Is CPAP covered by insurance in Canada? Usually in part. Most Canadians pay for CPAP therapy through some mix of private extended health benefits, a provincial program, and their own money. This guide covers the private insurance side in detail: what plans usually pay for, how to get a quote pre-approved before you buy, how to file a claim, what to do if it is denied, and the two tax measures that reduce what is left over. For the provincial programs themselves, we keep a separate province-by-province guide to CPAP coverage in Canada, and this article links to it wherever a province comes up.
Many people arrive with a prescription in hand and no clear idea whether their work benefits will pay for the machine, or what paperwork the insurer wants first. The steps below answer both, in the order that avoids a rejected claim.
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Where CPAP Funding Comes From in Canada
Healthcare in Canada is a provincial responsibility, and no province treats a CPAP machine the way it treats a hospital stay. That leaves three sources, which can be combined:
- Private extended health insurance, usually through an employer, sometimes an individual plan. This is the largest source for most working Canadians.
- Provincial programs. Ontario’s Assistive Devices Program (ADP) is the broadest. British Columbia, Alberta, Saskatchewan and Manitoba have narrower income-tested or co-payment programs. Several provinces have none. The province guide has the current details and contacts for each.
- Federal programs for specific groups. The Non-Insured Health Benefits program (NIHB) covers medical equipment for eligible First Nations and Inuit clients, and Veterans Affairs Canada and WorkSafeBC-type workers’ compensation boards cover CPAP in specific circumstances.
If you qualify for more than one, the programs usually coordinate rather than overlap. The typical Ontario example is ADP paying 75% of the approved machine price and a private plan covering some or all of the remaining 25% plus the mask and supplies that ADP does not fund.
What Private Plans Usually Cover
Extended health plans in Canada generally treat a prescribed CPAP machine as durable medical equipment. Coverage is written into the plan in one of three shapes:
| Coverage shape | How it works | What to ask your insurer |
|---|---|---|
| Percentage | The plan pays a set share of the cost and you pay the rest. | What percentage, and is there a deductible first? |
| Fixed maximum | The plan pays up to a dollar cap, often per equipment type and per period of years. | What is the cap, and how often does it reset? |
| Combination | A percentage, up to a maximum. | Both of the above, plus whether supplies draw from the same cap. |
Usually covered: the machine itself, masks and headgear, tubing, humidifier chambers and filters, on a replacement schedule the plan sets.
Often excluded or limited: replacement supplies beyond the plan’s schedule, comfort items such as mask liners and CPAP pillows, batteries and travel machines bought as a second device, and cleaning equipment. Plans vary on cleaning supplies, so ask rather than assume.
The plan booklet or the insurer’s online portal will state all of this. The portal is faster than the phone line and gives you the wording in writing, which matters if a claim is later questioned.
How to Use Your Benefits, Step by Step
1. Get the diagnosis and the prescription
Every funding source starts with a diagnosis of obstructive sleep apnea from a sleep study, either in a sleep lab or with an at-home test, followed by a CPAP prescription. In Canada a prescription is required to buy a machine; masks and supplies do not need one. The prescription names the device type (CPAP, APAP or BiPAP) and your pressure settings. Keep a copy, because every insurer and program will ask for it.
2. Confirm what your plan will pay before you shop
Log in to the insurer’s member portal or call the number on your benefits card and ask five questions: Does the plan cover CPAP machines and supplies? What percentage or maximum? Is there a deductible? Is pre-authorization required? Are there exclusions specific to CPAP? Write the answers down with the date and the name of the person you spoke to.
3. Get an itemized quote and submit it for pre-approval
This is the step most people skip, and it is the one that prevents denied claims. Most insurers will pre-approve CPAP equipment if you send a quote first. The quote should show each item by name and model number, the price of each, quantities, the total, and your prescription details. Contact us and we will prepare one with no obligation; if you have not settled on a machine, our guide to CPAP machines in Canada and the cost guide will narrow it down.
Send the quote to the insurer with a copy of the prescription, the sleep study summary if they ask for it, and any pre-authorization form they use. Confirm they received it. A pre-approval tells you the exact amount they will pay, so the only surprise left is a pleasant one.
4. Buy, then claim
Once pre-approved, purchase the equipment and keep the itemized receipt. Submit the claim through the portal with the receipt and prescription attached. Some insurers accept direct billing from the retailer; most reimburse you. If you are using Ontario ADP, the purchase has to go through an ADP-registered vendor and funding is applied before you pay your share. We partner with an ADP-authorized vendor, so Ontario customers can contact us and we will point you to the right process.
5. Keep using the therapy
Modern machines record nightly usage, and both insurers and provincial programs can ask for that data before funding a replacement device or ongoing supplies. Clinicians commonly treat four or more hours a night on most nights as the benchmark for therapy that is working. If you are below that because the mask leaks or the air feels dry, fix the problem early. Most of it comes down to mask fit, humidification or ramp settings, and our team can help over the phone without a clinic appointment.
The Machines We Quote Most Often
Most of the insurance quotes we prepare are for one of three setups: an auto-adjusting machine on its own for someone who already has a mask, the same machine bundled with a mask for someone starting out, or the Philips alternative for people whose clinic or previous machine was Philips. Your prescription decides the machine type, so start there. If your plan pays a percentage up to a maximum, your member price is the one that matters, since a lower price leaves more of the maximum for the mask and the supplies that follow. Create a free account to see it before you request a quote.
Prescribed bi-level? See BiPAP machines. Every machine needs a prescription; masks and supplies do not.
