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
Will Medicare Pay For My Portable Oxygen
by OxiMedical | Oct 17, 2018 | Medicare & Insurance |
A lot of our customers seek the best oxygen equipment available. As you may know, your private insurance and Medicare do not always think the same. Medicare will provide only a rental reimbursement for medically necessary oxygen equipment Medicare does not provide for the purchase of oxygen equipment. However, most respiratory equipment suppliers are not convinced Medicare pays enough for them to see a return on their investment and while they must provide portable oxygen, they are not required to give you a portable oxygen concentrator.
To break down how the process works, in almost all states the reimbursement is $14-$16 a month for portable oxygen. Here is where things get tricky!! Portable oxygen in the eyes of your insurance and Medicare can mean heavy tanks, liquid devices, or battery-operated devices. Lets look back at the $14-$17 reimbursement that Insurance/Medicare pay their contracted suppliers, they can only bill you for 3 years at which point the following two years they dont get any money for services that they render.
Unfortunately, the only way to ensure you have Portable Oxygen and the freedom to live life as you want to is to purchase one.
Does Medicare Cover Inogen Portable Oxygen
The answer to this is, technically, yes. Medicare covers durable medical equipment , and Inogen oxygen concentrators fall into this category that also includes blood sugar monitors, walkers, and infusion pumps.
Did You Know: Due to their relatively high cost, portable oxygen concentrators are often available for rental, a great option for those who only need oxygen therapy in the short term.
Medicare covers the rental of oxygen equipment. Medicare will generally pay for oxygen if:
- Your doctor says you have a severe lung disease or youre not getting enough oxygen.
- Your health might improve with oxygen therapy.
- Your arterial blood gas level falls within a certain range.
- Other alternative measures have failed.
If your paperwork is approved and Medicare agrees to pay for oxygen equipment rental, you pay 20 percent of the Medicare-approved amount, and the Part B deductible applies. Medicare covers rental, not purchase, so youll rent your equipment from a supplier for 36 months. After that period is up, your supplier must provide oxygen equipment and supplies to you for an additional 24 months for a total of five years, so long as you have a medical need for oxygen. After that, if you still need oxygen, you are free to change the supplier if you wish.
Medicare pays a monthly rental payment to the supplier which covers both the oxygen equipment and accessories such as tubing and a mask or cannula. The payments also cover oxygen machine servicing, maintenance, and repairs.
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Why You Might Need An Oxygen Prescription
Because every cell in your body relies on oxygen to function properly, a doctor will prescribe supplemental oxygen if they find that you are not getting sufficient oxygen on your own. You might receive your oxygen prescription from your primary care physician, a palliative care doctor or a pulmonologist. There are any number of specialty physicians who might determine that you are in need of medical oxygen. Because oxygen therapy is prescribed for a number of different causes for breathing difficulties, including breathlessness, hypoxemia and hypoxia, the doctor that prescribes your oxygen therapy will likely be the doctor treating your present condition. Most often, however, the prescribing doctor will be a pulmonary specialist since they specialize in diseases of the lungs and bronchial tubes.
In order to determine how much oxygen you are currently getting and, accordingly, how much supplemental oxygen you will need, your doctor will administer a number of tests to ascertain your oxygen level. These tests will likely include the following:
Once your doctor has determined your current oxygen levels, they will be able to list your low oxygen saturation levels as the cause for a medical oxygen prescription. They can then prescribe the correct amount of supplemental oxygen for your needs.
What Does Medicare Cover For Portable Oxygen Concentrators
Medicare does cover medical equipment and oxygen devices but the key is they do not cover the cost to purchase this equipment outright. They cover a rental agreement where oxygen equipment can be rented to you monthly for a 36 month agreement. The problem for many suppliers is that in 2013 Medicare cut their reimbursement rates for oxygen equipment in half. So, a company would have to purchase the equipment upfront and get paid piece by piece over the next 3 year at a rate that might not be profitable for them.
Hence why we see many companies accept prescriptions for these saying they cover them but then only giving the patient oxygen tanks. They can bill the whole amount up front for supplies that are ordered each month like oxygen tanks and tubes. We often get told it is company policy to only allow a patient to get a portable oxygen concentrator when traveling long distance. One company told us they only allow a patient to have a portable oxygen concentrator for 3 days and they have to show that they are travelling out of town such that they would need it.
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B Durable Medical Equipment
Durable medical equipment like oxygen pumps are covered under Medicare Part B. Part B covers not only equipment but also many other outpatient services like doctor visits, lab testing, diagnostic imaging, medical supplies, and even outpatient surgeries.
In order for Medicare to cover your oxygen therapy, Medicare must prescribe the therapy for you and document why he believes it is medically necessary.
Usually, your doctor will conduct some testing to measure the level of gas in your blood. He can also document other therapies that you may have tried which have failed to improve your health.
For your part, you will need to use a Medicare-approved DME supplier when ordering your equipment. This not only meets Medicares rules but is also in your favor because Medicare has negotiated the lowest pricing possible with these vendors.
Will Medicare Cover My Portable Oxygen Concentrator
The answer to this question is sorta. Medicare has always paid a set amount towards medical oxygen equipment, however, in 2013 their reimbursement rate was reduced by 50%. Usually, durable medical equipment providers cover the cost of equipment up front and bill Medicare for it later, but this made it too expensive for most supplies to cover POCs.
