What Happens If The Equipment I Have Is No Longer Effective For Me
Your doctor may decide that your oxygen equipment is no longer effective for you. If so, he or she may notify the oxygen supplier with a new letter of medical necessity for different equipment. The oxygen supplier must provide you with equipment that fits your needs. It should address your mobility needs both inside and outside your home.
Does Medicare Cover Portable Oxygen Concentrators
- Portable oxygen concentrators can help people with COPD or other issues improve their quality of life. But does Medicare cover portable oxygen concentrators?
A portable oxygen concentrator is a piece of medical equipment that converts the air around you to purer oxygen. These devices are much smaller than oxygen tanks, which can help support mobility and lifestyle choices for those that require oxygen. But does Medicare cover portable oxygen concentrators? The answer might disappoint you.
What If I Have A Medicare Advantage Plan
If you have a Medicare Advantage plan you will not be able to get any reimbursement from Medicare. Since your Health Plan is primary, if you want any insurance coverage you will only be able to order oxygen supplies from a local durable medical equipment vendor that is in network for your plan.
If you do not want to use your insurance or do not like your options in your network, you can always purchase your equipment outright. You will still need the prescription and other requirements listed above but you can purchase a portable oxygen concentrator out right from any of the vendors above.
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What About Portable Oxygen Concentrators
Unfortunately, Medicare will not pay for a portable oxygen concentrator if you are already using Medicares oxygen rental benefit. The reason for this is that Medicare pays the supplier the same amount whether the supplier gives you a portable tank or a portable concentrator.
Since the tanks are considerably less expensive than the concentrators, most DME suppliers will only provide you with tanks because it is cheaper for them to do so.
If this is truly an inconvenience, ask your supplier if they offer smaller liquid tanks that could also be billed to Medicare Part B.
Information provided on the Aeroflow Healthcare blog is not intended as a substitute to medical advice or care. Aeroflow Healthcare recommends consulting a doctor if you are experiencing medical issues or concerns.
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What Happens After 36 Months
If you still need oxygen after renting the equipment for 36 months, your medical supplier must continue maintaining the equipment and furnishing supplies for up to 5 years . The DME supplier must also continue supplying the monthly delivery of oxygen tanks or cylinders, for which you will continue paying the 20 percent coinsurance.
After 5 years, your current provider no longer has to supply oxygen equipment â even if you still have a medical need for oxygen. You can, of course, continue with this provider if you both agree. You may also choose a different durable medical equipment supplier and begin a new 36-month rental period.
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Medicaid And Medicare Coverage On Pocs
Both Medicaid and Medicare indeed cover the rental for oxygen equipment and other accessories, which is classified as Durable Medical Equipment if your primary care physician prescribed it for home use. However, to get you covered for free rental of POC, you must meet the following conditions.
This article will reference Medicare, but Medicaid policy should follow Medicares quite closely. As always, please check with your local Medicaid office and insurance provider first!.
Does Medicare Cover Oxygen Equipment
Medicare does cover oxygen equipment as long as certain criteria are met. Since oxygen equipment is considered durable medical equipment, its covered under Part B of medicare. However, even after all criteria are met, you will still be paying for a portion of the device that youre purchasing or renting.
Like with any type of insurance, Medicare will find any excuse they can to deny you coverage, so its important to be meticulous in the way that you approach seeking reimbursement for your medical purchases simply contacting a Medicare provider and asking them to pay you will never work.
Generally, in order to seek reimbursement for oxygen equipment, you will need a medical report that shows you need supplemental oxygen to treat a condition or to maintain healthy blood oxygen levels. Remember that the more documents you have showing your need for supplemental oxygen, the less likely you are to be turned down for financial reimbursement.
Once you reach your deductible, Medicare will pay for 80 percent of the Medicare-approved amount and you will pay the remaining 20 percent out of pocket. The Medicare-approved amount is the sum of money that Medicare agrees to pay a provider for medical items or services.
Medicare will help pay for oxygen equipment and supplies when the following conditions are met:
When these criteria are met, Medicare will pay for the following:
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How Are Portable Oxygen Concentrators Covered By Medicare
Portable oxygen concentrators are covered by Medicare only if the DME supplier agrees to offer you a portable option.
Because portable concentrators are more expensive than stationary ones and because Medicares reimbursement rate to the supplier is the same either way many suppliers will only offer stationary oxygen concentrators to Medicare beneficiaries.
Details For Using Oxygen Dme
When it comes to oxygen equipment, Medicare will pay for you to rent this durable medical equipment. Your rental covers both the oxygen equipment and the other necessary accessories such as tubing, mouthpieces, and masks.
After 3 years, Medicare will stop paying the rental fee, but the Medicare supplier must still continue to supply you with both maintenance and accessories to go with your equipment for the next 2 years. The supplier cannot invoice you for these services. Finally, at the end of 5 years, the DME supplier doesnt have to continue providing your oxygen equipment or the maintenance required for it. At this point, you will start over on a new 3- year period either with the same DME supplier or a new one, if you prefer.
