Does Insurance Cover CPAP Supplies in Canada? Funding, Replacement Schedules, and How to Maximize Benefits

If you’ve been diagnosed with sleep apnea, you know that a CPAP machine—and the right supplies—are essential for effective treatment. But CPAP equipment can be costly. The good news? Most insurance companies in Canada cover CPAP supplies, some up to 100%.

Coverage details and frequency vary by policy. This guide explains typical replacement schedules, provincial funding options, and how to submit insurance quotes to maximize your benefits.

How Often Should You Replace CPAP Equipment? (Manufacturer Guidelines)

Replacing your CPAP supplies on schedule keeps your therapy hygienic, reduces leaks, and ensures proper airflow. Here are the general manufacturer recommendations:

Following these schedules also helps when submitting insurance claims, as many plans base coverage on these replacement timelines.

Do You Need a Prescription for a CPAP Machine in Canada?

Yes. A valid CPAP prescription (CPAP Rx) is required to purchase a machine in Canada.

To obtain one, you’ll need a sleep study—either in a lab or via a home sleep test—to confirm your diagnosis. A sleep specialist will prescribe the appropriate machine and pressure settings based on your results.

CPAP Funding by Province in Canada

Besides private insurance, some provinces offer public funding for CPAP machines and supplies, typically based on medical need and financial eligibility.

British Columbia
MSP usually does not cover CPAP therapy, but funding may be available under Employment and Assistance regulations for those with confirmed moderate to severe sleep apnea.

Alberta
Funding is primarily for individuals receiving Income Support (IS) or Assured Income for the Severely Handicapped (AISH) with a confirmed diagnosis.

Saskatchewan
The SAIL program offers CPAP machines for a program fee if medical criteria are met. Additional assistance may be available through charities like Kinsmen Telemiracle.

Manitoba
Requires a $500 co-payment for CPAP machines and initial supplies, with the program covering the remainder, including supplies for about one year.

Ontario
The Assistive Devices Program (ADP) covers 75% of approved CPAP machine costs. Ontario Disability Support Program (ODSP) and Ontario Works may provide full coverage for eligible individuals.

Quebec
The provincial plan (RAMQ) does not cover CPAP equipment. Costs may be claimed through the medical expense tax credit, with private insurance being the main source of support.

Nova Scotia
No direct provincial funding exists, but the Lung Association runs a refurbishment program redistributing CPAP equipment to eligible individuals.

Newfoundland & Labrador
Limited or no direct provincial funding for CPAP machines. Some assistance may be available through social programs for eligible individuals.

New Brunswick
Offers a Health Services Respiratory Program for eligible individuals that may cover CPAP equipment.

Northwest Territories & Yukon
Extended Health Benefits for Seniors cover moderate to severe cases.

First Nations & Inuit
Non-Insured Health Benefits (NIHB) may cover CPAP equipment with a valid prescription.

How to Submit a Quotation for Insurance Pre-Approval

Before purchasing CPAP supplies, it’s a good idea to get a quotation from your supplier to submit to your insurance provider for pre-approval. This step helps clarify exactly what your plan will cover and prevents unexpected expenses.

Key points for submitting your quotation:

• Include a copy of your CPAP prescription (Rx), especially if it’s your first claim, as insurers typically require proof of diagnosis.
• Attach supporting medical documents, like sleep study results, when possible.
• Understand your plan’s coverage limits—some insurers offer a fixed annual dollar amount instead of percentage coverage.
• Remember that insurance benefits often reset yearly, so submitting your quotation early each year helps maximize usage.

If you need assistance obtaining a quotation or understanding your insurance process, feel free to contact us.

How to Maximize Your CPAP Insurance Coverage

Once your coverage is confirmed, focus on these ongoing habits to get the most out of your benefits and keep your therapy effective:

• Know your benefits: Familiarize yourself with what supplies are covered and how often you can replace them.
• Replace supplies on schedule: Following manufacturer recommendations supports therapy quality and insurance approvals.
• Keep detailed records: Maintain copies of all prescriptions, sleep study reports, receipts, and claim forms for easy reference.
• Use benefits annually: Regularly filing claims ensures you don’t lose unused coverage at year-end.
• Explore provincial programs: Additional funding or assistance may be available beyond your private insurance.

Bottom line:

Most insurance companies in Canada provide coverage for CPAP machines and supplies. Between private health plans and provincial programs, multiple options exist to reduce your out-of-pocket expenses. By understanding your coverage, submitting pre-approvals, and following replacement schedules, you can maintain effective CPAP therapy and make the most of your benefits.

If you have questions about your CPAP insurance coverage or need assistance submitting a pre-approval quotation, don’t hesitate to reach out. We’re here to help you navigate your benefits and keep your therapy on track.