Medicare Part B covers home oxygen use. While Medicare will help cover the costs of some types of oxygen therapy, you may still have to pay a portion of those costs.

When you’re having trouble breathing, everything can become more difficult. Even everyday tasks may feel like a challenge. Low blood oxygen levels, known as hypoxemia, can lead to various health problems.

You may need oxygen therapy if you have an illness like COPD, asthma, cystic fibrosis, or heart failure that affects your breathing. This may require at-home or in-clinic therapy, depending on the cause and the extent of the impact on your day-to-day life.

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.

Medicare covers home oxygen therapy under Part B. Medicare Part B covers the cost of outpatient care and certain home therapies.

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 you must meet 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.

Medical necessity

Doctors often prescribe home oxygen for conditions like heart failure and chronic obstructive pulmonary disease (COPD).

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.

Costs

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.

The Part B deductible for 2024 is $240. The premium is $174.70 each month or higher, depending on your income.

Once you’ve met your Part B deductible for the year, Medicare will pay for 80% of the cost of your home oxygen rental equipment. Home oxygen equipment is considered durable medical equipment (DME). You’ll pay 20% of the costs for DME, and you must obtain your rental equipment through a Medicare-approved DME supplier.

You may also use a Medicare Advantage (Part C) plan to pay for oxygen rental equipment. The law requires these plans to cover at least as much as Original Medicare (parts A and B).

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 of 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 (ft) of tubing that connects to small, prefilled oxygen tanks. The tanks are delivered to your home based on the oxygen needed to treat your condition. Oxygen runs from the tank through a regulating device that conserves the oxygen, delivering it 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 filling tanks and only have 7 ft of tubing. However, 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

Medicare also covers other oxygen-related therapies, such as continuous positive airway pressure (CPAP) therapy, which is needed for conditions like obstructive sleep apnea.

Let’s explore the criteria you must meet for Medicare to cover your home oxygen therapy rental equipment:

  • To ensure that Medicare Part B covers your oxygen therapy, you must receive a diagnosis of 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; 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 as needed 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 must get your rental equipment through a supplier that participates in Medicare and accepts assignments. 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% of the rental fee. The rental fee covers the oxygen unit, tubing, masks and nasal cannula, gas or liquid oxygen, and service and maintenance.

Once the initial 36-month rental period ends, your supplier must 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% of these ongoing supply costs. You will pay your Medicare Part B deductible, monthly premium, and 20% of the remaining costs.

If you still need oxygen therapy after 5 years, a new 36-month rental period and a 5-year timeline will begin.

Using oxygen products safely

Oxygen is highly flammable, so you must take certain safety measures when using home oxygen equipment. Here are a few tips:

  • Do not smoke or use open flames wherever home oxygen is in use.
  • Place a sign on your door to let visitors know a home oxygen unit is in use.
  • Place fire alarms throughout your home and regularly check that they’re working.
  • Be extra cautious when cooking.
  • Remember 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.

If you need home oxygen and are enrolled in Part B, Medicare should cover most 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.

You should always use oxygen under the supervision and direction of your doctor. Be careful when using oxygen, and follow all safety precautions.