Navigating CPAP insurance coverage in Canada can feel overwhelming.
Between provincial health programs, private insurance policies, and federal funding initiatives, it’s easy to assume you’ll be paying for your CPAP machine out of pocket.
But here’s the good news: multiple pathways exist to help cover the cost of your sleep apnea treatment.
Understanding your options and knowing how to access them can make a real difference in your ability to afford the therapy you need.
We’ll walk you through your options step by step so you can find the coverage pathway that works for you.
Key Takeaway: CPAP coverage varies by province. Ontario offers the best public funding (75% of machine cost through ADP), while most other provinces rely on private insurance or social assistance. Verify your specific pathway with your insurer or provincial health program.
Important: This guide is for informational purposes only. Insurance coverage varies significantly by province and plan. Always verify your specific coverage with your insurance provider or provincial health authority before purchasing equipment. For medical questions about CPAP therapy, consult your healthcare provider.
Understanding CPAP Coverage in Canada: The Big Picture
CPAP machines are regulated medical devices in Canada, and coverage depends on three main sources: provincial health insurance plans, private insurance policies, and federal funding programs.
Coverage varies drastically across the country because healthcare in Canada is primarily a provincial responsibility and each province decides what to cover under its health plan.
Meanwhile, private insurance is a market-driven product. Policies vary by employer, insurance company, and plan level.
Federal programs cover specific populations (like First Nations members or federal employees).
This patchwork system means your CPAP coverage could look very different depending on where you live and what insurance you carry.
The good news is that most Canadians have access to at least one pathway.
Many people have both provincial coverage and private insurance, which can be stacked for better total support. Understanding which pathways apply to you is the foundation for accessing affordable CPAP therapy.
Provincial Programs & Public Funding: Your Government Coverage Options
Ontario’s Assistive Devices Program (ADP): The Gold Standard
Ontario offers the most comprehensive publicly funded CPAP coverage in Canada through the Assistive Devices Program (ADP).
Who’s eligible: You need a valid prescription from a sleep medicine specialist or respirologist and must meet specific criteria. Talking with your family doctor is often the first step in obtaining a prescription. They can refer you to a sleep specialist, who will order testing and, if sleep apnea is diagnosed, provide the prescription needed for ADP.
What’s covered: The ADP covers 75% of the approved cost of just your CPAP machine. You pay 25% out of pocket. ADP covers the device only. You (or your private insurance provider) are responsible for masks, tubing, and other supplies. You’re eligble for a new CPAP every five years, unless there’s medical justification for earlier replacement.
Important note on pricing: ADP covers 75% of the approved device price, not the retail price. Retailers cannot charge beyond the ADP-approved pricing structure, ensuring consistent and affordable access.
How it works: Once you have your prescription, visit an ADP-authorized CPAP retailer (including CPAP Supply, if you’re in Ontario). The retailer verifies your eligibility, processes your claim, and applies the funding at the point of purchase. You pay your 25% share and the program covers the rest!
Contact Ontario ADP:
- Phone: 1-800-268-6021 (toll-free in Ontario)
- Website: https://www.ontario.ca/page/assistive-devices-program
- Contact form: https://www.ontario.ca/feedback/contact-us?id=79782&nid=79779
British Columbia: Social Assistance & WorkSafeBC
British Columbia doesn’t have a universal CPAP funding program like Ontario’s ADP. However, coverage exists through specific programs:
BC Employment and Assistance (Social Assistance): If you receive income assistance, CPAP machines may be covered under the Medical Equipment and Devices policy of BC Employment and Assistance. Eligibility is income-based and requires a medical prescription. You’ll need to apply through your local Ministry of Social Development office.
WorkSafeBC: If your sleep apnea is work-related (occupational), WorkSafeBC may cover CPAP equipment.
Private Insurance: Most BC residents rely on private insurance through their employer or individual plans for CPAP coverage.
Contact BC Health Authorities:
- BC Health Services: 1-800-663-7867
- BC Ministry of Health: https://www2.gov.bc.ca/gov/content/governments/organizational-structure/ministries-organizations/ministries/health
Alberta: Social Assistance Programs
Alberta offers CPAP coverage for eligible low-income individuals through two programs:
Alberta Works – Health Benefits for Clients of Alberta Human Services: Covers durable medical equipment when medically necessary for eligible recipients.
Assured Income for the Severely Handicapped (AISH): Also covers CPAP equipment for eligible individuals.