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Sign Up Free →Provincial Programs in Brief
The full breakdown, including who qualifies and how to apply, is in our CPAP coverage by province guide. The short version:
| Province | Public CPAP funding |
|---|---|
| Ontario | ADP pays 75% of the ADP-approved price of a CPAP, APAP or BiPAP system for eligible residents assessed by a physician. Masks, headgear and supplies are not funded. Ontario Works and ODSP recipients can have the 25% share covered. Program page. |
| British Columbia | No universal program. Income-assistance recipients may qualify under the Ministry’s medical equipment policy, and WorkSafeBC covers work-related cases. |
| Alberta | Income-tested coverage through Alberta Works health benefits and AISH for eligible recipients. |
| Saskatchewan and Manitoba | Co-payment programs where the province supplies the machine and the patient pays a fixed program fee. Details in the province guide. |
| Quebec and Atlantic Canada | No direct provincial funding. Private insurance or out-of-pocket. |
| First Nations and Inuit (any province) | NIHB medical supplies and equipment benefit, with prior approval. NIHB program page. |
If none of these apply and your plan is thin, a refurbished machine is the usual way to bring the price down without giving up a current model. Our guide to buying a used CPAP machine covers what to check first.
Two Tax Measures That Reduce the Rest
The medical expense tax credit
The Canada Revenue Agency treats a CPAP machine prescribed by a medical practitioner, including replacement parts, as an eligible medical expense for the non-refundable medical expense tax credit. You claim the portion that private insurance or a program did not reimburse, and the credit applies to the amount of your total eligible expenses above an income-based threshold. Supplies used to run the machine, such as distilled water, do not qualify. Keep every receipt and the prescription. The CRA’s list of eligible medical expenses is the reference, and a tax professional can confirm how the threshold applies to you.
Health Spending Accounts
Many Canadian employers offer a Health Spending Account alongside or instead of a traditional plan. The employer funds the account with a set annual amount, and you use it to reimburse expenses on the CRA’s eligible list, which includes a prescribed CPAP and its parts. Outside Quebec the reimbursement is not taxable income to you. If your benefits include an HSA, it is often the simplest way to cover the share a percentage plan leaves behind, and the mask and supply purchases that come later.
If a Claim Is Denied
A denial letter states the reason, and the common ones are fixable: a missing prescription or sleep study, a prescription that does not name the device type, a purchase made before pre-authorization, or an item that falls outside the plan’s replacement schedule. Resubmit with the missing document, or ask the insurer for its appeal process and send supporting documentation from your doctor. Your retailer can supply a corrected itemized invoice if the original did not list items the way the insurer wants to see them. For a provincial program, contact the program office directly; the province guide has the numbers.
Major Canadian Extended Health Insurers
Use the member portal first. The number on your benefits card routes to the right group plan, which the general lines below may not.
| Insurer | Member site |
|---|---|
| Blue Cross (regional plans) | bluecross.ca |
| Canada Life | canadalife.com |
| Chambers of Commerce Group Insurance Plan | chamberplan.ca |
| Co-operators | cooperators.ca |
| Desjardins Insurance | desjardins.com |
| Equitable | equitable.ca |
| Green Shield Canada | greenshield.ca |
| Manulife | manulife.ca |
| Sun Life | sunlife.ca |
Shop APAP machines in Canada.
Frequently Asked Questions
Is CPAP covered by insurance in Canada?
Usually yes, if you have extended health benefits and a prescription. The plan sets the percentage or maximum, and almost all of them want a pre-approved quote. Provincial health plans do not cover CPAP in most provinces; Ontario’s ADP is the main exception.
Does OHIP cover CPAP machines?
Not OHIP directly, but Ontario’s Assistive Devices Program pays 75% of the ADP-approved price of the machine for eligible residents. It does not fund masks, headgear or supplies. The province guide covers eligibility and how to apply.
Can I use ADP and private insurance together?
Yes. ADP pays its 75% of the approved machine price first. Your private plan can then be claimed for your 25% share and for the mask and supplies ADP excludes, subject to the plan’s own limits.
Does my coverage change if I switch retailers?
No. Private coverage follows your plan, not the store. The only program that cares where you buy is ADP, which requires an ADP-registered vendor.
Can I claim a CPAP machine on my taxes in Canada?
Yes. A prescribed CPAP machine and its replacement parts are eligible medical expenses for the federal medical expense tax credit, for the portion insurance did not reimburse. Operating supplies such as distilled water are not eligible.
Do I need a prescription to buy CPAP supplies?
No. In Canada a prescription is required for the machine, not for masks, tubing, filters or other supplies. Your insurer may still ask for the original prescription when you claim supplies.
Final Thoughts on CPAP Insurance in Canada
Get the prescription, confirm the plan in writing, send a quote for pre-approval, then buy. Done in that order, most private claims are paid without a second phone call. If any part of it has you stuck, that is what we are here for.
I’m Jeremy, and I read every message that comes through the store. If you want a quote prepared for your insurer, a second set of eyes on your plan booklet, or just someone to explain what a line in your denial letter means, call 1-855-492-3316 or email [email protected] and ask for me. We answer seven days a week from 9 AM to 9 PM, and there is no such thing as a question too small. Orders over $150 ship free anywhere in Canada.
This guide is here for general information and is not a substitute for medical, legal or tax advice. Insurance coverage, eligibility and reimbursement rules vary by province, plan and individual circumstances and change over time. Confirm coverage with your insurer or provincial program before purchasing equipment, and talk to your healthcare provider about questions regarding CPAP therapy.
