People living with breathing disorders such as COPD, asthma, lung disease, cystic fibrosis, sleep apnea, or pneumonia may have difficulty absorbing enough oxygen through their lungs. For them, getting oxygen therapy may mean improving their quality of life, or even surviving.
Your health care provider may prescribe oxygen therapy if you are experiencing shortness of breath, coughing or wheezing, rapid or shallow breathing, a fast heart rate, or changes in the color of your skin.
Because oxygen therapy has been proven to provide relief in these situations, it is vital for you to have all the details about whether your Medicare coverage includes oxygen, if you are eligible, and what to expect from oxygen therapy.
Medicare Coverage of Oxygen
Medicare classifies the coverage of oxygen under the category of durable medical equipment. It is included in Medicare Part B (Medical Insurance). Medicare assists with payment for oxygen, equipment, supplies, and delivery if you meet the following criteria:
• Your physician prescribes oxygen for you to use at home.
• Your physician confirms that you are not getting enough oxygen due to a
severe lung disease.
• Oxygen therapy may improve your health.
• Your arterial blood gas levels are in a certain range.
• You have tried other types of treatment that have failed.
If you qualify, your coverage includes the systems that provide oxygen, the oxygen storage containers, tubing, accessories that are necessary for oxygen delivery, and the oxygen contents. If you use a humidifier with your oxygen machine this may also be paid for with your Medicare benefits.
You are responsible for paying 20% of the Medicare-approved amount. The Part B deductible of $185.00 (as of 2019) applies.
Getting Equipment for Oxygen Therapy
If your physician prescribes oxygen and you have Medicare Part B coverage, you can rent the oxygen equipment from a supplier for 36 months. When the initial 36-month period ends, and you still required oxygen, your supplier will provide all the equipment and supplies for 24 months longer.
If you have a medical need that exceeds these two periods of time, your supplier is obligated to provide the equipment and supplies for up to five years. The following items are included in the monthly rental payment to the supplier:
• Oxygen equipment
• Tubing and mouthpiece
• Oxygen contents
• Machine maintenance
• Machine service and repairs
If you own your own oxygen equipment, your Medicare coverage pays for the oxygen contents and any necessary supplies for the delivery. You are responsible for paying 20 percent of the Medicare-approved final amount as well as your Part B deductible.
If you continue oxygen therapy for an extended period, you might have special circumstances to consider. For example, if you move to a new location and need a new supplier, or if your usual supplier goes out of business. You won’t lose your coverage, but you need to discuss the details with your health care provider and inform Medicare of the changes.
The Costs of Oxygen Therapy With Medicare Coverage
It is difficult to calculate the exact cost of at-home oxygen therapy because it depends on factors like location, the type of machine, and what accessories are included. But looking at the U.S. average cost for weekly rental, a portable oxygen concentrator costs approximately $210.00 excluding the additional costs for tubing and other accessories. On a daily basis the cost is approximately $35.00.
Your doctor may prescribe supplemental oxygen therapy to help increase the level of oxygen in your blood. Scientists have found that using oxygen therapy for certain conditions also reduces stress on the heart, improves tolerance for exercise, improves brain function, and improves quality of life.
Be sure to discuss all your health care options and concerns with your doctor before making any decisions about your care.
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