is no provincial health coverage for CPAP equipment, but a  local organization (the Sleep Apnea Refurbishment Program by the Lung Association of Nova Scotia) helps offset the costs by collecting and distributing CPAP equipment. 

Using both the provincial funds available to you combined with your private health care coverage will help ensure you offset as much of the CPAP equipment costs as possible.

Consulting with us will allow you to leverage both online savings and local expertise, so that you get the very best CPAP equipment possible without breaking the bank.