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Obstructive Sleep Apnea (OSA) is becoming very common in North America regardless of age and gender. CPAP therapy is the best way to keep the airway open with continuous air pressure during sleep, but the equipment, mask, and maintenance can be quite expensive. In Canada, health care may be able to cover some of the expenses with each province offering their own level of funding for CPAP.
For Ontario residents, patients have to do a sleep study and be diagnosed with sleep apnea, in order to obtain a prescription by a sleep doctor to buy a CPAP. The Assistive Devices Program (ADP) offered by the Ministry of Health and Long-Term Care will subsidize 75% of the approved cost of the machine, and you only pay 25% of the machine. Other programs such as Ontario Disability Support Program (ODSP) and Ontario Works Program (OWP) also provide coverage for CPAP therapy if eligible. Thankfully, sleep studies and consultations with sleep specialists are all covered by OHIP.
Another province, such as Alberta, only offer CPAP therapy funding for citizens that require social assistance such as Income Support (IS) and Assured Income for the Severely Handicapped (AISH). Patients must also have a sleep study and be diagnosed with moderate to severe sleep apnea in order to qualify for funding. You can visit any cpap vendor to do a sleep study for a service charge. Income Support (IS) provides coverage up to a maximum of $1700 for a CPAP device and $2000 for an APAP device. Most people have to pay out of pocket or have insurance to cover cpap expenses. For more information please contact Alberta Health Services.
Similarly in British Columbia, public health insurance is called Medical Services Plan (MSP), and does not cover any portion of your therapy unless under the Employment and Assistance Regulation and the Employment and Assistance for Persons with Disabilities Regulation. The ministry will consider funding positive airway pressure devices when medically essential for treatment of moderate to severe sleep apnea validated by a sleep study.
About 80% of the time Quebec residents are using private insurance to cover their CPAP expenses as it is currently not reimbursed by the Quebec Health Insurance Plan, but the related costs for the treatment are eligible for the medical expense tax credit. Sleep studies are normally done at the hospital, but usually the wait list is over 6 months long. Many in the end choose to do them privately at a local vendor.
Saskatchewan however, provides the CPAP systems but patients need to buy their own mask, humidifier and necessary accessories. Since October 1, 2017, the province allowed patients with moderate to severe sleep apnea to receive a machine on loan at a cost of $275 for the life of the machine. In Manitoba, effective April 23, 2018, there will be an additional co-payment of $500 for the initial or replacement CPAP set up. WRHA announces that remainder cost and service fees will continue to be covered, but individuals will be responsible for the cost of accessories related to their therapy going forward. Both provinces will require a sleep study to be done at the hospital and to begin with a cpap trial.
Many provinces, such as Newfoundland, unfortunately offer a limited amount to no funding for CPAP machines. Note that if you meet the necessary eligibility requirements for social assistance or provincial disability, New Brunswick has a Health Services Respiratory Program, The Government of the Northwest Territories (GNWT) and Yukon sponsors the Extended Health Benefits for Seniors Program to seniors that have moderate to severe OSA. Inuit and First Nations are eligible for Medical Supplies and Equipment Benefits from the Government.
Nova Scotia has a Sleep Apnea Refurbishment Program by The Lung Association of Nova Scotia who are actively looking for donations of pre-owned positive airway pressure units to re-distribute for those in need.
If eligible for CPAP funding programs, you’re most likely required to attend a sleep study to obtain a sleep doctor-diagnosed obstructive sleep apnea prescription. Call a local homecare provider that provides CPAP therapy to learn more about the procedure of getting a CPAP machine in your province. It is good to remember that many personal health insurance companies will reimburse or cover the remaining expenses of obtaining a machine for CPAP treatment. Contact your public health service, social assistance, or insurance agent to verify and obtain more information.