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How Medicare Covers Oxygen Therapy

Oxygen is vital to human life. It is the most abundant element in the human body making up around 65% of the body’s mass. There is an old proverb that asserts, “Life is in the breath. He who half breathes half lives.” If you suffer from a chronic or long term respiratory disorder- this proverb may hit close to home for you.  

Breathing disorders such as Asthma, Emphysema and Chronic Obstructive Pulmonary Disease (COPD) plague millions of people in the United States each year. In fact, the American Lung Association reports that COPD is the third leading cause of death here in the United States. If you are a Medicare beneficiary who has recently been diagnosed with a breathing disorder, or if you suffer from one and are nearing your Medicare eligibility, you may be wondering if and how Medicare covers oxygen.

Let’s go over how Medicare covers oxygen for for treatments of respiratory/lung disorders:

Medicare provides care and treatment for most illnesses whenever it is deemed medically necessary. Home oxygen therapy is one treatment that Medicare may pay for if your doctor regards that it is medically necessary.

Original Medicare:

Medicare Part A: is most commonly referred to as hospital insurance. Part A will cover your inpatient hospital benefits. If you are ever hospitalized for a lung disorder or any other illness, Part A will pay for your inpatient stay, any skilled nursing care afterward and if ever needed, hospice benefits.

Medicare Part B: is often referred to as medical insurance. Part B covers your doctor and specialist visits, preventative care services, lab tests, outpatient surgeries, cancer treatments, as well as medical procedures when admitted to the hospital. It also covers durable medical equipment (DME). Oxygen therapy and all related equipment fall under the durable medical equipment benefit of Part B. Medicare does not pay 100% of your costs for oxygen therapy. You will be responsible for a small Part B deductible each year. After that is met, Medicare pays 80% of the approved amount of oxygen.

Medicare Part C:

Medicare Part C: Some Medicare beneficiaries opt for a Part C (often referred to as Medicare Advantage plans) instead of Original Medicare. People who enroll in a Medicare Advantage plan instead of Original Medicare will get their Part A and B benefits from a private insurance company. These plans usually have a network of providers. You will need to see these providers to keep your costs as low as possible. Your copay, deductible and coinsurance costs on Medicare Advantage vary by plan

Medicare Supplement Plans

Medicare Supplement Plans: It’s important to know that there is no limit on the total amount that you might spend under Part B in any year. For this reason, many beneficiaries enroll in Medicare Supplement plans when they are first eligible for Medicare coverage. These plans help to cover the deductibles and coinsurance that you would otherwise pay. Medicare Supplement  plans, also called Medigap, pay after Medicare. They also let you access Medicare’s nationwide network of providers. Medigap plans have monthly premiums but very predictable back-end spending.

Oxygen Therapy: 

Oxygen therapy helps to increase the amount of oxygen that your circulatory system delivers to your lungs. Doctors may prescribe this type of therapy for people who are suffering from a respiratory disorder. While oxygen can be used while in a hospital setting, it can also be used by people in their home. A Medicare approved durable medical equipment provider can deliver it to a patients home in tanks.

Medicare’s guidelines require that you meet certain criteria to be eligible for home oxygen therapy. This starts with a prescription from your doctor for oxygen therapy. Your Medicare doctor must document that you are not getting enough oxygen due to a severe or prolonged lung disorder. They will also need to measure the gas levels in your blood and confirm that it falls within the range at which oxygen treatment is normally prescribed. Your doctor also needs to confirm that other measures have been tried without success and that oxygen treatment will improve your health.

*It is worth noting that Part B has a preventive care benefit to help Medicare beneficiaries to quit smoking. Since smoking is the leading cause of many respiratory illnesses, Medicare Part B’s smoking cessation benefit covers up to 8 visits of smoking and tobacco-use cessation counseling visits in a 12-month period smoking.

Oxygen Rental Under Original Medicare:

If you have Medicare and use oxygen, you will rent oxygen equipment from a supplier for 36 months. After 36 months, your supplier must continue to provide oxygen equipment and related supplies for an additional 24 months. Your supplier must provide equipment and supplies for up to a total of 5 years, as long as you have a medical need for oxygen.

The monthly rental payments to the supplier cover not only your oxygen equipment, but also any oxygen accessories and services like:

-Tubing or a mouthpiece
-Oxygen contents
-Oxygen machine maintenance
-Oxygen machine servicing
-Oxygen machine repairs

To learn more about Medicare Coverage of Oxygen Equipment under certain situations:
https://www.medicare.gov/coverage/oxygen-equipment-accessories

https://www.medicare.gov/what-medicare-covers/what-part-b-covers/getting-oxygen-equipment-supplies-in-certain-situations 

A great understanding of your breathing problems, along with an accurate diagnosis and effective treatment plan can help you regain control of your life. If you have questions regarding Medicare, and what it does, or doesn’t cover when it comes to treatments and therapies, give us a call. We can help you research plans and providers in your area. Let us help you with this next important step.

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