Over 10 million people are diagnosed each year with chronic obstructive pulmonary disease (COPD). Millions more are diagnosed with other serious lung disorders such as asthma and emphysema. Many of these individuals are treated with oxygen therapy.

People with Medicare can rest assured that Medicare covers oxygen therapy. However, there are some rules and guidelines that you will want to follow to ensure coverage for your items are approved.

Part B Durable Medical Equipment

Durable medical equipment like oxygen pumps are covered under Medicare Part B.  Part B covers not only equipment but also many other outpatient services like doctor visits, lab testing, diagnostic imaging, medical supplies, and even outpatient surgeries.

In order for Medicare to cover your oxygen therapy, Medicare must prescribe the therapy for you and document why he believes it is medically necessary.

Usually, your doctor will conduct some testing to measure the level of gas in your blood. He can also document other therapies that you may have tried which have failed to improve your health.

For your part, you will need to use a Medicare-approved DME supplier when ordering your equipment. This not only meets Medicare’s rules but is also in your favor because Medicare has negotiated the lowest pricing possible with these vendors.

Other Related Equipment

While Medicare normally doesn’t cover items like humidifiers, Part B may pay for a humidifier when there is a medical need for someone to use them with their oxygen equipment.

Rental of ventilators may be covered by Medicare when treating for certain conditions such as chronic respiratory failure that is subsequent to COPD.

Your doctor and supplier must document medical necessity, the payable diagnosis, and ventilator settings to be used and the supplier should also outline a backup plan in case the ventilator was to break down.

Details for Using Oxygen DME

When it comes to oxygen equipment, Medicare will pay for you to rent this durable medical equipment. Your rental covers both the oxygen equipment and the other necessary accessories such as tubing, mouthpieces, and masks.

After 3 years, Medicare will stop paying the rental fee, but the Medicare supplier must still continue to supply you with both maintenance and accessories to go with your equipment for the next 2 years. The supplier cannot invoice you for these services. Finally, at the end of 5 years, the DME supplier doesn’t have to continue providing your oxygen equipment or the maintenance required for it. At this point, you will start over on a new 3- year period either with the same DME supplier or a new one, if you prefer.

Your Cost-Sharing Under Medicare

Part B will pay for 80% of the cost of your oxygen therapy equipment after you have first satisfied the annual deductible of $185 (in 2019).

You are responsible for paying the other 20%. However, if you are also enrolled in a Medicare supplement, then your supplement policy will generally pay some or all of this coinsurance for you depending on which plan you purchased.

We should also mention that some DME supplies accept Medicare’s assigned rates while others may be non-participating providers who do not accept Medicare’s assigned rates. If your provider does not accept assignment, you may be responsible for paying up to a 15% excess charge on your equipment.

There are a couple of Medicare supplement plans that cover excess charges for you, such as Medicare Supplement Plans F and G. Consider one of these if you want to be sure that any excess charges will not fall to you to pay.

What about Portable Oxygen Concentrators?

Unfortunately, Medicare will not pay for a portable oxygen concentrator if you are already using Medicare’s oxygen rental benefit. The reason for this is that Medicare pays the supplier the same amount whether the supplier gives you a portable tank or a portable concentrator.

Since the tanks are considerably less expensive than the concentrators, most DME suppliers will only provide you with tanks because it is cheaper for them to do so.

If this is truly an inconvenience, ask your supplier if they offer smaller liquid tanks that could also be billed to Medicare Part B.