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Does Medicare Cover Home Oxygen Equipment and Supplies?
Medicare will help cover most of the cost of home oxygen equipment and supplies if you have a breathing condition that it will help improve. Medicare payment for oxygen equipment and supplies is subject to the requirement that it is necessary and reasonable for treatment of an illness or injury and/or to improve the functioning of the patient. To ensure that Medicare pays for oxygen equipment and supplies, you must follow the steps below:
- Only your doctor can prescribe oxygen equipment and supplies for you, so do not order anything until you have visited your doctor, no matter what the sales person tells you.
- The doctor must document the need by writing information in your medical records and by giving you a signed and dated order (prescription) for it.
- The order must be received by the supplier before Medicare is billed and it must be kept on file by the supplier.
If you receive your Medicare through a Medicare Advantage Plan (like an HMO or PPO) it is likely you will have to follow the plan's steps for approval and purchase. Make a point of calling your plan's customer service number and ask about their steps for coverage for oxygen equipment and supplies.
How Do I Qualify for the Coverage for Home Oxygen Equipment and Supplies?
You must have Medicare Part B coverage and your doctor must have documented your need for oxygen equipment and supplies. The doctor must also write you an order (prescription) for the equipment. Your doctor will know what is necessary to qualify for the type of oxygen equipment and supplies prescribed for you. Medicare will pay for the oxygen equipment and supplies when:
- It will be used repeatedly
- It is needed for a medical purpose
- It is needed for an illness or injury
- It is for use in the home
To qualify for oxygen equipment and supplies:
- Your doctor must document a severe lung disease or other condition that interferes with your ability to breathe
- Your condition might improve with the use of oxygen
- Your blood gas level falls within a certain range
- Other alternative measures were not helpful for you
Under the above conditions, Medicare helps pay for:
- Systems for furnishing oxygen
- Containers that store oxygen
- Tubing and related supplies for the delivery of oxygen
- Oxygen contents
- Portable oxygen units when used to move around the home
Medicare will not pay for:
- Portable oxygen for use during sleep only
- Portable oxygen when provided only as a backup to a stationary oxygen system
Cost Associated With Oxygen Equipment and Supplies
How much you pay will depend on whether or not you have Part B coverage and where you buy your equipment. Basically, if you are enrolled in Medicare Part B:
- You will pay 20% of the approved Medicare amount, after you have paid your yearly deductible.
- You will pay less if you buy from a supplier who accepts assignment. A supplier who accepts assignment has agreed to charge only the Medicare-approved amount.
- You may owe little to no money for your equipment and supplies, if you have a Medigap/Medicare Supplemental plan).
- You may be restricted on who you can go to for service if you receive your service through a Medicare Advantage Plan. You should contact that plan for details.
The monthly allowance for stationary oxygen equipment covers the oxygen equipment; oxygen contents including all refills for stationary and portable systems; equipment delivery, setup, and maintenance; accessories and supplies; patient education and other services associated with furnishing home oxygen. Medicare pays an additional amount for portable equipment that a beneficiary rents to provide mobility in the home. Typically, beneficiaries rent both stationary and portable units.
Medicare will pay for oxygen as a rental for the first 36 months. After that time if you still need the equipment and all your deductible and copays are met, the supplier will continue to own the equipment. Your supplier will supply the oxygen equipment and related supplies for 2 additional years (5 years total), as long as oxygen is still medically necessary.
It is important to do your homework. Read about the factors that affect how much coverage you will receive. Make sure all paperwork is completed correctly and that you buy your equipment through an approved supplier that accepts assignment.
Where Do I Buy the Oxygen Equipment and Supplies?
You will save money if you order from a Medicare-approved provider. You may also buy your oxygen equipment and supplies from any store that sells them. Keep in mind that if the supplier from which you order is not enrolled in Medicare, Medicare will not pay for the equipment and supplies. Things you should think about before you choose a supplier:
- There are two types of Medicare suppliers: participating suppliers, and those who are enrolled but have chosen not to participate.
- Participating suppliers must accept assignment, and they agree not to charge more than the Medicare approved.
- A Medicare approved supplier who does not want to participate can charge more than the Medicare-approved amount. However, they cannot charge more than 15% above the Medicare-approved amount. They may also ask you to pay the entire bill when you pick up the equipment. In this situation Medicare will send the reimbursement directly to you. However, be prepared to wait; it may take a couple of months to receive payment.
- If you receive your Medicare coverage through a Medicare Advantage Plan (like an HMO or PPO), it is likely that the plan will have its own steps for equipment purchases. In addition, the plan may have restrictions on the supplier from which you can buy. It is important to know that your health plan must supply at least what Medicare covers -- they cannot supply less. Depending on your plan you may actually receive more coverage than you would get with Medicare alone. It is wise to call your Medicare Advantage Plan's customer service and ask about your coverage before you order any oxygen equipment and supplies.