Does Medicare Pay for Home Oxygen?

Home oxygen therapy is an important part of managing chronic conditions, enhancing daily living, and improving overall health for many individuals. Understanding how Medicare covers this therapy is crucial for beneficiaries to navigate their healthcare journey effectively.

Medicare Coverage Criteria for Home Oxygen

Medicare Part B covers home oxygen equipment and supplies as durable medical equipment (DME) when a physician deems it medically necessary for use in the home. This coverage applies to individuals with severe lung disease or hypoxemia requiring supplemental oxygen. The need for oxygen must be chronic, not temporary. Medicare requires specific blood gas levels to establish medical necessity, such as an arterial partial pressure of oxygen (Pao2) at or below 55 mm Hg, or an arterial oxygen saturation (SpO2) at or below 88%, measured at rest while breathing room air.

Medicare covers various types of home oxygen equipment, including stationary oxygen concentrators, which extract oxygen from the air, and oxygen tanks, which store compressed gas. Liquid oxygen systems are also covered, providing a more concentrated form of oxygen. Medicare Part B also covers related supplies and accessories such as tubing, masks, and humidifiers, essential for safe and effective delivery. Portable oxygen concentrators may also be covered if documentation demonstrates a medical need for mobility and oxygen desaturation during activity.

Steps to Obtain Home Oxygen Coverage

Securing Medicare coverage for home oxygen therapy begins with a written order from your prescribing physician. This order must specify the oxygen flow rate, duration of use, and state the medical necessity for the therapy. Prescriptions for “oxygen as needed” do not meet Medicare’s requirements for coverage.

Diagnostic tests are required to confirm the medical need for oxygen, including arterial blood gas studies or pulse oximetry, performed while the patient is in a stable state. For initial certification, these tests must be conducted within 30 days prior to the certification date, or within two days prior to discharge if oxygen is prescribed at hospital discharge. The physician and oxygen supplier submit necessary documentation to Medicare, often including a Certificate of Medical Necessity (Form CMS-484), to initiate coverage.

Once initial coverage is established, continued medical need must be periodically recertified. While the initial coverage period can be 90 days for certain acute conditions, recertification is required after 12 months. This process involves the physician confirming that oxygen therapy remains reasonable and necessary based on the patient’s medical records.

Understanding Your Costs

Beneficiaries with Original Medicare have financial obligations for home oxygen therapy. Medicare Part B covers 80% of the Medicare-approved amount for oxygen equipment and supplies, after the annual Part B deductible has been met. For 2025, the Medicare Part B deductible is $257. After meeting this deductible, the beneficiary is responsible for the remaining 20% coinsurance.

Medicare covers oxygen equipment on a rental basis rather than through direct purchase. The initial rental period lasts for 36 months. During this period, monthly rental payments to the supplier include the oxygen equipment, accessories, and services like maintenance and repairs.

After the 36-month rental period, if the medical need for oxygen continues, the supplier must continue providing the equipment and all related supplies for an additional 24 months, totaling five years. During this additional 24-month period, the supplier cannot charge for the equipment itself, though coinsurance may apply for the delivery of gaseous or liquid oxygen contents. If the medical need persists beyond five years, a new 36-month rental cycle and a new five-year supplier obligation period will commence.

Selecting a Supplier and Ongoing Management

After medical documentation and eligibility criteria are established, selecting a Medicare-approved oxygen supplier is the next step. Beneficiaries can locate approved suppliers by visiting Medicare.gov or by calling 1-800-MEDICARE. Confirm that the chosen supplier accepts Medicare assignment, meaning they agree to accept the Medicare-approved amount as full payment for services.

A Medicare-approved supplier is responsible for delivering the oxygen equipment to the beneficiary’s home and providing proper setup. They handle routine maintenance, servicing, and repairs of the equipment throughout the coverage period. Suppliers also provide emergency services and ensure a consistent supply of oxygen contents.

Ongoing management of home oxygen therapy involves regular follow-up with both the prescribing physician and the oxygen supplier. The physician monitors the patient’s condition and can adjust the oxygen prescription if needs change. The supplier ensures the equipment functions correctly and provides supplies, supporting adherence to the prescribed therapy.