Does Medicare Cover Oxygen for COPD?

Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease that makes breathing difficult, often leading to shortness of breath and fatigue. For many individuals living with COPD, oxygen therapy becomes an important part of managing their condition. Medicare offers coverage for oxygen therapy, providing financial assistance for this necessary medical treatment.

Medicare Coverage Criteria for Oxygen Therapy

Medicare generally covers oxygen therapy as Durable Medical Equipment (DME) under Medicare Part B, which addresses outpatient care and medical supplies. For oxygen therapy to be covered, a physician must determine it is medically necessary for the treatment of a severe lung disease, such as COPD. This determination requires specific medical documentation and test results to demonstrate a genuine need for supplemental oxygen.

A core requirement for coverage involves specific blood oxygen levels. Medicare typically covers oxygen therapy if an arterial partial pressure of oxygen (PaO2) is at or below 55 mm Hg, or if oxygen saturation is at or below 88%. These measurements are usually taken while the individual is at rest and breathing room air. Testing might also include measurements taken during exercise or sleep if desaturation occurs under those conditions.

The physician’s prescription must include a detailed medical necessity determination, often supported by qualifying blood gas studies. This documentation should also confirm that other treatment measures have been tried or considered and deemed ineffective. The patient’s condition must be chronic and severe enough to warrant ongoing oxygen therapy for use in the home environment.

Initial coverage may be limited to a specific period, such as 3 or 12 months, depending on the patient’s qualifying criteria. For continued coverage, periodic re-evaluations by the physician may be required to confirm the ongoing medical necessity of the oxygen therapy. The oxygen equipment must be for use in the home, though Medicare’s rules generally allow for mobility within and outside the home with the covered equipment.

Types of Oxygen Equipment Covered

Medicare typically covers various types of oxygen delivery equipment once the medical necessity criteria are fulfilled. These devices are classified as Durable Medical Equipment (DME) and are intended for home use. The aim is to ensure beneficiaries receive the specific equipment best suited to their individual medical needs and lifestyle.

Oxygen concentrators, which extract oxygen from the air, are commonly covered. These include both stationary units for continuous home use and portable oxygen concentrators (POCs) that offer mobility. Compressed oxygen tanks, available in various sizes for both stationary and portable use, are also covered. Another option includes liquid oxygen systems, which store oxygen in a highly concentrated, liquid form, providing a compact and often more mobile solution.

Beyond the primary oxygen delivery devices, Medicare also covers necessary accessories and supplies. This includes items such as tubing, masks, cannulas, and humidifiers, which are essential for the safe and effective use of oxygen therapy. These related supplies ensure the complete system functions properly and meets the patient’s therapeutic requirements.

Medicare’s policy for oxygen equipment typically involves a rental agreement rather than outright purchase. Beneficiaries rent the equipment from a Medicare-approved supplier for an initial period, usually 36 months. During this rental period, the monthly payments from Medicare cover the equipment, oxygen contents, and necessary maintenance and repairs. After the 36-month period, the supplier must continue to provide and maintain the equipment for the remaining useful life of the device, which is generally five years from the start of the rental.

Understanding Your Costs for Oxygen Therapy

Beneficiaries receiving Medicare-covered oxygen therapy typically have financial responsibilities under Medicare Part B. These costs are a standard component of Medicare’s coverage for Durable Medical Equipment (DME). Understanding these out-of-pocket expenses is important for financial planning related to ongoing therapy.

Before Medicare begins to pay for services, beneficiaries must first meet the annual Medicare Part B deductible. For 2025, this deductible is $257. Once the deductible has been satisfied, Medicare typically pays 80% of the Medicare-approved amount for oxygen equipment and supplies. The beneficiary is then responsible for the remaining 20% coinsurance.

This 20% coinsurance generally applies throughout the initial 36-month rental period for oxygen equipment. During this time, the monthly rental payments cover the equipment, oxygen contents, and maintenance. Even after the 36-month rental period concludes and the supplier continues to provide the equipment, the 20% coinsurance may still apply to payments for maintenance, servicing, and any necessary oxygen contents if tanks or cylinders are used.

For individuals enrolled in a Medicare Advantage (Part C) plan, the costs for oxygen therapy may differ from Original Medicare. Medicare Advantage plans are required to offer at least the same coverage as Original Medicare Parts A and B, but they may have different cost-sharing structures, such as varying deductibles, copayments, or coinsurance amounts. Beneficiaries with these plans should consult their specific plan documents for details. Additionally, Medigap policies, which are Medicare Supplement Insurance plans, can help cover some or all of the out-of-pocket costs, including the Part B deductible and coinsurance.

Obtaining Oxygen Therapy through Medicare

Obtaining Medicare-covered oxygen therapy begins with securing a detailed prescription and comprehensive medical documentation from a treating physician. This documentation must substantiate the need for oxygen therapy, including relevant test results and clinical notes.

Once the medical necessity is established, beneficiaries must select a Durable Medical Equipment (DME) supplier that is enrolled in Medicare and accepts Medicare assignment. This ensures the supplier agrees to accept the Medicare-approved amount as full payment, limiting potential out-of-pocket costs for the beneficiary. Medicare provides resources, such as its website, to help individuals locate approved suppliers in their area.

The chosen supplier will handle the billing directly to Medicare, submitting claims for the rental of the oxygen equipment and associated services. Upon approval, the supplier will arrange for the delivery and setup of the equipment in the patient’s home. They are also responsible for providing thorough instructions on how to use, clean, and maintain the equipment safely and effectively.

Ongoing medical necessity for oxygen therapy may require periodic re-evaluations and updated documentation from the physician. The supplier also has an obligation to provide necessary oxygen contents, maintenance, and repairs for the duration of the coverage period, which is generally a five-year cycle.