Both programs require a medical prescription and income-based eligibility verification. You’ll need to apply through the relevant Alberta program office.
Coverage is limited and varies by individual circumstances.
Private Insurance: Most Albertans with CPAP coverage rely on private insurance plans through their employer.
Contact Alberta Health:
- Alberta Supports and AISH: 1-877-644-9992
- Alberta Health Services: 780-407-8822
Other Provinces: Limited Public Coverage
Most other Canadian provinces offer limited dedicated CPAP funding. However, pathways exist through specific programs and private insurance:
Quebec: The Régie de l’assurance maladie du Québec (RAMQ) does not provide direct CPAP funding. However, some health regions offer limited device loan programs through hospital-based sleep clinics. Most Quebec residents rely on private insurance for CPAP coverage.
Other provinces: Coverage typically comes through:
- Private insurance (employer or individual plans)
- Provincial social assistance programs (for low-income individuals)
- Out-of-pocket payment
If you live outside Ontario, check with your provincial health ministry to confirm current coverage, as programs occasionally change.
Federal Non-Insured Health Benefits (NIHB)
The Non-Insured Health Benefits Program is a federal initiative covering medical equipment (including CPAP machines) for:
- First Nations people living on-reserve
- Registered Inuit (Inuvialuit, Inuit Tapiriit Kanatami members)
Eligibility requires a valid prescription from a licensed healthcare provider. Coverage is typically 100% for approved equipment. If you’re eligible, work with your community health centre or NIHB coordinator to initiate claims.
Federal inmates: Federal inmates are covered separately through Correctional Service Canada Health Services, not NIHB.
Contact NIHB:
Private Insurance Coverage: What to Expect
If you don’t qualify for provincial funding (or want additional coverage), private insurance is often your next pathway.
Most extended health insurance plans cover CPAP machines as durable medical equipment. Coverage usually falls into one of these patterns:
- Percentage-based coverage: Plans cover 50–80% of the cost; you pay the remainder
- Fixed dollar amount: Your plan covers up to a certain limit (e.g., “$2,000 for CPAP equipment over 3 years”)
- Combination: A percentage up to a maximum dollar amount
Common plan components:
- Deductible: You pay this amount out of pocket before insurance kicks in (typically $25–$500 per year)
- Co-insurance: You pay a percentage; insurance covers the rest (e.g., you pay 20%, they pay 80%)
- Co-pay: A fixed amount per visit or claim (less common for equipment)
- Maximum annual/lifetime benefit: A cap on what the plan will pay in a year or lifetime
What private plans typically cover:
- CPAP machines (purchase and replacement)
- Masks and tubing
- Humidifiers and filters
- related accessories
What private plans typically DON’T cover:
- Routine replacement supplies beyond the annual/lifetime benefit cap
- Specialty accessories not deemed medically necessary
- Supplies purchased outside of approved retailers
- Ongoing technical support fees
- Batteries
- Travel machines
- Some plans cover cleaning supplies; others don’t
Other common exclusions include routine replacement supplies (some plans require you to exhaust coverage annually before renewal), cosmetic or comfort-only items like premium mask liners, and equipment deemed “experimental” (though this is rare for CPAP, which is a well-established treatment).
How to verify your coverage: Contact your insurance provider directly. Have your policy number handy and ask:
- “Does my plan cover CPAP machines and supplies?”
- “What’s the coverage percentage or maximum benefit?”
- “What’s my deductible?”
- “Do I need pre-authorization or a prescription?”
- “Are there any exclusions specific to CPAP equipment?”
Many insurers now have online portals where you can check coverage details yourself. This is faster than calling.
Step-by-Step: How to Access Your CPAP Benefits
Getting CPAP coverage requires following a specific pathway. Here’s what to expect, from diagnosis to using your covered device.
Step 1: Get a Medical Diagnosis
Before any coverage applies, you need a formal diagnosis of obstructive sleep apnea (OSA) from a healthcare provider. This requires a sleep study.
Your family doctor can order a sleep study, usually through one of two methods:
- In-lab polysomnography (PSG): You spend a night in a sleep laboratory while monitors track your breathing, oxygen levels, heart rate, and sleep stages. Results are comprehensive and diagnostic.
- Home Sleep Apnea Test (HSAT): A portable device you take home. It’s less comprehensive than in-lab testing but increasingly accepted across Canada. Results typically come back in 1–2 weeks.