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Medicare Deductible And Coinsurance
Since portable oxygen concentrator and other oxygen equipment falls under the category Durable Medical Equipment and is covered on Medicare Part B. It says that you need to pay 20% of the Medicaid-approved amount , and then the Part B deductibles will apply.
Therefore, if you have been approved for the coverage of oxygen equipment through Medicare, the cost for oxygen equipment rental from the accredited supplier will be covered by Medicare for 36 months. Once 36 months have passed, you will be covered for another 24 months of oxygen equipment and other supplies until you will be covered for a total of 5 years, or as long as you medically need oxygen therapy.
Aside from the oxygen equipment, here are some oxygen accessories and services that are also included in the coverage for monthly rental payments:
- Oxygen machine servicing
- Oxygen machine repair and maintenance
How Much Does It Cost To Have Oxygen At Home
According to the study, the average cost per patient, per month, for home oxygen therapy is $201.20, with $55.81 of that total for equipment and $145.39 for services.
How much is a portable oxygen tank?
New portable oxygen concentrators vary in pricing and usually cost between $1495 and $3495 depending on batteries and other accessories. Customers can opt to purchase a used portable oxygen concentrator, with prices that range from $800 to $2,000 depending on the hours, warranty and condition of the unit.
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Why Are Portable Oxygen Concentrators Popular
Portable oxygen concentrators are popular because theyre small, light, and convenient to use. Many portable oxygen concentrators weigh as little as 5lbs and are less than 10 inches high. That means you can easily put them in a carrying case and take them with you as you go shopping, visit friends, go out to dinner, or even catch a flight.
Portable oxygen concentrators require batteries that must be changed regularly, but they dont need refilling the way gas or liquid oxygen delivery systems do. That makes them much more convenient than other delivery systems. Most units are very user-friendly too, so its not an extra stressor to have one close at hand.
However, portable oxygen doesnt come cheap, with most units costing somewhere between $2000 $3500.
If youve been prescribed portable oxygen and are worried about the cost, you might be wondering if Medicare will pay for a portable oxygen concentrator. Unfortunately in most cases, the answer is no.
How Much Does Oxygen Equipment Cost
Medicare Part B covers oxygen equipment rental instead of an outright purchase. You must first meet the Part B deductible before Medicare begins paying its share. In 2022, the Medicare Part B deductible is $233.
Once you meet your annual deductible, you pay the standard Part B coinsurance of 20 percent of the Medicare-approved amount, with Medicare covering the remaining 80 percent.
The cost to rent oxygen equipment varies widely depending on the type of equipment, supplier, tank size, and more. On average, though, you can expect to pay around $140 per week for an oxygen concentrator rental if you don’t have health insurance.
That price rises considerably when you add in the portability factor. Renting a portable oxygen concentrator costs around $210 per week on average.
For either option, Medicare pays their 80 percent, leaving you owing between $30 and $40 per week, on average, for oxygen equipment rental.
These calculations assume that the Medicare-approved amount is about the same as the market price for oxygen equipment rental. However, Medicare typically contracts a much lower rate than the going market price. You’ll need to call medical equipment suppliers in your area to get a better idea of what your cost would be.
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How Does Medicare Cover Oxygen Equipment
Medicare covers the rental of oxygen concentrators and other oxygen equipment for up to five years, as long as you continue to have a medical need for oxygen therapy.
If you have Medicare Part B, you will rent your oxygen concentrator from a DME supplier for 36 months . After that period, your supplier will continue to provide coverage for an additional 24 months .
If you need to continue using the equipment after five years, you will begin a new five-year contract with the same or different DME supplier.
If you own the oxygen equipment yourself, Medicare Part B will cover the cost of oxygen contents and supplies if all of the following apply:
- Your doctor determines that you are not getting enough oxygen
- Your doctor believes your health might improve with oxygen therapy
- Your arterial blood gas level falls within a certain range
- Other alternative treatments have been tried and failed
You will pay 20 percent of the Medicare-approved amount for the oxygen concentrator after you meet your Part B deductible .
Medicare.gov details some additional coverage rules for oxygen equipment under certain circumstances.
Portable Oxygen Concentrator Financial Assistance Overview
Portable oxygen concentrator financial assistance can help many Chronic Obstructive Pulmonary Disease sufferers improve their quality of life. While already struggling with COPD, it becomes difficult to carry heavy oxygen tanks along.
Portable Oxygen Concentrators are much lighter and smaller that can be carried in a shoulder bag.
Though oxygen tanks are standard of care, POC is considered a luxury item that is usually not covered under medical insurance.
However, this does not mean that you have to settle with those clumsy oxygen tanks for a lifetime. There are various options available to receive coverage for POC.
Portable Oxygen Concentrator Financial Assistance Make your Breathing Easier
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What Is Your Cost For Oxygen Equipment And Supplies
Under Medicare, you will rent your oxygen equipment from a supplier for 36 months. During this time, you will be responsible for your Medicare Part B deductible and 20 percent of the Medicare-approved cost of the monthly rental.
