- If you qualify for Medicare and have a doctor’s order for oxygen, Medicare will cover at least a portion of your costs.
- Medicare Part B covers home oxygen use, so you have to be enrolled in this part to get coverage.
- While Medicare will help cover the costs of oxygen therapy, you may still have to pay a portion of those costs.
- Medicare might not cover all types of oxygen therapy.
When you can’t breathe, everything might become more difficult. Everyday tasks may feel like a challenge. Plus, many other health problems can result from low blood oxygen levels, known as hypoxemia.
If you find it hard to breathe or have a condition that lowers your body’s oxygen level, you may need oxygen therapy at home. Read on to find out whether Medicare will help cover the costs of home oxygen and what you must do to make sure you have the equipment you need.
Basic requirements for coverage
To have home oxygen needs covered through Medicare, you must:
- be enrolled in Part B
- have a medical need for oxygen
- have a doctor’s order for home oxygen.
The Centers for Medicare & Medicaid Services (CMS) clearly outlines specific criteria that must be met in order for Medicare to cover home oxygen. Requirements include:
- appropriate Medicare coverage
- medical documentation of an applicable medical condition
- laboratory and other test results that confirm the need for home oxygen
We’ll cover the details of how to qualify for coverage later in this article.
The medical necessity of home oxygen is determined by testing to see whether your condition is causing hypoxemia. Hypoxemia occurs when you have low levels of oxygen in your blood.
Conditions like shortness of breath without low oxygen levels likely won’t be covered by Medicare.
Your doctor’s order must include information about your diagnosis, how much oxygen you need, and how often you need it. Medicare doesn’t usually cover orders for PRN oxygen, which is oxygen required on an as-needed basis.
If your condition meets the CMS criteria, you must first fulfill your Medicare Part B deductible. This is the amount of out-of-pocket costs you must pay before Medicare begins to cover approved items and services.
Once you’ve met your Part B deductible for the year, Medicare will pay for 80 percent of the cost of your home oxygen rental equipment. Home oxygen equipment is considered durable medical equipment (DME). You’ll pay 20 percent of the costs for DME, and you must obtain your rental equipment through a Medicare-approved DME supplier.
Your specific coverage and costs will depend on the Medicare Advantage plan you choose, and your choice of providers may be limited to those in the plan’s network.
Medicare will cover a portion of the cost for rental equipment that provides, stores, and delivers oxygen. Several types of oxygen systems exist, including compressed gas, liquid oxygen, and portable oxygen concentrators.
Here’s an overview of how each of these systems works:
- Compressed gas systems. These are stationary oxygen concentrators with 50 feet of tubing that connects to small, prefilled oxygen tanks. The tanks are delivered to your home based on the amount of oxygen needed to treat your condition. Oxygen runs from the tank through a regulating device that conserves the oxygen. This allows it to be delivered to you in pulses rather than a continuous stream.
- Liquid oxygen systems. An oxygen reservoir contains liquid oxygen that you use to fill a small tank, as required. You connect to the reservoir through 50 feet of tubing.
- Portable oxygen concentrator. This is the smallest, most mobile option and can be worn as a backpack or moved on wheels. These electric units don’t require tanks to be filled and come with only 7 feet of tubing. But it’s important to know that Medicare covers portable oxygen concentrators only in very specific circumstances.
Medicare will cover stationary oxygen units for use at home. This coverage includes:
- oxygen tubing
- nasal cannula or mouthpiece
- liquid or gas oxygen
- maintenance, servicing, and repairs of the oxygen unit
Let’s explore the criteria you must meet for Medicare to cover your home oxygen therapy rental equipment:
- To ensure your oxygen therapy is covered under Medicare Part B, you must be diagnosed with a qualifying medical condition and have a physician’s order for oxygen therapy.
- You must undergo certain tests that demonstrate your need for oxygen therapy. One is blood gas testing, and your results must fall into a specified range.
- Your doctor has to order the specific amount, duration, and frequency of oxygen you need. Orders for oxygen on an as-needed basis don’t typically qualify for coverage under Medicare Part B.