If sleep apnea is confirmed (measured by your Apnea-Hypopnea Index, or AHI), your doctor will discuss treatment options. For moderate-to-severe sleep apnea, CPAP is usually the first recommendation.
Timeline: Diagnosis typically takes 4–12 weeks, depending on wait times in your region and whether you need specialist referral.
Step 2: Obtain Your CPAP Prescription
Once diagnosed, your healthcare provider prescribes CPAP therapy. The prescription specifies:
- The device type (CPAP, APAP, or BiPAP)
- Your prescribed pressure setting(s)
- Duration and frequency of use
In Ontario, CPAP prescriptions for ADP funding must come from a sleep medicine specialist or respirologist. In other provinces, a family doctor can prescribe CPAP, though a sleep specialist may provide more tailored recommendations.
Important: Keep your prescription handy. You’ll need it to claim coverage and verify you’re using prescribed equipment.
Step 3: Determine Your Coverage Pathway
Before purchasing, figure out what coverage applies to you:
If you live in Ontario: Check if you qualify for ADP. You’ll need:
- A valid CPAP prescription (from a sleep medicine specialist or respirologist for ADP)
- Confirmation of eligibility (visit your local Ontario Works office or check online)
If you have private insurance: Contact your insurer to confirm coverage, deductible, and whether pre-authorization is required.
If you’re in another province: Check with your provincial health ministry to see if coverage exists. If not, private insurance is typically your pathway.
If you’re eligible for federal NIHB: Work with your community health centre or NIHB coordinator to initiate coverage.
If you qualify for multiple pathways: You may be able to stack coverage. For example, Ontario ADP covers 75% of the device cost, and your private insurance might cover part of your 25% co-pay or cover masks and supplies. Work with your insurer to understand how benefits coordinate.
Step 4: Get an Itemized Quote from a Retailer
If you have private insurance (or any coverage that requires pre-approval), the next step is to get a detailed, itemized quote for your CPAP equipment. This quote is essential for securing pre-authorization from your insurer.
Insurance companies want to know exactly what you’re planning to purchase and the cost before they commit to coverage. A quote gives them the information needed to approve or deny your claim and helps prevent unexpected out-of-pocket expenses.
How to get a quote:
- Contact CPAP Supply (or another authorized CPAP retailer) and specify which machine, masks, and accessories you’re interested in based on your prescription and needs
- Request an itemized quote that clearly shows:
- Product names and model numbers
- Individual prices for each item
- Total cost
- Quantity of items (especially important for supplies like masks that you might buy multiples of)
- Your prescription details (to confirm you’re ordering equipment appropriate for your needs)
- Many retailers can provide quotes without you committing to a purchase. Some have online quote tools; others can email or mail you a formal estimate
What to do with the quote:
- Submit the itemized quote to your insurance provider as part of your pre-approval request
- Include a copy of your CPAP prescription, sleep study results, and any pre-authorization forms your insurer requires
- Contact your insurer’s claims or benefits department to confirm they’ve received your documents
If your insurer pre-approves your claim (before you purchase), it means they’ve guaranteed they’ll cover your equipment up to the approved amount. This removes the guesswork and helps you proceed with confidence that you know your exact out-of-pocket cost.
Note: Some retailers, like those authorized for Ontario’s ADP, handle the quote and approval process automatically at the point of purchase. If that’s your situation, you can proceed directly to Step 5. For most private insurance users, however, getting pre-approval via quote is a critical step that can save time and prevent claim denials later.
Step 5: Purchase Your CPAP Machine & Submit Claims
Once you know your coverage, purchase your device through an authorized retailer.
For Ontario ADP:
- Visit an ADP-authorized CPAP retailer (like CPAP Supply)
- Bring your prescription and proof of eligibility
- The retailer processes your claim at point of purchase
- You pay your 25% share; ADP covers 75%
For private insurance:
- Purchase your device (through any authorized retailer)
- Collect itemized receipts and your prescription
- Submit your claim to your insurance company
- Insurance reimburses you (or the retailer, if direct billing is available)
For other provincial programs:
- Contact your provincial health authority for approved retailers and claim procedures
Step 6: Understand Compliance Requirements & Maintain Your Coverage
Here’s a critical point many people don’t realize: To keep receiving coverage, you typically need to use your CPAP regularly.
Most insurance plans and provincial programs have compliance requirements, usually defined as using CPAP at least 4 hours per night and on at least 70% of nights per month.
