CPAP devices are costly, so it may not be affordable to all. The CPAP paid by OHIP is a program initiated by the Ministry of Health and Long-Term Care in Ontario to offer CPAP machines to Ontario residents at minimum cost. Only the health cardholders are eligible for the program. CPAP paid by OHIP pays for the CPAP devices to patients suffering from obstructive sleep apnea syndrome and have been certified by a sleep physician.
Before making the application for CPAP paid by OHIP the person will have to undergo diagnostic tests to find out the fundamental reason of disruptive sleep by a physician who specializes in sleep medicine. The application will be completed if the client satisfies the medical eligibility criteria and the sleep physician affirms that the client has obstructive sleep apnea syndrome. The sleep physician and sleep clinic staff will then select the suitable device for the client.
CPAP paid by OHIP will pay up to 75 percent of the approved price. The balance amount will be charged to the client. OHIP will pay full-approved price if the client is receiving social assistance benefits from Ontario works, Ontario Disability Support Program. Lots of private health insurance companies pay their client’s share. The clients can purchase the CPAP equipments from any respiratory vendor registered with the program. The vendors can directly bill CPAP paid by OHIP for the 75 percent portion of the cost of the equipment. The registered vendors can charge their clients less than the approved price but cannot charge more than the approved price.
CPAP or APAP system offered through CPAP paid by OHIP consists of a CPAP/APAP device, heated humidifier, basic mask and headgear, carrying case, 6 ft tubing, all necessary caps and filters, power cord and patient instruction manual. If any item that the client required is not part of the CPAP or APAP system, the vendor will charge the client the full cost of the item.
Registered respiratory vendors should ensure their clients receive appropriate instructions for the safe use of the equipment. The OHIP funded CPAP/APAP systems must have a 3-year warranty. The clients can receive additional services such as an extended warranty, yearly pressure checks and calibrations or pressure adjustments from the respiratory vendor for extra cost, which falls apart from the CPAP paid by OHIP. Additional services are not mandatory. The clients can decide whether they need the additional services or not.
The clients can replace the equipment after five years if the equipment is no longer working and cannot be repaired. CPAP paid by OHIP will contribute towards the cost. For this the client needs a new form signed by the doctor to prove that still meet the eligibility requirements. Any client who is a resident of Ontario more than three months comes under the coverage of OHIP.
To know more about the CPAP paid by OHIP, you may contact CPAP Clinic, an ADP-authorized dealer of CPAP machines and accessories.
Our address:
CPAP Clinic – Sleep Apnea Treatment at-your-home
Toronto, ON, Canada
1-877-430-CPAP (2727)
For more information about CPAP Paid by OHIP or CPAP Machine, please visit www.cpapclinic.ca or call 1-877-430-CPAP(2727).
35 thoughts on “CPAP Paid by OHIP”
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I have been trying out a cpap but the office I’m trying it at insists I have to buy their mask and hose. Their mast is $245 and hose $95. I can buy exact same on line for $109. And $60. Is there someplace I can buy just the machine under OHIP plan. I already have a mask but I can’t seem to buy just the machine without buying their overpriced mask. Are all offices the same?
You can get the PAP unit in Ontario and it should be a price of $860 including everything but a mask. OHIP pays $645 and you pay $215. This is a standard pricing structure. Our masks avergae $175. For more, go to cpapclinic.ca
I purchased my CPAP machine June12 /2015. I had to go for a stay in the hospital for an unrelated treatment on July 12/2015 . I took my CPAP machine with me . When I plugged the machine in I found that it was failed.
Apparently there is only a 3 year warranty on CPAP . Does OHIP cover repairs to the CPAP machines ? The machine has never before been unplugged until I had to stay in the hospital . If the machine is not repairable will OHIP cover a replacement CPAP machine ?
OHIP does not cover repair costs. We can help you with a trial unit (in the interim) should you decide to go after a sleep study. Anther study might reveal your need for an APAP. If so, OHIP would cover the $765 for the APAP you pay $255. And this can happen inside the 5 year span required between PAP units. It’s only when you have a change in health that requires you to go from a CPAP to an APAP that OHIP will foot the bill before the 5 year anniversary between PAP units. 1.877.430.2727 if you have questions.
I just went to Mexico to have a sleep study done. Will OHIP cover 75% of the cost of a machine if I get it here in Mexico and bring it back to Canada with me?