Because it became increasingly difficult for respiratory suppliers to cover the expenses involved with providing portable oxygen concentrators to patients, many now opt to provider other, less expensive oxygen supplies instead. For example, an oxygen tank is way less costly than a POC. So, depending on your provider, you could have your POC fully or only partially covered.
If you own your own equipment, Medicare will help pay for oxygen contents and supplies for the delivery of oxygen upon meeting Medicare conditions including doctor recommendation, failing arterial blood gas level range and other alternative measures have failed. Medicare helps pay for systems for furnishing oxygen, containers that store oxygen, tubing and related supplies for the delivery of oxygen and oxygen contents, and in some cases Medicare may also pay for a humidifier.
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Look For A Financing Option
Youll find some oxygen suppliers offer a financing option that lets you spread the cost of purchase. This can be a good way to ease the financial burden while still knowing youll own the equipment once its paid off. If you want to go for a financing deal, be sure to check the small print and make sure you can comfortably afford the repayments.
Medicare/medicaid Portable Oxygen Guidelines
If you are eligible for Medicare, Medicare will help you cover the cost of your oxygen equipment and supplies only if you meet the following criteria:
- A chest examination that proves you have a severe lung disease and you have difficulty breathing in
- A doctors order that recommends your health will improve with the use of oxygen therapy and includes the following information such as full name, detailed description of all the oxygen equipment and accessories, how long you will need the oxygen equipment, and the date of the order
- You have below normal arterial blood gas
- Other alternatives to meet your oxygen needs failed
Hence, if you meet the above conditions, the coverage of oxygen equipment and supplies include the following:
- Containers that will store oxygen
- Systems that will provide oxygen
- Oxygen accessories such as tubings that will help in delivering oxygen
Make sure you have submitted properly and completed all the necessary paperwork and documents so that youll get approved for Medicare coverage Once you get the approval from Medicare, make sure you know what is the extent of the coverage, which you can read the details below.
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How Do I Qualify For Coverage
Lets 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 physicians 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 dont typically qualify for coverage under Medicare Part B.
- To qualify for coverage, Medicare may also require your doctor to show that youve 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.
Whats The Reality Of Medicare And Inogen Portable Oxygen
Although on paper Medicare covers oxygen equipment , the reality isnt nearly so straightforward.
Back in 2013, Medicare cut its reimbursement rates by 50%. Essentially that meant that many oxygen equipment suppliers simply couldnt afford their contract with Medicare anymore. The cost of supplying portable oxygen is higher than the reimbursement they get from Medicare, especially when you consider that they have to pay the cost of the equipment upfront and then bill Medicare later.
Medicare also implemented a competitive bidding program, so that companies with the lowest bids got the Medicare contracts. The result of all this? Finding a Medicare-approved oxygen supplier is difficult at best, and nearly impossible in some cases.
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Can I Change Homecare Providers To Get A Portable Oxygen Concentrator
Again, the answer is a bit complicated. Your Medicare oxygen benefit runs on a 5-year cycle. During the first 3 years, your homecare provider can bill Medicare the full benefit amount for your home and portable equipment. They receive about $125 per month for all oxygen equipment. During the final 2 years, they can only bill Medicare for the maintenance on the equipment, so they receive even less.
Any company that may provide a portable oxygen concentrator would need to take advantage of the full 5-year cycle in order to recoup enough cost to cover their expenses. Thus, they would need to be able to bill Medicare within the first couple months of your initial need for oxygen, or at the beginning of your next 5-year cycle. Timing is everything.
Also, keep in mind that oxygen equipment falls under Medicares competitive bidding which is geographic in nature. Most likely there are several homecare companies that have won the bid for your area and only those companies can bill Medicare on your behalf.
More About Oxygen Therapy
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.
Heres a list of some conditions that may require you to use occasional or continuous oxygen therapy at home:
- COPD
- sweating
- 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.
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How Much Will Medicare Pay For Portable Oxygen Concentrator
Renting Portable Oxygen Concentrator Equipment. If you qualify, Medicare helps pay for the systems that provide the oxygen, containers that store the oxygen, the tubing and other related supplies. Youll pay just 20 percent of the Medicare-approved amount, and this rule applies with many insurance policies, too.
Making Your Choice: The Pros And Cons Of Each Oxygen Delivery Device
In most cases, your choices will be narrowed for you based on your particular needs from your oxygen delivery device. Depending on the flow rate, dosing and times you will need to use oxygen therapy, some options may not work for you. However, generally speaking, there are some pros and cons you should consider when it comes to oxygen tanks versus oxygen concentrators. Before making your final decision, consider the following:
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How Does Equipment Rental Work
When you qualify for oxygen therapy, Medicare doesnt exactly buy the equipment for you. Instead, it covers the rental of an oxygen system for 36 months.
During that period, youre 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.
Final Thoughts On Medical And Oxygen Equipment
Medicare will cover a home oxygen concentrator through Medicares DME benefit. A patient needs the documentation of medical necessity from a doctor, as well as a Medicare-approved provider that is able to supply a concentrator on a long-term rental basis. The process can be very time-consuming, taking months before the patient sees their oxygen solution.
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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.
Q: What Happens To My Inogen Concentrator If Exposed To Covid
A: COVID-19 is a living virus. It needs living cells to replicate. Since there are no living cells within Inogen concentrators the virus will not thrive or grow. If exposed the virus may remain active for hours to several days. If you believe your concentrator to be contaminated please follow the cleaning and disinfection procedures contained within the Instructions for Use that came with your product. Refer to What if my unit gets contaminated question below for information on cleaning.
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