This data is automatically recorded by modern CPAP machines and can be downloaded by your healthcare provider or retailer.
If you’re not hitting compliance targets, your insurer may:
- Deny claims for replacement supplies
- Require you to reapply for coverage
- In some cases, deny future CPAP-related claims
If you’re struggling with CPAP therapy or not meeting usage targets, reach out to your respiratory therapist or healthcare provider early.
Many compliance issues can be solved with mask adjustments, humidification changes, or gradual acclimatization—before your coverage is affected.
Additional Financial Assistance: Tax Credits & Employer Benefits
Beyond provincial and private insurance, other financial resources can reduce your CPAP costs.
Medical Expense Tax Credit
In Canada, you can claim medical expenses (including CPAP equipment) on your income tax return if they exceed a threshold.
How to claim:
- Keep all receipts for CPAP-related purchases
- Include them with your tax return (consult a tax professional for specifics)
- You can claim as much as qualifies in any given year
This reduces your taxable income and may result in a tax refund or reduced taxes owed.
Employer Health Spending Accounts (HRSAs)
Some employers offer Health Spending Accounts (also called Flexible Benefits Accounts or FSAs). These allow employees to set aside pre-tax dollars to pay for medical expenses, including CPAP equipment.
How it works:
- You contribute a designated amount to your HRSA (pre-tax)
- You use HRSA funds to pay for eligible medical expenses (CPAP, prescriptions, etc.)
- You save money because these contributions aren’t subject to income tax
Typically, you save 20–30% on eligible expenses because you’re not paying income tax on that portion of your salary.
Check with your employer’s HR or benefits department to see if an HRSA is available.
Employer Extended Health Plans
Some employers offer extended health coverage as a benefit, separate from provincial insurance. If your employer offers this, you’re often automatically covered. Verify your coverage as you would with private insurance (see “Step 3: Determine Your Coverage Pathway” above).
Common Coverage Questions & How to Handle Them
“What if I’m Denied Coverage?”
If your claim for CPAP coverage is denied, don’t assume it’s final.
Contact your insurer or provincial program to ask why (the reason will be on your denial letter) and ask if you can appeal or resubmit with additional information.
Common reasons for denial include missing documentation, a prescription that didn’t meet requirements, and exceeding your plan’s maximum coverage.
If you have a valid prescription and legitimate medical need but were denied, request a formal appeal. All insurers are required to provide an appeals process.
Be sure to provide additional medical documentation from your healthcare provider. You can also reach out to your retailer or healthcare provider as they can often advocate on your behalf
“Does Switching Providers Affect My Coverage?”
No. Your CPAP coverage follows you. It’s tied to your insurance plan or provincial program, not to a specific retailer.
If you switch from one CPAP retailer to another, you can transfer your prescription and ongoing care. Your provincial or private coverage remains valid.
The only caveat here is that some programs (like Ontario ADP) have authorized retailer networks. Ensure your new retailer is authorized to avoid claim complications.
“What Happens If I Don’t Use My CPAP Enough?”
If you fall below compliance thresholds (typically 4+ hours per night, 70% of nights per month), your insurer or provincial program may:
- Deny claims for replacement supplies until you demonstrate improved compliance
- Require re-justification of medical need
- In rare cases, stop covering your device
If you’re struggling with compliance, talk to your respiratory therapist or healthcare provider early.
Often, simple changes such as mask adjustments, changing humidification settings, or learning to use the ramp settings on your CPAP machine can make reaching compliance goals much less daunting.
You can also call your retailer. Many (including CPAP Supply) can help troubleshoot common issues without needing to wait for an appointment with your family doctor.
The bottom line is that most compliance issues are solvable. It’s better to address them proactively than to lose coverage.
“Can I Appeal a Coverage Denial?”
Yes. Both private insurers and provincial programs are required to provide an appeals process.
For private insurance:
- Request a written explanation of the denial
- Gather supporting medical documentation
- Submit a formal appeal (your insurer will provide instructions)
- Most insurers have a 30–60 day timeline for appeals
For provincial programs (like Ontario ADP):
- Contact the program directly for their appeal process
- Provide additional documentation if available
- Provincial appeals typically have longer timelines but are often more accommodating of additional documentation
Comprehensive Insurer & Provincial Contact Reference
When verifying your CPAP coverage, here’s where to turn. Have your policy number and prescription ready.
Use the tables below to contact your insurer or provincial program. Have your policy number and prescription information ready.
