Does Medicare Cover Home Oxygen Therapy?

Home oxygen therapy helps individuals with respiratory conditions maintain adequate oxygen levels, improving quality of life. Understanding how federal health insurance programs, particularly Medicare, cover this essential medical support is important for patients.

Medicare Part B Coverage for Home Oxygen Therapy

Medicare Part B, which is medical insurance, covers home oxygen equipment and related supplies. This includes various types of oxygen equipment such as oxygen concentrators, oxygen tanks, and liquid oxygen systems. The coverage extends to the necessary supplies that facilitate the therapy, like tubing, cannulas, and masks.

Medicare also covers services associated with the equipment, including its delivery, set up, and any necessary maintenance and repairs. While Part B covers these items, the approval for coverage is contingent on a physician determining that the therapy is medically necessary for the patient’s condition.

Medical Necessity and Documentation Requirements

Obtaining Medicare coverage for home oxygen therapy requires adherence to medical necessity criteria. A physician must certify that the patient has a severe lung disease or other medical condition causing hypoxemia, which is low oxygen levels in the blood. This determination involves specific arterial blood gas levels (PaO2 at or below 55 mm Hg or SaO2 at or below 88% on room air at rest) or oximetry readings taken at rest, during exercise, or during sleep.

The treating physician prescribes and certifies this medical necessity. They must provide a detailed written order (DWO) for the oxygen equipment and supplies, outlining the prescribed flow rate and duration of use. This order serves as a foundational document for Medicare coverage.

Beyond the detailed written order, medical records supporting the diagnosis and oxygen levels are required. These records must demonstrate the patient’s qualifying condition and test results that confirm the need for oxygen therapy. A Certificate of Medical Necessity (CMN) form, Form CMS-484, must also be completed by the physician.

The CMN must include the patient’s diagnosis, the date of medical necessity, the prescribed oxygen flow rate, and the estimated duration of need. Accurate and complete documentation is crucial, as any missing or incorrect information can lead to delays or denial of coverage.

Selecting a Supplier and Understanding Costs

When seeking home oxygen equipment, choose a supplier that is enrolled in Medicare and accepts Medicare assignment. This ensures that the supplier agrees to accept the Medicare-approved amount as full payment for the equipment and services. Beneficiaries can find enrolled suppliers through Medicare’s official website or by contacting their current healthcare providers for recommendations.

Medicare Part B covers 80% of the Medicare-approved amount for durable medical equipment, including home oxygen. After meeting the annual Part B deductible, beneficiaries are responsible for a 20% coinsurance. This cost-sharing applies to the rental or purchase of the oxygen equipment and associated supplies.

Medicare has specific rules regarding the rental versus purchase of oxygen equipment. Medicare pays for the rental of oxygen equipment for 36 months. After this 36-month rental period, the supplier must continue to provide the equipment and any necessary supplies and maintenance for an additional 24 months.

While Original Medicare follows these specific cost-sharing and rental rules, Medicare Advantage (Part C) plans may have different cost structures. These plans are offered by private companies approved by Medicare and must cover at least everything that Original Medicare covers. However, they can have different deductibles, copayments, and coinsurance amounts, so check the specific plan details.

The Process for Receiving Home Oxygen

Once medical necessity has been established and all required documentation is in place, the process for receiving home oxygen therapy moves to the practical steps of equipment acquisition and ongoing management. The physician’s detailed order and supporting medical records are submitted to the chosen Medicare-approved supplier. This allows the supplier to verify coverage and prepare for equipment delivery.

The supplier will then schedule the delivery and setup of the oxygen equipment at the patient’s home. During this visit, they typically provide instructions on how to properly use and maintain the equipment, ensuring the patient understands its operation and safety precautions. This initial setup is an important step in integrating the therapy into daily life.

Ongoing follow-up requirements are an integral part of continued Medicare coverage for home oxygen. Patients will typically need periodic physician visits to re-evaluate their condition and the ongoing medical necessity for oxygen therapy. These re-evaluations ensure that the therapy remains appropriate and effective for the patient’s current health status.