Thanks;
Marcus
Ontario OHIP will not honor a mexicam prescription for PAP. Only a sleep study in Ontario and and sleep doctor prescription for a PAP unit will be honored by OHIP. 1.877.430.2727 for more questions.
The sleep clinic wrote me a prescription for APAP, full face mask, humidity to set as HOT,and machine is Airsense 10 F/H. My question is,I am on Onatrio works assistance and hoping to get 100% costs of the equipment covered.Can I buy Philips Respironics Dreamstation Auto with heated humidifier, F&P SleepStyle or HDM Auto-CPAP : # 218275 Z1 Auto with PowerShell instead? or must I get exactly as written on my prescription? The doctor asked me to shop around as prices and specifications vary a great deal. Anyone has used the above machines and which ones do you recommend and why? Appreciate your feedback. Thanks in advance!
Thank you for your question. We have several answers:
1) A prescription for an APAP typically has a low number and high number on it, representing your APAP settings. A sleep doctor will know to write this in.
2) Ontario Works will pay the remaining 25% of the cost of the unit while ADP will pay for 75% of the unit, with a valid prescription from a sleep doctor.
3) The Dreamstation with heated humidifier and the F&P Sleepstyle are covered. The HDM Auto-CPAP is not, per ADP and OW.
4) The price for any APAP in Ontario is regulated to be $1020. If you see other prices that are higher, accessories and upgraded features have been given a dollar value. This varies from Vendor to vendor. But ADP and OW will not pay for the price difference(s).
5) Either the F&P and Dreamstation can be purchased using the ADP and OW coverage.
Please call 1.877.430.2727 option 1 for more information.
does the government cover an additional amount if you’re 65 years of age or older?
People who require CPAP machines are being ripped off by the companies supplying this equipment. Nasal masks made of cheap plastic are being sold for over $100 when the actual cost of manufacture would be less than $3. shame the Health Ministry and OHIP has not done anything about it.
OHIP actually sets the pricing for PAP devices (thereby lowering the out-of-pocket cost for the CPAP user). The cost of PAP units have dropped by $800 (approx) in the last 10 years. So, the market is favoring the buyer in this way.
Unfortunately, OHIP doesn’t have a say in CPAP mask prices, which are largely dictated by market supply and demand (which is behind the force of any market). Our prices are significantly lower than average market pricing. The leading companies who manufacturer CPAP masks do not have such low cost design in their pricing for every mask, every mask part, etc. and sacrifice value. Companies like Resmed, Respironics and Fisher Paykel continue to create valuable, resilient effective sleep products and PAP units, etc.
If there is a comparison between Canada CPAP pricing and USA CPAP pricing there will be a big difference. However, there is no question about the quality one invests in when it comes to CPAP machines and supplies, especially because masks and accessories are demanded to possess high quality and comfort.
Here at Cpapclinc, you can expect high quality CPAP products and solutions because we strive to offer the best with competitive pricing and free shipping for Canadian orders. Private insurance has also been known to lessen any costs with decent coverages. 1.877.430.2727 if you have questions so we can help you get the best value for any CPAP purchase. Thank you!
I have been using my CPAP machine since 2013 (4 years now) and I was told to replace the nasal mask. Is it covered by Health Ontario?
OHIP does not cover a new mask, only the PAP device every 5 years. We do have varying masks ranging between $100-200. 1.877.430.2727 if you have any more questions.
Hi, I was on disability at the age if 52 (retired after suffering many kidney stones, a transplant of my own kidney (have 2 on left side now, transplanted 1 on top of bladder due to ureter blockage). Then developed huge hernia at surgery site that now has a mesh implanted from my rib to hip as prevention to stop bowel protruding. I am seeing a physician for sleep apnea at a clinic close to me. I gad a machine with a small mask that I purchased a few years ago. The problem us now they say I need a full mask as I sometimes breathe through my mouth & thus not getting enough oxygen. Would I be covered for this mask alone- which is a breathable cloth one through OHIP, or would I have to pay the full amount myself? Or, if it has passed 5 yrs since getting my last machine would they cover everything?
If you still are on ODSP, OHIP will pay for your machine and ODSP will cover the remainder. So, OHIP and ODSP will pay for an entire PAP unit with a valid prescription and 5 years passage since your last PAP device. The breathable mask is called the Sleepweaver ( here — https://www.cpapclinic.ca/CPAP-store/Circadiance/CPAP-Full-Face-Mask/SleepWeaver-Anew-Blue-Sma.php?CatalogID=1392 ) ODSP may cover the cost of the sleep weaver and we will work with you to make that happen. 1.877.430.2727 for more details.