- To qualify for coverage, Medicare may also require your doctor to show that you’ve tried alternative therapies, such as pulmonary rehabilitation, without complete success.
- You have to get your rental equipment though a supplier that participates in Medicare and accepts assignment. You can find Medicare-approved suppliers here.
When you qualify for oxygen therapy, Medicare doesn’t exactly buy the equipment for you. Instead, it covers the rental of an oxygen system for 36 months.
During that period, you’re responsible for paying 20 percent of the rental fee. The rental fee covers the oxygen unit, tubing, masks and nasal cannula, gas or liquid oxygen, and the costs of service and maintenance.
Once the initial 36-month rental period ends, your supplier is required to continue supplying and maintaining the equipment for up to 5 years, as long as you still have a medical need for it. The supplier still owns the equipment, but the monthly rental fee ends after 36 months.
Even after the rental payments have ended, Medicare will continue paying its share of the supplies needed to use the equipment, such as the delivery of gas or liquid oxygen. As with the equipment rental costs, Medicare will pay 80 percent of these ongoing supply costs. You will pay your Medicare Part B deductible, monthly premium, and 20 percent of the remaining costs.
If you still need oxygen therapy after 5 years, a new 36-month rental period and 5-year time line will begin.
You may need oxygen therapy to treat one of many different conditions.
In some cases, trauma or severe illness could lessen your ability to breathe effectively. Other times, a disease like COPD might change the chemistry of the gases in your blood, lowering the amount of oxygen your body can use.
Here’s a list of some conditions that may require you to use occasional or continuous oxygen therapy at home:
To determine whether your condition requires oxygen therapy at home, your doctor will perform a variety of tests that measure the effectiveness of your breathing. Symptoms that may lead your doctor to suggest these tests include:
- shortness of breath
- cyanosis, which is a pale or blueish tone to your skin or lips
- coughing or wheezing
- fast breathing or heart rate
If you have these symptoms, your doctor will perform certain tests. These may include breathing activities or exercises, blood gas testing, and oxygen saturation measurements. Special tools may be used in the activity tests, and blood gas testing requires a blood draw.
Testing oxygen saturation with a pulse oximeter on your finger is the least invasive way to check your oxygen level.
Typically, people whose oxygen drops to between 88 percent and 93 percent on the pulse oximeter will require oxygen therapy, at least occasionally. Guidelines for how much oxygen to use and when will depend on your specific condition.
In some cases, your doctor may prescribe pulmonary rehabilitation in addition to oxygen therapy.
Pulmonary rehab helps people with a condition like COPD learn to manage it and enjoy a better quality of life. Pulmonary rehab often includes education on breathing techniques and peer support groups. This outpatient therapy is typically covered by Medicare Part B.
Oxygen therapy should be treated like any other medication. You need to work with your doctor to find the right treatment, dosage, and duration for your specific condition. Just as too little oxygen can harm you, too much oxygen can also carry risks. Sometimes, you only need to use oxygen for a short time. Be sure to talk with your doctor and check in regularly if you need — or think you may need — home oxygen therapy.
Using oxygen products safely
Oxygen is a highly flammable gas, so you need to take certain safety measures when using home oxygen equipment. Here are a few tips:
- Don’t smoke or use open flames wherever home oxygen is in use.
- Place a sign on your door to let visitors know there’s a home oxygen unit in use.
- Place fire alarms throughout your home and regularly check that they’re working.
- Be extra cautious when cooking.
- Be mindful that oxygen tubing and other accessories can present a fall hazard because you might trip over them.
- Store oxygen tanks in an open but secure area.
- Oxygen should always be used under the supervision and direction of your doctor.
- Be careful when using oxygen, and follow all safety precautions.
- If you need home oxygen and are enrolled in Part B, Medicare should cover the majority of your costs.
- Medicare might not cover some oxygen equipment, like portable concentrators.
- Work with your doctor to find the best therapy for your condition and coverage.
- Always talk with your doctor if you think your oxygen needs have changed.
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