Without proper oxygen levels, breathing can become severely impacted. Because there are many lung diseases and other medical conditions that can affect the body’s oxygen levels, treatment varies based on the cause of the problem. For some people, breathing exercises, weight loss and other lifestyle changes can help. For others, including those with conditions like asthma, medications may be required to correct oxygenation concerns. Still, for others, oxygen delivery through artificial means is required.
The Use of Oxygen Equipment
If you are prescribed the use of medical supplies to artificially supplement the body with oxygen, you may have to use portable, refillable oxygen tanks and oral or nasal delivery systems. Modern oxygen tanks are lightweight and can often travel with a person using a tank that can be carried or mounted on a rolling case.
These types of systems typically supply a specific amount of oxygen, but many can be adjusted to fit the needs of the user. Oxygen tanks are not used to open blocked airways or to assist in breathing that is hindered by blockages. Instead, oxygen delivery equipment is used to supply pure oxygen for people whose lungs have a hard time leeching it out of the air that they breathe naturally.
Does Medicare Cover Oxygen Supplies?
While lung diseases requiring oxygen supplies can affect people of all ages, older Americans tend to be affected by these conditions more than younger people. Some conditions, including emphysema, may require long-term use of oxygen supplies. Others, including hypoxemia after being discharged from a hospital facility following a cardiac incident, may only require the use of oxygen supplies for a short period of time. This is why Medicare coverage offers benefits for oxygen supplies in several different ways.
At-Home Oxygen Supplies
If you are prescribed the use of oxygen supplies for use at home, Medicare Part B will provide coverage if certain conditions are met. Included in these conditions is the requirement that the oxygen is considered medically necessary and that you have been diagnosed with a severe lung disease. You may also have to have arterial blood gas levels that fall within a certain range to be considered eligible for coverage.
Under Medicare coverage provided through Part B, oxygen supplies are considered durable medical equipment (DME). This equipment is covered at a rate of 80% by Medicare, leaving the remaining 20% to be paid for by the recipient. Medicare coverage applies to delivery systems, oxygen containers and masks and tubing used to connect oxygen systems and tanks.
Inpatient Oxygen Supplies
If you require the use of oxygen while admitted to a hospital or skilled nursing facility, Medicare still supplies coverage, but benefits are provided through Part A, the inpatient portion of the program. In order to qualify for coverage, oxygen must be supplied by and administered by the facility’s staff. If oxygen is administered by an outside provider who is servicing the facility, separate billing under Part B may apply.
Inpatient care is covered for a total of 60 days at 100% per benefit period. After 60 days, an additional 30 days of coverage are available at a discounted rate. Beyond 90 days, inpatient care will only be covered by Medicare at a discount if you have lifetime reserve days available to utilize. Care beyond any lifetime reserve days will be billed at full cost.
Medicare Advantage and Oxygen Equipment Coverage
Medicare Advantage plans must provide at least the same coverage as Original Medicare, but MA plans may offer additional benefits. Medicare Advantage plans may also offer coverage for oxygen and other supplies within a network of equipment suppliers you will need to use. This will depend on your plan and plan provider as well as the state in which your plan is issued.