When Is Home Oxygen Prescribed
Your doctor may prescribe home oxygen if you have a medical condition that reduces blood oxygen levels. This is known as hypoxemia.
Symptoms of hypoxemia include:
- A pale or blueish tint to the lips and skin
- Fast breathing or shortness of breath
- Increased heart rate
A wide array of health conditions may cause hypoxemia, including:
- Chronic obstructive pulmonary disease
- Cystic fibrosis
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.
Medicare And Oxygen Tanks: Does Medicare Cover Oxygen Therapy
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Oxygen tanks are equipment used as part of oxygen therapy, a type of treatment for various health conditions such as COPD, heart failure, and others.
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Medicare Part B will cover oxygen equipment if it is deemed medically necessary. That said, it will not cover all types of oxygen tanks.
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Medicare Advantage plans will also cover oxygen therapy, though overall costs and rules may differ from Original Medicare plans.
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Oxygen equipment and supplies will be paid for on a rental basis. If a Medicare beneficiary already owns oxygen equipment, Medicare will help pay for oxygen supplies and delivery.
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Medigap plans may help reduce out-of-pocket expenses by paying deductibles, copayments, coinsurance, etc.
Sometimes, the use of an oxygen tank may be necessary for certain health conditions. But will Medicare cover oxygen tanks? Yes, Medicare covers the use of an oxygen tank and accompanying medical supplies. That said, there are rules and stipulations in place for how much and if Medicare will cover oxygen therapy.
This resource will explain everything Medicare beneficiaries need to know about Medicare and oxygen tanks, including rules, regulations, costs, and more.
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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.
Medicare Advantage Plans Can Cover Oxygen Concentrators
Medicare Advantage plans cover all the same benefits as Original Medicare and may also offer additional coverage for things like dental, vision, prescription drugs and more.
One of extra benefits that may be included in some Medicare Advantage plans is air conditioners for people who have asthma. If you have asthma and have a Medicare Advantage plan, you could potentially have both an oxygen concentrator and an air conditioner covered by your plan.
Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!
About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles hes written, helping Americans better understand their health insurance and Medicare coverage.
Christians work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
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Warranty Length And Type Of Coverage
Warranties vary among manufacturers of portable oxygen concentrators, both in terms of length and what they cover. One thing to ask about is when the warranty starts. Some companies begin their warranty on the date the unit is put on a stores shelves , not when it arrives at your house.
For example, if a portable oxygen concentrator has been sitting on the shelf for three months before you buy it, you may have lost three months of your warranty. Other companies dont start the warranty period until you purchase the unit, and this is obviously better for you as the customer.
Why You Can Trust Our Expert Review
Our Reviews Team recommends products and services we believe provide value in the lives of our readers. Weve spent more than 1,000 hours carrying out in-depth research on portable oxygen concentrators to give you the most accurate review. To make our selections, we:
- Engaged in independent research
- Consulted with three geriatric care experts
- Mystery shopped four brands and five models of portable oxygen concentrators
- Reviewed academic research into the efficacy of portable oxygen concentrators
- Read verified customer reviews from trusted third parties such as the Better Business Bureau and Trustpilot
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Getting Oxygen Equipment Covered After Qualifying For Medicare
Once you determine your eligibility, you will need to find a Medicare-approved supplier of oxygen and apply with them to determine what your total costs will be. If you are wondering, why wont Medicare pay for oxygen concentrators in full?, the answer is that Medicare rarely covers 100% of your medical bills. As the leading health insurer for people 65 and older, providing this coverage is expensive, and the funding comes from taxpayers. However, Medicare usually covers part of your medical expenses if you qualify.
If the conditions above are met, Medicare will cover up to 80% of the cost for the rental of oxygen equipment from an approved oxygen supplier for 36 months. This includes the oxygen delivery system, any required oxygen storage containers, tubing and other related oxygen accessories required to deliver the oxygen to the patient. Oxygen machine maintenance, servicing and repair costs can also be included for a portable oxygen concentrator covered by Medicare. You will still pay 20% of the Medicare approved cost for your oxygen supplies, and your Part B deductible will still apply if you have one.
