Does OHIP cover CPAP machines?
OHIP will cover some of the cost of a CPAP machine.
This coverage is through the Assistive Devices Program (ADP).
Here’s how it works:
You need to be an Ontario resident with a valid health card. You need to have a disability – like sleep apnea, in this case – that requires equipment and supplies for 6six months or longer.
If your doctor prescribes you a CPAP machine, OHIP will cover 75 percent of the cost. This coverage comes through the Assistive Devices Program.
You will be reimbursed 75 percent of the cost of a basic CPAP machine at a price predetermine by ADP. That “ADP price,” which is currently $554.
This means that you will pay 25 percent, or $138.50 out of pocket.
There are a few exceptions to this. If you get financial help from Ontario Works, Ontario Disability Support Program (ODSP) or Assistance For Children With Severe Disabilities, OHIP will cover 100 percent of the ADP cost of a CPAP machine.
You will also need to buy your CPAP machine through a business that is registered with the ADP. Your medical practitioner can help you find one near you.
Does private health insurance cover CPAP machines in Ontario?
Yes, private health insurance can help cover the out-of-pocket cost of a CPAP machine in Ontario if you’re eligible for coverage.
If you have workplace benefits, you may have coverage for a CPAP machine. If you don’t have coverage through your employer, a private health insurance plan like Freedom to Choose health and dental insurance can also help cover you.
For example: All of the Freedom to Choose health and dental insurance plans will help cover the cost of a CPAP machine. Your provincial coverage is applied first, and then your private insurance would cover the remaining balance, up to what is reasonable and customary. This depends on the machine that you purchased.
Looking for the right plan for you? Take this quiz to find the Freedom to Choose health and dental insurance coverage that works for you – and could help to cover a CPAP machine if you ever need it.
What is a CPAP machine?
A CPAP machine, also called a continuous positive pressure airway machine, is a device commonly used to treat sleep apnea.
Sleep apnea causes interruptions in breathing while people sleep. A CPAP machine steadily blows air into the nose and mouth while someone is sleeping. This helps the airway stay open.