Major Canadian Extended Health Insurance Providers
| Provider | Phone | Website |
|---|---|---|
| Blue Cross Canada | 1-800-661-6995 (varies by region) | www.bluecross.ca |
| Canada Life | 1-888-252-1847 | www.canadalife.com |
| Chambers of Commerce Group Plan | 1-800-665-3365 | www.chamberplan.ca |
| CINUP | 1-800-665-1234 | https://cinup.ca/ |
| Co-operators | 1-877-682-5246 | www.cooperators.ca |
| Desjardins Insurance | 1-800-463-7843 | https://www.desjardinslifeinsurance.com |
| Equitable Life | 1-800-265-4556 | https://www.equitable.ca |
| Green Shield Canada | 1-888-711-1119 | https://onlineservices.greenshield.ca |
| Manulife | 1-800-268-6195 | https://www.manulife.ca |
| RWAM Extended Healthcare | 1-877-888-7926 | https://planmember.rwam.com |
| Sun Life Financial | 1-800-361-6212 | https://www.sunlife.ca |
Provincial Health Programs & Coverage Contacts
| Province/Program | Contact | Details |
|---|---|---|
| Ontario ADP | 1-800-268-6021 | Covers 75% of device cost for eligible individuals. Sleep medicine specialist or respirologist prescription required. |
| Ontario (General) | https://www.ontario.ca/page/assistive-devices-program | Official ADP program page |
| BC Ministry of Social Development | BC Medical Equipment Program | Available to recipients who are eligible for general health supplements or meet the life-threatening health needs criteria |
| BC Health Services | 1-800-465-4911 | General BC health inquiries |
| Alberta Works | 1-877-644-9992 | Covers durable medical equipment when medically necessary for eligible recipients. |
| AISH (Assured Income for the Severely Handicapped) | 1-877-644-9992 | Covers CPAP equipment for eligible individuals. |
| Alberta Health Services | 780-407-8822 | General Alberta health inquiries |
| Federal NIHB (Indigenous peoples) |
| Non-Insured Health Benefits Program. Covers 100% of approved CPAP equipment for First Nations and Inuit. |
| NIHB Official | Program details and eligibility | Program details and eligibility |
| Correctional Service Canada | CSC Health Program | Covers CPAP for eligible federal inmates |
General Insurance & Support Resources
| Organization | Phone | Details |
|---|---|---|
| Insurance Bureau of Canada (IBC) | 1-844-227-5422 (1-844-2ASK-IBC) | General insurance inquiries and consumer support |
| Patient Advocacy Foundation | Varies by province | Helps patients navigate insurance and coverage issues |
| CPAP Supply | 1-855-492-3316 | We can help verify your coverage and guide you through the claims process |
Conclusion
CPAP therapy is a gold-standard, evidence-based treatment for obstructive sleep apnea and can significantly improve sleep quality and daytime alertness when used consistently.
Whether you live in Ontario with access to ADP funding, carry private insurance, or live in a province with limited public coverage, pathways exist to help you afford your CPAP machine and supplies.
Here’s what to remember:
- Start with your healthcare provider. They’ll diagnose your sleep apnea and provide the prescription you need for any coverage.
- Know your coverage options. Provincial programs, private insurance, and federal benefits each have different eligibility and timelines.
- Don’t assume you’ll pay full price. Many Canadians qualify for at least partial coverage.
- Use compliance to your advantage. Regular CPAP use not only improves your health—it keeps your coverage active.
- Reach out for help. Your retailer, healthcare provider, and insurer’s customer service team are there to guide you through the process.
If you’re unsure about your coverage options or need help navigating the claims process, reach out to your CPAP retailer. Most retailers (including CPAP Supply) work with major insurers and provincial programs and can verify your specific coverage and guide you through the process. You deserve access to the treatment you need, and we’re here to help make it affordable.
Medical Disclaimer
The information provided in this article is for educational purposes only and is not legal, tax, or financial advice. Insurance coverage, eligibility criteria, and reimbursement policies vary by province, insurance plan, and individual circumstances, and are subject to change.
Always verify coverage details directly with your insurance provider or provincial health authority before purchasing equipment. Do not rely solely on this guide to make coverage decisions. Eligibility requirements, coverage percentages, and claim procedures should be confirmed with the relevant insurer or program administrator.
For tax-related questions, consult a tax professional or the Canada Revenue Agency directly. For insurance questions, contact your insurance company or provincial health ministry using the contact information provided above.