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MedicallyModern

Sleep & Respiratory Care

CPAP & Sleep Apnea Supplies, Covered by Insurance

CPAP and BiPAP therapy, masks, tubing, filters, and nebulizers, billed to your plan for patients across the five boroughs, Long Island, Westchester, Putnam County, Dutchess County including Poughkeepsie, and all of New York. We verify your benefits first and confirm each refill with you before it ships.

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CPAP machine with mask and tubing beside a nebulizer, CPAP covered by insurance for New York patients

Key takeaways

  • We verify your current benefits and provide an estimate of your expected out-of-pocket cost before shipment. Benefit information is not a guarantee of payment; final coverage and patient responsibility are determined when your plan processes the claim. After the Part B deductible, patients generally owe 20% of the Medicare-approved amount unless secondary coverage pays it.
  • 2 sleep & respiratory care bundles available, billed to Medicare, New York Medicaid, and major commercial plans.
  • Same-day benefit verification, with your expected out-of-pocket sent to you in writing before anything ships.
  • Delivery across the five boroughs, Long Island, Westchester, Putnam County, Dutchess County including Poughkeepsie, and all of New York. Eligible supplies can be shipped statewide. Items requiring measurement, customization, fitting, or adjustment are handled through an in-person delivery or fitting process.

What we offer

CPAP, BiPAP and nebulizer therapy covered by insurance

  • CPAP/BiPAP Therapy & Resupplies

    The device, humidifier, mask, cushions, tubing, and filters as one managed therapy. For obstructive sleep apnea, plans generally start with CPAP; BiPAP is typically covered only after a documented CPAP trial proved ineffective.

  • Nebulizer Therapy & Resupplies

    Compressor nebulizers with masks, mouthpieces, and tubing for patients managing COPD, asthma, or chronic bronchitis at home.

Coverage explained

How CPAP insurance coverage actually works

A sleep apnea diagnosis on its own does not guarantee PAP coverage. Medicare requires a qualifying sleep study meeting its AHI or RDI criteria, a practitioner order, and, for continued coverage, a re-evaluation between day 31 and day 91 documenting benefit, together with objective adherence data. Nebulizer coverage is a separate determination with its own criteria; a respiratory diagnosis alone is not a complete coverage standard for either therapy.

  1. 1

    Qualifying sleep study and order

    A home or in-lab sleep study must meet the payer's AHI or RDI thresholds, and the practitioner's order must specify the device and pressure settings. We request both from your provider.

  2. 2

    Adherence window and re-evaluation

    Medicare requires documented use of at least 4 hours per night on 70% of nights in a 30-day window during the first 90 days, plus a practitioner re-evaluation between day 31 and day 91 documenting that therapy is helping. We monitor the data and flag mask fit and pressure comfort issues early so your clinician can address them.

  3. 3

    Rental period

    Under Medicare, PAP devices are a 13-month capped rental and then the device is yours. Commercial and Medicaid plans set their own rental or purchase rules, which we confirm for your plan. We handle the monthly billing so nothing lapses.

  4. 4

    Supply replacement you confirm

    Cushions, masks, tubing, and filters have separate replacement schedules. We track when you may be eligible for a refill and contact you before each cycle. Nothing ships until you or your representative confirms that it is needed.

What patients typically pay

We verify your current benefits and provide an estimate of your expected out-of-pocket cost before shipment. Benefit information is not a guarantee of payment; final coverage and patient responsibility are determined when your plan processes the claim. After the Part B deductible, patients generally owe 20% of the Medicare-approved amount unless secondary coverage pays it.

Want the specifics for your plan? Read how our insurance process works or check your coverage.

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Why Medically Modern

Why patients choose Medically Modern for sleep & respiratory care

Fit is where new CPAP patients struggle. We check in during the first month, coordinate a different mask style with your clinician when your plan allows it, and keep your compliance documentation on track.

