Medicare beneficiaries or any patient who deals with specific medical issues that reduce blood oxygen levels, might already be prescribed oxygen therapy by their provider. For beneficiaries, certain equipment is most often rented but may be purchased, either way Medicare Part B will pay 80% of the cost after beneficiaries meet their annual deductible. Durable equipment is long lasting, Medicare may cover most items that will stick with you for a while.
Who Needs Oxygen Therapy?
The human body requires oxygen for cells to produce energy. Some medical conditions reduce blood oxygen levels, resulting in such symptoms as:
- Fatigue, confusion, and feeling short of breath.
- Medical conditions that can result in low oxygen levels in the bloodstream include heart failure, COPD, COVID-19, and pneumonia.
Oxygen therapy, or supplemental oxygen, offers a treatment to help maintain optimal oxygen levels. Without treatment, low blood oxygen levels may cause permanent damage.
When Does Medicare Part B Cover Oxygen Therapy?
According to Medicare.gov, Part B covers doctor-prescribed equipment or accessory rentals for oxygen therapy as durable medical equipment.
Medicare also covers the delivery of oxygen and supplies for people who already own equipment if:
- The doctor must diagnose a lung disease that causes inadequate blood oxygen.
- Blood oxygen levels must fall below a specified range.
- Oxygen therapy can help the condition improve.
- Alternative treatments have failed.
Are Portable Oxygen Concentrators Covered by Medicare?
Oxygen concentrators can filter medical-grade oxygen from ordinary air. Thus, they can produce an unlimited supply of oxygen, unlike the finite contents of an oxygen bottle. According to The University of California San Francisco, airlines only allow portable oxygen concentrators but not traditional tank systems.
Medicare Part B typically does not cover portable oxygen concentrators. Medicare will cover small, portable tanks that contain liquid oxygen. Medicare probably decided to cover the portable tanks and not concentrators because tanks offer a more cost-effective treatment option.
Some people may need an airline-approved portable oxygen concentrator to travel. According to Medicare, they are not required to supply this device. Thus, Medicare beneficiaries will need to rent or purchase this equipment at their own expense. Medicare suggested that oxygen therapy patients should proactively try contacting their regular oxygen supplier for rentals a few weeks before travel. Other companies and sometimes airlines may also supply this equipment.
Does Medicare Help Pay for Hyperbaric Oxygen Therapy?
Hyperbaric oxygen therapy describes a pressurized environment that lets patients breathe pure oxygen. Medicare advises beneficiaries that it might help pay for this treatment for certain conditions, including decompression sickness, diabetic wounds, and progressive necrotizing infections. Medicare pays 80% of approved treatments after the annual deductible, as with other oxygen therapy.
How Do Oxygen Therapy Rentals Work Under Medicare?
After Medicare beneficiaries pay the annual Part B deductible, Medicare Part B pays 80% of the approved amount. Medicare has some specific rules for obtaining oxygen treatment supplies:
- Patients need to rent equipment for 36-month contracts. After this initial period ends, suppliers still own their equipment but will continue to offer supplies for an additional 24 months, totaling five years.
- During the entire five years, Medicare will continue to pay its share of expenses.
- After the five-year period ends, patients who still require oxygen treatment can begin a new one. Currently, they have the option to contract with another supplier.
What is the Cost of Oxygen Therapy for Medicare Beneficiaries?
Costs of oxygen delivery can vary, but some estimates predict a monthly fee of up to $275, totaling about $3,300 a year. In this case, the beneficiary’s annual bill would equal $660 for 20% of the cost. A Medicare supplement could cover the beneficiary’s copay. A Medicare Advantage must also cover oxygen therapy, but out-of-pocket costs can vary between plans.
- Oxygen Equipment and Accessories, Medicare.
- Traveling With Oxygen, UCSF Health.
- Hyperbaric Oxygen Therapy, Medicare.