So you are looking for treatment for Sleep Apnea and want to find out one of the most important questions, How much will it cost me? Well, you’ve come to the right place! We’ll go over the 3 routes to get a CPAP machine specifically in Ontario, Ministry Coverage, and the effects of ADP (Assistive Devices Program) on Private Insurance coverage and we will touch on some of the history of funding.
At Capital Home Medical we provide transparent advice without the fine print.
3 Ways to Obtain a CPAP
01.
Private Sleep Study
- No Wait Times
- Insurance Navigation
- Similar Costs to Public Funding Routes
1 week Turnaround time for Interpreted Sleep Test Results
- Multiple Sleep Solution Therapies Review
02.
Prescription from your family physician
To purchase a new CPAP machine or Oral Appliance privately. This will be 100% private pay with no assistance from the government or insurance for Ontario citizens. Many physicians will ask for a sleep test prior to signing a CPAP prescription.
03.
Public Funded Sleep Lab test
- Similar Costs to Private Routes of Sleep Therapy
- 6-12 month wait times
- Service Fees not covered by insurance
- $415.50 Provincial coverage towards CPAP Therapy
Home Sleep Testing (Private):
$300.00 Immediately Available
CPAP Monitor and reporting by
RRT if Clinically indicated
CPAP Therapy Total cost:
$1750.00
Ministry Funding for CPAP:
$0.00
Capital Home Medical Therapy Rebate:
$300.00
Total CPAP Package before
insurance coverage: $1450.00
*Insurance Coverage (If Applicable):
$325 - $1350.00
Sleep Lab Testing (Publicly Funded)
OHIP - 6 month- 1 year Wait
CPAP Monitor and reporting by
RRT if Clinically indicated
CPAP Therapy Total cost:
$1750.00
Ministry Funding for CPAP:
$415.50
Capital Home Medical Therapy Rebate:
$0.00
Total CPAP Package before
insurance coverage: $1334.50
Insurance Coverage (If Applicable):
$325 - $1350.00
All CPAP Packages from Capital Home Medical Equipment come with 5 year worry-Free Therapy:
Monitoring & Titration, RRT backed therapy, warranty, and rental equipment if needed.
Costs and services may vary from different providers
Frequently Asked Questions
How much does The Ministry Of Health Cover for CPAP machines?
What does the Ministry of Health Cover for CPAP machines?
The Ministry of Health is responsible for the provision of the CPAP machine, non-heated tubing, and a complimentary mask. Please note that any associated reporting or human services will incur additional fees. Additionally, be aware that the complimentary masks are currently experiencing a backlog with no anticipated resolution timeline.
The Ministry states they cover 75% of the cost of a CPAP. Has the Ministry of Health’s funding changed in the past years?
Yes! Year over year funding has been reduced by dollar standards but kept as a relative percentage. As you consider the information presented here, please reflect on the following questions: Have the costs of raw materials increased? Have manufacturing expenses risen? Is there a notable increase in fuel prices, affecting shipping costs? What changes have occurred in hourly labor wages? Additionally, how do the online prices of CPAP machines compare, particularly when factoring in the absence of service, paperwork management, and the availability of loaner machines in case of issues?
Year | Subsidized CPAP Price | Coverage Amount (75%) | Patient Amount (25%) |
|---|---|---|---|
2015 | $ 2160.00 | $ 1620.00 | $ 540.00 + CPAP Mask + heated Tubing |
2016 | $ 1860.00 | $ 1395.00 | $ 465.00 + CPAP Mask + heated Tubing |
2017 | $ 1560.00 | $ 1170.00 | $ 390.00 + CPAP Mask + heated Tubing + Protection Package |
2019 | $ 860.00 | $ 645.00 | $ 215.00 + Fees + Protection Package + CPAP Mask + Heated Tubing |
2021 | $ 554.00 | $ 415.00 | $ 138.50 + Protection Package + Surcharges + CPAP Accessories |
So, let’s break it down! The Ministry of Health claims it’s all about “saving Ontarians money” on CPAP machines. But honestly, at this point, you might as well be picking one up from a vending machine for $554 as it does not even cover the costs associated with the equipment. Sure, it’s affordable—but good luck finding someone to help you with the fine print! Who’s going to handle the paperwork, send reports to your doctor, chase down signatures, or offer decent service? With funding cuts, you’re basically left with just the machine and a cheerful “good luck!”
And here’s the cherry on top: local and international companies are more focused on selling to provinces that don’t have the same funding cuts, leaving Ontarians in the lurch. Why? Well, places like British Columbia, Quebec, and Alberta don’t have the same pesky funding reductions and all come with services covered by insurance. Meanwhile, in Ontario, your trusty OHIP card only gets you a $415.50 subsidy, leaving you to foot the rest for rental and accessories. Ouch!
On one hand, reducing costs sounds great for making therapy more accessible, but when you’re stuck in a system that hasn’t changed in 15 years, it’s like trying to use a rotary phone in a smartphone world.
So, what’s the game plan? If you’re after CPAP therapy in Ontario, brace yourself—it’s going to be tricky. Your best bet? Go private and find a company that’s willing to help with out-of-pocket expenses while working with your insurance.
And speaking of insurance—if you call up, you might hear that you’re covered for up to $2000. But hold on! You’ll need to apply for the Assistive Devices Program (ADP) to snag that subsidized price and unfortunately, that $2000.00 becomes a maximum of $138.50 for the machine itself, leaving you to pay for all the extras out of pocket.
Is the Ministry really covering 75% of costs? Well, they’ve set a price limit that doesn’t quite add up to sustainable service. It’s more like they hand over the machine and say, “Best of luck!” And if you try to get reimbursed for an online purchase, good luck with that—insurance companies have slashed their coverage to match that $554 price tag.
At Capital Home Medical, we understand the complexities of navigating insurance coverage, which is why we partner with a variety of insurance companies to help ensure you receive the maximum benefits available. Our team is dedicated to working closely with your insurer to streamline the process, making it easier for you to access the care and equipment you need without the stress of unexpected costs. We’re here to advocate for you, so you can focus on your health and well-being.
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