Does Medicare Cover Oxygen? 

Oxygen therapy is often necessary for people who have low blood oxygen levels (hypoxemia). The low levels may be due to health conditions like COPD, pneumonia, bronchitis, pulmonary fibrosis, heart disease, sleep apnea, cystic fibrosis, late-stage heart failure, or asthma.

You may be experiencing hypoxemia if you have any of the following symptoms:
• Dyspnea (shortness of breath or labored breathing)
• Tachycardia (a rapid or erratic heart rate)
• Coughing and/or wheezing
• Confusion
• Cyanosis (blue skin, fingernails, and lips)
Hypoxemia can be a life-threatening condition if it isn’t treated, so you should see your physician immediately if you’re experiencing any of these symptoms. Your health care provider can test your blood oxygen levels through a blood sample or using a pulse oximeter.

If your physician prescribes oxygen therapy to help you breathe more easily, your Medicare insurance may help you cover some of the expenses.

How does Medicare cover oxygen?
If you’re enrolled in Original Medicare Part B (medical insurance), you can get help to pay for oxygen, oxygen equipment, and any necessary accessories you use in your own home if you meet all the following criteria:
• Your physician tests your blood oxygen levels and certifies that you aren’t getting enough oxygen due to a diagnosed medical condition. He must also specify the amount, duration, and frequency of oxygen you need.
• Your physician certifies that oxygen therapy may improve your health. She may need to report that you’ve tried other types of therapy that didn’t improve your health.
• Your arterial blood gas levels are below a certain range.
If Medicare approves this benefit, Part B will cover its share of the cost to rent the following equipment and supplies necessary for oxygen therapy at home if you get them from a medical supplier who accepts Medicare assignment:
• Stationary oxygen units to use at home
• Liquid or gas oxygen
• Oxygen tubing
• A nasal cannula or mouthpiece
• Necessary service, repair, or maintenance of the equipment
• A humidifier that’s used with the oxygen machine

Medicare Part B pays 80 percent of the cost for the above-listed supplies and equipment, and you pay the remaining 20 percent after you’ve covered the annual Part B deductible.

Medicare covers the rental of this equipment for 36 months. If you still require oxygen therapy at home after 36 months, the supplier must provide the equipment, oxygen, and supplies for 24 months longer. Your Medicare-affiliated supplier must continue to provide this for up to five years if it is medically necessary.

If you need oxygen therapy for longer than the original 36-month and five-year period, the original supplier isn’t obligated to continue providing your equipment and supplies, and you can get replacement equipment from another supplier. If you begin service with a new supplier, a new 36-month payment period and five-year supplier obligation period begins.

How does Medicare Advantage help pay for oxygen?

If you’re enrolled in a Medicare Advantage (MA) plan, your insurance provider is obligated to cover at least all the benefits provided by Original Medicare Parts A and B. Depending on the type of Medicare Advantage plan you have, you may need to get your oxygen equipment and supplies from a medical supplier that is included in your plan’s network of providers.

If you aren’t sure about restrictions or costs associated with your oxygen therapy, check with your insurance provider for details before you purchase or rent your equipment.

Similar Posts