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If you are still using Cpap and you need to get new one than does family doctors referral will work or need from respiratory Dr’s note that still this machine is required to use.
A family doctor’s prescription will work if you are only going to bill your insurance and not involve government funding. If you want government funding, there needs to be a five-year gap between your original CPAP and your potential new one. Plus, a doctor’s prescription from a sleep doctor is required for government funding and billing the difference you spend to your insurance. 1.877.430.2727 if you have questions.
Does the OHIP coverage recognize the nasal mask as well as the facial mask please?
Dear Jeremy,
OHIP recognizes a free mask. Unfortunately, it cannot be substituted for any other mask. 1.877.430.2727 if you have questions,
Thank you!
Bill Bistak
CPAP Consultant
cpapclinic.ca
1.877.430.2727
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Is the Minicpap covered by OHIP?
Unfortunately, it is not covered because it must be sold with a water humidifier under ADP guidelines.
1.877.430.2727 for more details.
I’ve had my machine for 10 years do I need to redo a sleep study or can my family doc give me a prescription
Steven,
You can do either. Please call 1.877.430.2727 to discuss.
Thank you,
CPAPClinic.ca
My brother is under the caregiver program and he was recently seen by a sleep specialist doctor and diagnosed with severe sleep apnea. He needs a CPAP Machine. My question is, is he eligible to get the discount from OHIP? He has been working here for almost 2 yrs but under the live in program. Thanks
Hello,
Any first time applicant to ADP for a CPAP is approved with a valid prescription (for a CPAP device) from a sleep doctor. With your phone call, we can assure your brother will get everything necessary to get great sleep with a CPAP. 1.877.430.2727 Talk soon!
i have recently got approved for a cpap machine and went to the place recommended by doctor.
the issue is i cannot find a mask that fit, they insist me trying different mask when i insisting them they are too small. my problem is i have the machine and they are forcing me with the masks which i can never use. i have to pay for extra mask because they dont carry any other than one brand. is that anyway i can refund that machine get a new one at a place that carry better mask or exchange that mask and get gov funding for the mask alone? mask is like 300 cost quite alot.
We can help. And here’s what we can do:
You can visit our Mississauga (6200 Dixie Rd, unit 102), Vaughan (644 Millway, unit 4) or Toronto branch (1110 Sheppard Ave East, unit 13) anytime between 9-7 mon-fri, 10-3 sat to trial a mask to borrow before you buy anything. Our masks range from $70-$350, depending on the type. Most sizes and mask types are available (nasal, nasal pillow, full face mask are examples of what’s available) to try on first. Once purchased, all masks have a 30 day one time switch-out, starting from the day of purchase. Refunds for machines are difficult because it’s one machine per person per 5 years when funded by OHIP, unless your actual machine is broken, therewith the 3 year warranty will enable a successful replacement. Government funding for a mask applies to individuals on ODSP and OW. Gov funding covers $645.00 once every 5 years for a CPAP. When you call 1.877.430.2727 we can make things right for you!
I recently purchased from Medigas in Oshawa, a CPAP AIRSENSE 10 ELITE
W/HUM for $ 860.00 minus the Ministry’s cost of $ 645.00 leaving me the balance of $ 215.00. No problem here. I cannot use the device without the
mask with attached small air hose and the Ministry does not cover this cost.
I was charged $ 320.00 for this mask and hose, which if a similarly made
product was sold at Canadian Tire. it would sell for less than $ 25.00. The price
I was charged was exorbitant and I think the price of mask and hose should be
regulated like the CPAP machine by the ministry. I think I was ripped off. Thanks
for letting me air my grievance. Arnold Jacenty
We can assist you with mask and tubing at better prices! 1.877.430.2727
This may be a little late for you, but the AssitiveDevicesProgram through OHIP should cover part of the cost of the hose and mask as well as the CPAP machine. As the mask and hose are considered part of the CPAP system. Info here:
http://www.health.gov.on.ca/en/public/programs/adp/publications/cpap.aspx
An entire PAP device is sold with a bag, non-heated hose, filter, bag, manual, humidifier chamber, machine, and choice of a basic mask, per ADP requirements. If you have further questions, please use 1.877.430.2727. Thank you!