  • In-network with all major insurances

    Medicare, Medicaid, and the major commercial carriers. We verify your current benefits and provide an estimate of your expected out-of-pocket cost before shipment. Benefit information is not a guarantee of payment; final coverage and patient responsibility are determined when your plan processes the claim.

  • White-glove, high-touch service

    A named care coordinator who contacts your doctor's office and handles prior authorization. We support or submit an appeal where permitted and authorized. You never sit on hold chasing paperwork.

  • Adherence-window tracking and mask-fit support

    We watch the download data through the day 31 to day 91 window, prompt the practitioner re-evaluation your plan requires, and work through mask fit and pressure comfort with your clinician before coverage is at risk.

Sleep & Respiratory Care covered by the plans we bill every day

  • Medicare A&B
  • NY Medicaid
  • Aetna
  • Humana
  • Fidelis
  • NYSHIP Empire
  • Anthem BCBS
  • MagnaCare
  • UnitedHealthcare

Participation varies by plan and product, we verify your specific plan before anything ships.

Plus most regional Medicaid, Medicare Advantage, and commercial plans. Not sure? We'll check for you.

Sleep & Respiratory Care FAQ

CPAP insurance coverage questions

Official coverage sources

Read the payer rules directly, then let us verify what your own plan allows.

Often, but a sleep apnea diagnosis alone is not enough. Medicare Part B covers CPAP as durable medical equipment when a qualifying sleep study meets its AHI or RDI criteria and a practitioner orders therapy; commercial plans apply their own criteria. Continued coverage also requires a practitioner re-evaluation between day 31 and day 91 plus objective adherence data.

Medicare treats a PAP device as a 13-month capped rental; other plans set their own rental or purchase rules and pay a percentage of the allowable amount and pay a percentage of the allowable amount after your deductible. After the Part B deductible, patients generally owe 20% of the Medicare-approved amount unless secondary coverage pays it. We verify your current benefits and provide an estimate of your expected out-of-pocket cost before shipment. Benefit information is not a guarantee of payment; final coverage and patient responsibility are determined when your plan processes the claim.

Under Part B, when a qualifying sleep study meets Medicare's AHI or RDI criteria, the order specifies pressure settings, a practitioner re-evaluation between day 31 and day 91 documents benefit, and adherence data is on file. We monitor the adherence data so coverage does not lapse.

Yes, masks, cushions, tubing, filters, and water chambers all have covered replacement schedules. Many patients are eligible for new cushions monthly and a new mask every three months. We track when you may be eligible for a refill and contact you before each cycle. Nothing ships until you or your representative confirms that it is needed.

Nebulizer coverage is decided separately from PAP therapy. Compressor nebulizers are covered under Part B and by most commercial plans when the medical-necessity criteria for the specific device and the covered inhalation drug are documented; a respiratory diagnosis alone is not the whole standard.

Yes. We supply CPAP and BiPAP therapy across the five boroughs, Long Island, Westchester, Putnam County, Poughkeepsie, and all of New York, and we bill Medicare, NY Medicaid managed care, NYSHIP, Fidelis Care, and the major commercial carriers.

For obstructive sleep apnea, plans generally cover BiPAP only after a documented trial of CPAP shows it was ineffective or could not be tolerated, with the clinician's findings in the record. Other respiratory conditions follow their own criteria.

Coverage can be paused, but it's fixable. We troubleshoot pressure and mask fit with you and coordinate a re-titration with your physician if needed.

Submit the coverage form and we request your records and rental history from your current supplier. We coordinate the transition to reduce the risk of a gap by checking the rental status of your device, your current supplier's last date of service, your same-or-similar equipment history, whether your prescription and chart notes are still valid, and our network and authorization status with your plan.

See what your plan covers for sleep & respiratory care

Two minutes now saves weeks of phone calls later. We verify your benefits and follow up within one business day.

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Other ways we help

Explore all nine categories

One supplier, nine insurance-covered product lines.