Medicare recipients may have coverage for oxygen devices they need. Medicare Part B (Medical Insurance) includes coverage for medically necessary services and supplies, including benefits for durable medical equipment (DME). DME includes a wide range of medical equipment, including oxygen supplies, such as the systems, storage containers, tubing and associated accessories needed to transport the oxygen. However, there are several prerequisites that may determine specific coverage.
Requirements for Medicare Coverage
To qualify for coverage of the apparatus needed for oxygen fulfillment, your physician must attest to the medical necessity of your equipment, certifying that the severity of your lung disease demands assistance. Additionally, the doctor must state that the oxygen therapy is expected to improve your health. If your arterial blood gas level drops below a set range, your physician may order oxygen equipment once other options have been explored but have been unsuccessful.
You may choose to rent or purchase the DME you require, but must use a Medicare-approved supplier who accepts assignment and is currently participating in Medicare.
Out-of-pocket Expenses for DME
Once your DME has been approved, Medicare recipients with Original Medicare can expect to pay 20% of the approved amount plus the deductible for Part B. If you have Medicare Advantage or a Medicare supplement plan, otherwise known as Medigap, check with your plan administrator for any additional coverage that may apply.
The equipment rental period is stipulated for 36 months. If another 24-month period is deemed medically necessary, the vendor must continue providing the accouterments and accompanying materials up to five years. The auxiliary items and services covered include the tubing or mouthpiece as well as the oxygen contents, machine maintenance, servicing and repairs.
For the five-year period, the supplier is obligated to ensure the oxygen provisions are maintained and is prohibited from billing you for maintenance services. When the tanks or cylinders need to be refilled, Medicare monthly payments cover delivery of the contents, but Medicare recipients may continue to be responsible for the 20% portion of the Medicare-authorized amount. If this need extends beyond the five-year term, the supplier is no longer bound to continue these services, but you are free to select an alternate vendor. The five-year cycle then begins anew with the successor service provider.
To gauge how the charges may vary for you personally, discuss with your health care practitioner, review your other insurance coverage if applicable, find out your physician’s fees, confirm if your physician accepts assignment, and factor in the type of medical facility and source of the items and services.
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