🏥

Get Your Medical
Supplies Delivered

CPAP, CGM, and diabetic testing supplies — shipped to your door. Most Medicare beneficiaries qualify at little or no out-of-pocket cost*.

✓ Medicare Accepted

✓ HIPAA Secure

✓ No Obligation

Takes about 5–7 minutes

🔒 Encrypted

🏥 HIPAA Compliant

📦 Fast Delivery

📞 Live Support

Step 1 of 15 · Your Info

What's your name?

Let's start with the basics — this will appear on your enrollment.

First Name *

Last Name *

Step 2 of 15 · Your Info

Date of birth & gender

Required for Medicare eligibility and prescription processing.

Date of Birth *

Gender assigned at birth *

Step 3 of 15 · Your Info

How can we reach you?

We'll use these to confirm your enrollment and ship your supplies.

Primary Phone *

Cell Phone optional

Email Address *

Step 4 of 15 · Your Info

Security & preferences

Your Social Security Number (last 4 digits, or full SSN) is used to verify your Medicare account.

Last 4 digits of Social Security Number *

Enter last 4 digits, or full SSN (we'll use only last 4). Encrypted and never stored in plain text.

Preferred Language *

Step 5 of 15 · Your Info

Delivery address

Where should we ship your supplies? Must be a US address.

Street Address *

Apt / Suite / Unit optional

City *

State *

ZIP Code *

🎉

Personal info complete!

Great progress. Now let's find out which supplies you need — just a few more sections to go.

Step 6 of 15 · Supplies

Which supplies do you need?

Select all that apply. You can choose both.

😴

CPAP / PAP Therapy

Masks, tubing, filters, and CPAP machine supplies for sleep apnea therapy.

🩸

CGM / Diabetic Testing

Continuous glucose monitors, test strips, lancets, and insulin delivery supplies.

ℹ️ We specialize in CPAP, CGM, and diabetic testing supplies. For other DME needs (wheelchairs, oxygen, hospital beds, etc.), visit DMEHelper.com to find a DME provider near you.

Step 7 of 15 · Supplies 😴

CPAP / PAP details

Tell us about your current CPAP setup so we can send the right supplies.

PAP mask type *

Mask size *

CPAP / BiPAP machine model if known

Machine Questions

Do you use a heated humidifier tube?

Is your current machine working properly?

Are you requesting a new CPAP / BiPAP machine?

Is your current machine 5 years old or older?

Step 8 of 15 · Supplies 🩸

CGM & diabetes details

Help us send the right testing supplies for your needs.

How often do you test blood sugar daily? *

Insulin units per day

Strips / lancets remaining

Current or preferred meter brand

Clinical History

Are you currently using a CGM device?

Do you use sliding scale insulin?

Have you had hypoglycemic episodes in the past 6 months?

Any supplies you do NOT want? optional

💪

Perfect — we've got everything we need about your supplies.

Now let's add your prescribing doctor so we can request your prescription.

Step 9 of 15 · Your Doctor 👨‍⚕️

Your prescribing doctor

Search by name, or enter details manually below.

Search Doctor by Name

Doctor's Information

First Name *

Last Name *

NPI Number *

Valid NPI format

NPI must be exactly 10 digits

Office Address

Suite / Floor optional

City

State

ZIP Code

Office Phone

Office Fax optional

🩺

Got it! Now let's handle your insurance.

We'll look up your coverage to make sure you qualify and your supplies ship quickly.

Step 10 of 15 · Insurance 🏥

Insurance plan details

Enter the information from your insurance card.

Insurance Plan Name *

Member ID *

Group Number if shown

Insurance Phone optional

Step 11 of 15 · Insurance

Medicare Beneficiary ID

Enter your MBI from your Medicare card, or we can look it up using your SSN.

I don't have my Medicare card handy — look up my MBI

Medicare Beneficiary ID (MBI)

Checking your coverage… (30s)

Coverage check failed. Please try again.

✓Coverage Verified

Step 12 of 15 · Insurance

Secondary insurance

Do you have a secondary insurance plan (Medigap, supplemental, or employer coverage)? This is optional — skip if not applicable.

Secondary Plan Name optional

Member ID optional

Plan Phone optional

Step 13 of 15 · Card & Verify 📷

Insurance card photos

Upload a photo of the front and back of your Medicare card. Photos are encrypted and transmitted securely.

🪪

Card Front

Tap to take photo or upload

Waiting for front photo

🔄

Card Back

Tap to take photo or upload

Waiting for back photo

Step 14 of 15 · Card & Verify ✍️

Please confirm the following

Federal regulations require these confirmations before we can process your enrollment.

No one has offered me gifts, payments, or incentives for enrolling in this program.

I understand that submitting false information is fraud under federal law and may result in civil and criminal penalties.

I am a Medicare beneficiary and I am eligible for the medical supplies I am requesting through this enrollment.

Final Step · Review 🎯

Almost there!

Please review your information below. Tap any section to make changes before submitting.

Personal Info

Contact

Delivery Address

Supplies Requested

Prescriber

Insurance

Get Your MedicalSupplies Delivered