After the initial 36-month rental period ends, your supplier must continue providing you with oxygen equipment, supplies and regular maintenance for another 24 months, free of charge as long as the equipment remains a medical necessity.
Five years after starting oxygen therapy, you will have to decide how to continue, as a new 36-month rental period will begin. Several factors will determine your out-of-pocket expenses going forward including the use of alternative insurance, if you choose to rent or buy the equipment and what your doctor or supplier charges.
What Criteria Must Be Met For Medicare To Pay For Home O2 Therapy
For Medicare to cover oxygen equipment and supplies, beneficiaries must have the following: Have a prescription from your doctor. Have documentation from your doctor showing you have a lung disorder preventing you from receiving enough oxygen and that other measures have not been successful in improving your condition.
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How To Pay For A Portable Oxygen Concentrator
Portable oxygen concentrators are great devices for those with a medical need for oxygen who live an active, on-the-go lifestyle. After choosing to buy a portable oxygen concentrator, youll likely have some questions, especially related to how youll pay for the device. There are several options when it comes to getting a portable oxygen concentrator.
The most pressing question might be how to get Medicare to cover the concentrator since theyre not exactly cheap. The answer isnt entirely straightforward or black and white. There are conditions that must be met and some hoops youll need to jump through.
Medicare has always paid for durable medical equipment like wheelchairs. But when it comes to medical oxygen equipment, the rules change a bit. Medicare does cover part of medical oxygen equipment, but not all of it. Theyve always paid a certain amount towards oxygen equipment, but in 2013, their reimbursement rate was slashed by 50 percent. In the past, durable medical equipment providers would cover the cost of the equipment and then bill Medicare later, but this was too costly for suppliers to cover.
Because of this, insurance providers are now likely to cover less expensive oxygen supplies instead.
I Need A Portable Oxygen Concentrator Is It Covered By Medicare
You know you need a portable oxygen concentrator, but will Medicare cover it? Unfortunately, this is a complicated question to answer. Upon being diagnosed with needing this oxygen machine or other medical equipment, this probably isnt the only question you have.
For example, will you receive your equipment at little to no cost? Should you consider purchasing a used portable oxygen concentrator? Who is the best person to contact about your coverage? Its rare to receive direct answers to these queries, but were here to help guide you through coverage solutions.
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What Is A Portable Oxygen Concentrator
Oxygen tanks are heavy, awkward and hold a limited supply of oxygen. Alternatively, portable oxygen concentrators are lightweight, easy to transport and never run out of oxygen.
Portable oxygen concentrators take in oxygen from the atmosphere and then compress and purify it. The result is the delivery of new, clean oxygen to the patient via a nasal cannula. These machines run on battery power, requiring access to a power source in order to work continuously however, if you have charged spare batteries then you arent reliant on electricity to make it work all the time.
For most patients, a portable oxygen concentrator is more reliable and easier to integrate into daily life than oxygen tanks.
Does Medicare Cover Oxygen Therapy
Yes, oxygen therapy, as well as oxygen therapy tank accessories, are covered under Part B. Oxygen equipment and all accessories are Durable Medical Equipment. Part B covers the rental and use of DME for beneficiaries to use within their homes.
Medicare covers storage containers for oxygen, tubing, other oxygen accessories, and units that provide oxygen. Also, if the oxygen machine works with a humidifier, this may have coverage.
For Medicare to cover oxygen equipment and supplies, beneficiaries must have the following:
- Have a prescription from your doctor
- Have documentation from your doctor showing you have a lung disorder preventing you from receiving enough oxygen and that other measures have not been successful in improving your condition
- Proof of gas levels in your blood from your doctor
Its more cost-effective to rent your oxygen equipment from a participating DME supplier. Your rental payments will be paid up to 3 years. After that, the supplier will still own the equipment. However, they must still supply oxygen to you for an additional 24 months. If you still need oxygen therapy after 5 years, you can renew your contact with the supplier or find a new one.
If you use an oxygen concentrator, your Part B benefits will cover the cost of servicing your equipment every 6 months once the 36-month rental window has ended.
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Is Every Type Of Dme Covered Under Part B
Unfortunately, the catch that many people dont realize at first is that just because Medicare will help you pay for oxygen supplies doesnt necessarily mean they will pay you for the one you want. There are a lot of different types of oxygen devices on the market including oxygen tanks, portable liquid oxygen tanks, oxygen concentrators, portable oxygen concentrators, and CPAP and BiPAP machines.
Although every health insurance company is different, most tend to only offer reimbursement for the bare minimum. While oxygen therapy has constantly been evolving over the years, providing patients with more effective portable oxygen devices, Medicare and many private companies will likely only pay for oxygen tanks. However, if certain criteria are met, you may be able to receive an oxygen concentrator on an extended rental basis.