What Happens If My Oxygen Supplier Goes Out Of Business Or Leaves The Program During My Rental Period
Suppliers leaving the program must give you a 90-day notice in writing, telling you that they can no longer provide oxygen therapy services. This notice must be one of these:
- A letter notifying you of their intent to stop oxygen therapy services, including the date when theyll stop services.
- A letter to a new supplier youve chosen, transferring responsibility for oxygen therapy services to the new supplier on a specific date.
Work with your supplier to find a new oxygen supplier in your area, and request that they send a letter to the new supplier on your behalf. This will ensure youll have continuous service and your medical records will be transferred to the new supplier within 90 days.
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How Does Oxygen Equipment Rental Work Under Medicare
Medicare beneficiaries who use oxygen will need to rent oxygen equipment from a supplier for 36 months. After this 36-month rental period, the oxygen supplier must continue to supply the beneficiary with oxygen equipment and supplies for an additional 24 months. In total, the DME supplier must provide supplies for a total of five years, so long as the medical need for oxygen persists.
The supplier will bill Medicare a monthly rental payment. These rental payments cover more than just the oxygen equipment, however. The rental payments also go towards:
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Tubing or a mouthpiece
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Oxygen machine repairs
Our Reviews Teams Customer Service Experience
A member of our Reviews Team called the Oxygen Concentrator Store to learn more information about all of the brands and models in this list. It took less than 30 seconds to get a representative on the line, and he was friendly, helpful, and knowledgeable about every model we asked about.
He shared that all of the portable oxygen machines sold through Oxygen Concentrator Store come with a free seven-day trial period. If you find the unit youve purchased has mechanical problems, is hard to use, or just isnt a good fit for you, simply call the store to receive a shipping label. Then you can send the unit back and exchange it for a different one.
Shipping takes about three to five business days, but Oxygen Concentrator Store also offers two-day and overnight shipping.
After sharing details of the various models over the phone, the representative offered to email the information as well and gave us his direct phone number for any future questions.
He also said even if we didnt buy a unit from Oxygen Concentrator Store, he would be happy to answer questions and provide help in the future. We were very pleased with the customer service experience it felt like we were learning about portable oxygen concentrators rather than enduring a high-pressure sales call.
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What Type Of Portable Oxygen Concentrator Is Best
Portable oxygen concentrators are not one size fits all. Your oxygen needs, lifestyle, and budget will all affect which device is the best choice for you. A few of the most reliable portable oxygen concentrators that have received the best customer reviews include the Inogen One G4 and G5, and the Invacare Platinum.
What Durable Medical Equipment Does Medicare Cover
Medicare covers a wide variety of durable medical equipment. Covered items include :
- Blood sugar monitors and test strips
- Canes, crutches, and walkers
- Manual wheelchairs and power mobility devices when required inside the home
- Nebulizers and CPAP
- Pressure reducing beds and mattresses
Medicare.gov provides a more comprehensive list of covered DME.
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Will Medicare Cover Oxygen Equipment
Yes, Medicare covers oxygen equipment and its accessories under Part B. Your coverage allows you to rent from a supplier for 36 months with continued supplies for a total of five years, as long as you have a medical need for oxygen. Medicare will help pay for oxygen, contents and supplies if you own your oxygen equipment and meet certain medical requirements.
Qualifying For Medical Oxygen
Not everyone who is short of breath needs supplemental oxygen. However, if your oxygen levels show that you are chronically hypoxemic, meaning you have a long-term, insufficient supply of oxygen in your blood, you are probably a good candidate.
In order for Medicare to pay for oxygen and the additional supplies needed to administer it, you must have Medicare Part B coverage.
If your healthcare provider thinks you would benefit from home oxygen, you’ll want to follow the steps as outlined by Medicare. Before calling the oxygen supply company, make sure you have a practitioner for the home oxygen equipment and supplies you’ll need, from the oxygen concentrator all the way down to the tubing. If you don’t have a practitioner’s order, Medicare won’t cover the supplies. Make sure your prescription is signed and dated by your medical professional.
