Medicare covers oxygen therapy that your doctor has prescribed to treat a lung or respiratory condition. If you have oxygen therapy at home, you will be responsible for a small deductible and 20 percent of the cost of the oxygen therapy equipment.
Oxygen therapy can vastly improve your quality of life if you suffer from COPD, emphysema, severe asthma, heart failure, or any other condition that affects your respiratory system.
Respiratory conditions can prevent you from getting enough oxygen into your blood, causing fatigue, shortness of breath, and difficulty thinking clearly.
Medicare Coverage for Oxygen Therapy
Medicare will cover oxygen therapy administered in a hospital or at home, provided that certain conditions are met. If you receive oxygen while you’re a patient in a hospital or skilled nursing facility, it is covered under Medicare Part A.
You will pay a deductible for your overall hospital stay, and Medicare will pay the rest, as long as you are not hospitalized for more than 60 days. After 60 days, you are responsible for a daily co-pay.
Many people with respiratory conditions benefit from being “on oxygen” all the time. If your doctor has prescribed oxygen for home use, it will be covered by your Medicare Part B coverage as “durable medical equipment,” as long as you meet certain requirements:
- You must have a lung disease or inability to take in enough oxygen.
- Your doctor may measure your blood oxygen level to show that it falls within the range at which oxygen is usually prescribed.
- Your doctor must also certify that other treatments haven’t worked, or that oxygen will improve your breathing ability and quality of life.
- You must get your oxygen from a durable medical equipment (DME) supplier that accepts Medicare assignment.
It’s important to remember that Medicare Part B will never cover all your costs for any medical procedure. You must pay a small deductible each year, and after that you will pay 20 percent of the cost of your oxygen therapy.
Purchasing Oxygen Equipment
Although you can rent or buy oxygen equipment, most people choose to rent. You can find a list of Medicare-approved DME suppliers that offer oxygen equipment here.
Be sure to ask the supplier if they are a “participating supplier” that accepts Medicare assignment. These suppliers have agreed to provide oxygen at the Medicare-approved rate, meaning you won’t have any unexpected charges.
If you get oxygen from a supplier that doesn’t accept Medicare assignment, there is no limit on how much you can be charged, and Medicare may not cover your oxygen at all.
When you rent oxygen equipment, you’ll pay a monthly rental fee for three years (36 months). Your rental includes filled tanks, equipment such as tubing, face masks and nose attachments, and servicing and repairs.
The supplier will deliver the equipment to your home. Your rental payments end after 36 months, but your oxygen supplier must still provide you with service for another two years (24 months).
If you need oxygen for more than five years, you will need to renew your contract or sign up with a new supplier. The oxygen company always owns all the equipment.
Will Medicare Cover a Portable Oxygen Concentrator
Oxygen therapy can dramatically improve your life, but it may not be practical to lug a full-sized oxygen tank everywhere you go. Medicare will cover the cost of portable oxygen tanks, and you can get them from your oxygen supplier as part of your service.
Portable oxygen concentrators are another option. However, they are more expensive than tanks, and they may not be available as part of your oxygen rental agreement. If you prefer an oxygen concentrator, you can always buy one on your own.
Will Medigap Help Me Pay for Oxygen
Medigap, or Medicare Supplement, plans are private insurance plans that work alongside Medicare Parts A and B. If you buy a Medicare Supplement plan, you will pay a monthly premium, but your out-of-pocket costs will be lower than if you just had traditional Medicare.
If you need oxygen, a Medicare Supplement plan can pay some or all of the 20 percent coinsurance that you would ordinarily be responsible for. Two of the available Medigap plans, Plans C and F, even pay the Medicare Part B deductible.
What if I Have Medicare Advantage
Medicare Advantage plans must cover the same equipment and services as Medicare Parts A and B, and this includes oxygen therapy.
But because Medicare Advantage plans are offered by private insurance companies, their rules, provider networks, and out of pocket costs can vary.
If you have a Medicare Advantage plan, contact your insurance company to find out how their oxygen therapy coverage works.
Find the Best Medicare Coverage for Your Healthcare Needs
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