Original Medicare Part B covers oxygen and equipment for use at home, although certain conditions apply. Part A covers oxygen therapy during an inpatient stay.
If someone has a lung disorder, such as severe chronic obstructive pulmonary disease (COPD), a heart problem, or asthma, they may need oxygen therapy.
In the United States, more than 1.5 million adults use oxygen therapy to help them breathe more easily, sleep better, and lead a more active life.
In this article, we look at Medicare’s coverage of oxygen equipment, supplies, and therapy. We then discuss the types of equipment and supplies, eligibility and costs, and alternative therapies.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
If someone has original Medicare, Part B covers the cost of outpatient health needs, such as durable medical equipment (DME), that a doctor deems medically necessary. Medicare includes oxygen equipment and accessories in the DME classification.
Part B covers the rental of DME for beneficiaries to use within their home. However, a person’s doctor and the DME supplier need to be enrolled in Medicare and accept assignment.
If someone stays in a hospital and needs oxygen therapy during their inpatient stay, Medicare Part A covers this cost.
Medicare Advantage plans have to offer the same health coverage as original Medicare, including oxygen therapy.
Doctors can prescribe different types of oxygen therapy for people, which they can receive at home or in a hospital.
These include:
- oxygen gas for home therapy
- liquid oxygen for home therapy
- hyperbaric oxygen therapy (HBOT) in a hospital
Home oxygen therapy
When a person needs oxygen therapy in their home, Medicare covers the rental of the following equipment:
- systems to provide oxygen
- containers to store oxygen
- tubing and accessories to deliver the oxygen
If the oxygen machine works with a humidifier, Medicare may also cover this equipment.
A DME company supplies the oxygen equipment for 36 months. The supplier makes sure that the equipment and accessories are in working order, which may include repairs, servicing, and maintenance. The monthly payments include these services.
If a person still needs the equipment after 36 months, the supplier will continue to provide the supplies for another 24 months.
After these 5 years, the supplier will have completed their contract. People can find a new supplier or continue with the original supplier if both parties are happy to do so.
Hyperbaric oxygen therapy
In HBOT, the person uses a special oxygen chamber to expose the whole body to oxygen with increased atmospheric pressure. This therapy takes place in a hospital or specialized clinic.
Medicare may cover HBOT for several conditions, including gas embolism, acute carbon monoxide intoxication, and severe peripheral arterial insufficiency.
Portable oxygen concentrators
If someone wants a portable oxygen concentrator, they will need to purchase the equipment.
Oxygen concentrators are small, mobile devices that deliver oxygen through pulse dosage. This delivery system means that the person receives only the oxygen that they need, thus avoiding waste.
Medicare makes monthly payments to pay for stationary oxygen equipment, including stationary concentrators and stationary gaseous and liquid equipment. To get a portable oxygen concentrator or tank, as well as a machine that can fill a portable tank in the home, a person will need to make an add-on payment.
The person who needs oxygen therapy must have Medicare insurance and meet each of these conditions:
- A doctor has diagnosed a severe lung condition that prevents the person from getting enough oxygen.
- The person’s health might improve with oxygen therapy.
- Their arterial blood gas level falls within a specific range.
- They have tried other measures, but their health has not improved.
If someone is eligible and needs oxygen therapy as an outpatient, their doctor can arrange the supply of home oxygen therapy from a Medicare-approved DME provider. This tool offers a search function to help a person find a DME provider in their area.
Medicare does not pay all of the costs of oxygen therapy. For example:
- An individual with original Medicare must pay an annual Part B deductible, which is $203 in 2021. They will also have to pay 20% of the Medicare-approved amount for HBOT or home oxygen therapy.
- There is a 36-month limit for Medicare payments for oxygen equipment rental. After that time, a person will pay 20% of the Medicare-approved amount if they use equipment that requires the delivery of gaseous or liquid oxygen contents.
- A person must also pay 20% of the Medicare-approved amount for a rented or purchased humidifier, as long as they use it with a respiratory assist device or a continuous positive airway pressure (CPAP) device.
For those with a Medicare Advantage plan, the costs of coverage may vary. People should contact their plan provider to find the coverage guidelines for oxygen therapy.
Equipment rental vs. owning
Medicare covers 80% of the costs of oxygen equipment rental after a person has met the yearly deductible.
If someone wishes to purchase a portable oxygen concentrator, Medicare will help pay for the supplies that the person needs to use alongside the machine. The cost may be either a flat monthly rate or based on use.
The price of a new home oxygen concentrator depends on several factors and ranges from
Some DME companies allow people to finance a new portable oxygen concentrator with monthly payments. Individuals must decide which is more cost effective: buying the oxygen therapy equipment or paying the 20% copayment to Medicare and renting the equipment.
If a doctor certifies that a person needs oxygen therapy, they should receive it as a lifesaving or life-extending measure. However, there are some additional therapies that may help a person’s breathing and oxygenation.
An example is pulmonary rehabilitation, which is a treatment approach that may help reduce symptoms and improve daily functioning.
If a doctor certifies that pulmonary rehabilitation is medically necessary, Medicare Part B is the Medicare portion that pays for this service. A person is responsible for 20% of the Medicare-approved amount for pulmonary rehabilitation.
Typically, Medicare covers oxygen and equipment for use at home, as well as oxygen therapy during an inpatient stay. Certain conditions apply, and a person will need to cover some costs. A doctor must certify that the oxygen therapy is medically necessary for Medicare to cover it.