Once that is set, make sure your healthcare provider has documented your need for oxygen in your medical record. Medicare will request your records before approving your home oxygen, and if your condition is not well-documented, they may deny your claim.
Make sure that your oxygen supply company has the order in hand before billing Medicare. They must also keep the order on file.
Your likelihood of being approved increases if you have:
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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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Medicare Oxygen Therapy Guidelines For 2022
Home / FAQs / Medicare Coverage / Medicare Oxygen Therapy Guidelines for 2022
Medicare coverage for oxygen therapy is available when your doctor prescribes it to treat a lung or respiratory condition. Oxygen therapy can serve as a source of relief for those with severe asthma, COPD, emphysema, or other respiratory diseases. Medicare covers oxygen therapy in a hospital or at home when you meet specific criteria. Below we discuss the requirements necessary to qualify for oxygen supplies.
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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!.
Home Oxygen Therapy & Medicare Advantage Plans
Medicare Advantage plans, also known as Medicare Part C or MA plans, may include prescription drug benefits. MA plans are a type of Medicare supplement plan and are provided by private insurance companies that are Medicare-approved. Medicare Part C plans consist of the standard Medicare coverage , in addition to other healthcare benefits including vision, hearing, and prescription drugs. Exact benefits will vary per plan. MA plan beneficiaries should confirm extra benefits with their insurance company.
Because MA plans include Medicare Part B, this means that oxygen tanks would be covered under an MA plan as durable medical equipment. Exact costs will vary.
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Home Oxygen Therapy & Medicare Supplement Plans
Medicare supplement insurance, also known as Medigap or MedSupp, are supplemental Medicare plans that help fill in the gaps of Original Medicare.
Medigap policies are sold by private insurance companies and help pay some out-of-pocket costs such as deductibles, coinsurance, and copays. This means a Medigap plan may help reduce costs for oxygen therapy and equipment.
Note: Learn more about Medigap plans at this resource.
What Else Is Covered By Medicaid
Aside from the equipment or the oxygen concentrator, you will be covered for a few other things, such as:
- Tubing or the mouthpiece
- Oxygen machine maintenance and repair.
All of this assumes that your Medicaid will fund the rental of an oxygen concentrator or equivalent device. In very rare situations, people with dual Medicaid and Medicare coverage may be entitled to purchase the equipment.
Again, this is subject to local rules and restrictions, so you must verify online and contact the reps for additional information.
Children, pregnant women, and the elderly are always regarded as the most vulnerable members of society, and they are usually covered for all expenditures.
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Which Is Better: An Oxygen Tank Or Oxygen Concentrator
Portable oxygen concentrators can cost a few thousand dollars, and patients often have to foot that bill out of their own pockets since Medicare doesn’t cover them. POCs also need to be powered by a battery or a connection to an electrical outlet, so you do have to plan for using one to maximize benefits such as flexibility and mobility.
Oxygen tanks are covered by Medicare, drastically reducing your out-of-pocket expenses . But they’re less flexible and can reduce your mobility.
Ultimately, you’ll need to weigh your own needs and budget to decide which option is right for you.
Do Medicare Benefits Include Dme
Whether you need short-term or long-term support, durable medical equipment is covered under your Original . Youll need a prescription from your doctor to access coverage to rent or buy eligible equipment. Youll be responsible for 20% of the Medicare-approved amount for the device, and Medicare Part B should cover 80%, as long as youve met your deductible.2
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Does Medicare Cover Oxygen
Original Medicare Part B covers oxygen and equipment for use at home, although certain conditions apply. Part A covers oxygen therapy during an inpatient stay.
If someone has a lung disorder, such as severe chronic obstructive pulmonary disease , a heart problem, or asthma, they may need oxygen therapy.
In the United States, more than 1.5 million adults use oxygen therapy to help them breathe more easily, sleep better, and lead a more active life.
In this article, we look at Medicares coverage of oxygen equipment, supplies, and therapy. We then discuss the types of equipment and supplies, eligibility and costs, and alternative therapies.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
If someone has original Medicare, Part B covers the cost of outpatient health needs, such as durable medical equipment , that a doctor deems medically necessary. Medicare includes oxygen equipment and accessories in the DME classification.
