Does Medicare Cover Oxygen Equipment?
Last Updated : 09/10/20184 min read
If your doctor believes that home oxygen therapy is medically necessary to treat your condition and you are enrolled in Original Medicare (Part A and Part B), Medicare generally covers 80% of the allowable charges after you’ve met your Part B deductible. You will have to meet certain other requirements before your Part B benefits apply.
What is oxygen therapy used for?
According to the National Institutes of Health National Heart, Lung, and Blood Institute (NHLBI), oxygen therapy increases the amount of oxygen delivered to your lungs. It is prescribed when you have a condition that causes your blood oxygen levels to fall to unsafe levels. NHLBI states that a lack of blood oxygen can make you feel tired, confused, and short of breath, and can also cause damage to your organs.
The U.S. National Library of Medicine indicates that oxygen therapy is often prescribed for people who suffer from:
- Chronic obstructive pulmonary disease (COPD)
- Severe asthma attacks
- Late stage heart failure
- Cystic fibrosis
- Sleep apnea
Oxygen therapy can be used for short periods of time in the hospital or other medical setting or over a longer term at home or other facility. Oxygen can be delivered as a liquid or gas in special tanks that will need to be refilled periodically, or you can choose an oxygen concentrator, which pulls oxygen out of the air for immediate use. Concentrators never need to be refilled, making them convenient and easy to use for home oxygen therapy according to the NHLBI.
How do Medicare benefits for oxygen equipment work?
Oxygen equipment and accessories are considered durable medical equipment (DME) under Medicare guidelines. Your Part B medical insurance typically covers allowable charges for DME, including home oxygen equipment, provided the following conditions are met:
- Your doctor says you’re not getting enough oxygen due to severe lung disease.
- Your arterial blood gas levels must be within a certain range.
- Your doctor believes your health may improve with oxygen therapy.
- Other measures haven’t helped your condition.
If you are eligible, Part B generally covers 80% of the allowable charges for your home oxygen equipment after you pay your deductible. Both your doctor and the supplier who provides your oxygen equipment must participate in the Medicare program.
Most people rent their oxygen equipment; under Medicare, you’ll pay 20% of your monthly rental charges for 36 months. If you still need home oxygen therapy, your supplier must continue to provide oxygen and maintain your equipment for an additional 24 months for a total of five years.
After five years, if you still need oxygen equipment, your original supplier is no longer obligated to continue to supply it, but you are free to find a new supplier or start a new 36-month rental agreement with your original supplier.
Keep in mind that if you live in certain areas, DME may be subject to Medicare’s competitive bidding program. If this applies to you, you must get your oxygen equipment from vendors contracted with Medicare.
If you have a serious health condition that requires home oxygen therapy, you may get better coverage with a Medicare Advantage plan (Medicare Part C). Medicare Advantage plans are offered by private insurance companies approved by Medicare and they must offer, at a minimum, all the same benefits as Original Medicare Part A and Part B (except for hospice care, which is still covered under Part A). In many cases, however, they have other helpful benefits such as Part D coverage for prescription drugs plus benefits for routine vision, dental, and even hearing care. In most cases, copayment and deductible amounts are lower than they are for Original Medicare.
Not all plan types and benefit options may be available in your area. You must continue to pay your Medicare Part B premiums, plus any other premium required by your plan, if you choose a Medicare Advantage Plan.
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