Original Medicare’s Part B can cover oxygen therapy and equipment if your doctor determines that you need it to maintain or improve your health.
Medicare Advantage also covers medically necessary oxygen therapy, but these private insurance Medicare plans may vary in cost and coverage.
For service or treatment to qualify as “medically necessary,” your doctor must perform medical tests to measure the amount of oxygen in your blood, among other requirements.
Your doctor will prescribe the dose and duration of your oxygen therapy, as well as what type of therapy you’ll receive.
Oxygen machines are supplied to Medicare beneficiaries for five years at a time. Medicare generally pays to rent an oxygen machine for 36 months, but the supplier must provide service on the device for another 24 months.
There are few things as central to living a comfortable life as being able to breathe. But, unfortunately, the ability to do so freely can get challenging with age. Because of this, many adults need oxygen therapy.
If you’re on Medicare and have a lung condition or other issue that lowers your blood-oxygen levels, you may need at-home oxygen therapy. You’ll need to know the different Medicare oxygen requirements you must meet for oxygen therapy, along with your options, costs, and more.
Here’s what you need to know about oxygen therapy, equipment and Medicare.
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Like other Medicare-approved treatments and durable medical equipment, Medicare Part B covers oxygen therapy and related equipment. However, Medicare oxygen requirements include a few more steps than other covered services, including lab work. If you or a loved one are on Medicare and need oxygen therapy, here’s what you’ll need to know to qualify for coverage.
Medicare oxygen guidelines 2022
If you need oxygen therapy, Medicare can help cover your care if you meet all of the following criteria:
- Your doctor certifies it’s medically necessary due to a severe lung condition or because you’re not getting enough oxygen, known as hypoxemia.
- Your health has the potential to improve with oxygen therapy.
- Your arterial gas level has fallen to a specified range.
- Other alternative treatments, such as medical and physical therapies, have been tried and will not work.
Again, you’ll need to meet all of the Medicare guidelines for oxygen qualifications spelled out above. If you do, you may qualify for oxygen therapy with Medicare.
The amount of oxygen in your blood is known as oxygen saturation, and it’s one of two main measurements a doctor uses to determine a need for oxygen therapy. The other is the arterial blood gas test. Known as PaO2, the test measures oxygen pressure in the blood to show how freely oxygen passes from your lungs into your blood. Both oxygen saturation and PaO2 measurements can give your doctor a good idea of your body’s current oxygen levels and when you may need more.
Suppose your doctor has determined that you have a lung condition and that treating it with oxygen is medically necessary. In that case, you’ll need to undergo tests that show your arterial blood gas and oxygen saturation levels qualify for oxygen therapy. Here are the measurements outlined by the Centers for Medicare and Medicaid Services (CMS):
- Arterial blood gas (PaO2): 55 mmHg or below
- Oxygen saturation: 88% or below
If your levels are below those limits while you’re at rest and manually breathing room air, you may qualify for oxygen therapy. The measurement of Arterial blood gas is millimeters of mercury (mmHg).
Oxygen therapy during sleep
Oxygen levels in the blood can vary throughout the day, especially as you sleep. Because of this, you may still qualify if:
- Your PaO2 drops to 55 mmHg or below, or your blood saturation reaches or falls below 88% while you sleep, or
- You experience a more significant than expected drop in oxygen levels while sleeping. Commonly a red flag can be a decrease in more than 10 mmHg or 5% oxygen saturation.
In these cases, Medicare may only approve the use of oxygen when you sleep.
Oxygen therapy during exercise
Like sleep, exercise may affect your blood-oxygen levels. Many people have a PaO2 above 56 mmHg and oxygen saturation at 89% or higher when they’re at rest, but these levels drop after activity. Movement and other strenuous exercise can sap the oxygen from your bloodstream, leaving you susceptible to hypoxemia-related fatigue. Your doctor will test your levels to see if they drop after exercise. If so, Medicare may help cover supplemental oxygen that you can use as part of your active lifestyle.
Other reasons for oxygen therapy
Some conditions require oxygen therapy even though your arterial blood gas and oxygen saturation levels are above average. Medicare may approve your coverage for oxygen if you’re experiencing:
- Specific signs of congestive heart failure
- Pulmonary hypertension
- Erythrocythemia, or increased red blood cells that makes oxygen distribution more difficult
Your doctor will prescribe a specific regimen for your treatment plan based on your oxygen levels and when your levels dip below the limits above. Like a prescription drug, instead of authorizing an unlimited supply, your doctor will determine:
- When you receive your oxygen treatment
- How much oxygen you’ll receive
- How long you can receive it
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The standard for being medically necessary is higher for oxygen therapy than most Medicare-approved treatments. The outlined tests and guidelines determine whether it’s a needed part of your care. Once your doctor and Medicare verify it is, you can obtain oxygen similarly to other services and equipment.
First, you must enroll in or have coverage from Medicare Part B or Medicare Advantage. Part B provides the medical coverage portion of Original Medicare (Parts A and B). Also, Part B covers therapies and durable medical equipment. However, if you have Original Medicare (Parts A and B) and need oxygen therapy and equipment, you must:
- Have certified test results and confirmation from your doctor that it’s medically necessary.
- Get a prescription for the oxygen and equipment.
- Receive the oxygen and equipment from a Medicare-approved supplier
Costs for oxygen therapy with Medicare
Coverage for oxygen therapy under Original Medicare is similar to other treatments and equipment. Original Medicare and Part B typically cover 80% of your Medicare-approved costs once you’ve paid your annual deductible. After that, you’ll pay the remaining 20%. You also are responsible for a monthly Part B payment, known as the Part B premium.
Suppose you have Medicare Advantage (Part C). In that case, you must receive at least the same amount of coverage as Original Medicare Part B. Part C replaces Original Medicare (Part A & B) but offers the same Part A and B benefits or coverage as Original Medicare. Along with receiving Part A and B benefits, Medicare Part C often bundles additional dental, hearing, vision, and prescription drug coverage. Part C beneficiaries usually pay different amounts for their services, including oxygen therapy. If you have Medicare Advantage and need oxygen therapy, call your plan to be clear about your benefits and how to access them.
Talk to your doctor if you’re curious about the kind of oxygen machine Medicare will cover for your care. There are several types of oxygen machines, each for beneficiaries with different needs. Some are made from large, stationary canisters and long tubing to deliver oxygen. Others use liquid oxygen in smaller tanks.
Medicare will also cover portable oxygen systems, either by themselves or in addition to a stationary machine. According to CMS, the beneficiary’s medical documentation provided by their doctor must indicate that you’re mobile in your home and would benefit from using a portable oxygen system. If you need oxygen therapy solely because your blood gas levels fall while you sleep, Medicare will not cover a portable oxygen machine.
Does Medicare pay for Inogen portable oxygen?
Medicare may pay for many name-brand oxygen machines. If you have questions about specific makes and models, talk to your doctor. They can make recommendations and help you find a unit that works for your needs.
What extra benefits and savings do you qualify for?
As you’ve seen, there are limitations to the kinds of oxygen therapy equipment Medicare will cover. However, meeting the requirements for care does qualify you to receive equipment that will help your treatments. Medicare typically pays to rent these items when you need them. They can include:
- The oxygen machines and systems that provide oxygen
- Containers and canisters that store your oxygen
- Masks, tubing and other pieces of equipment needed to administer your oxygen
It’s not uncommon to need oxygen treatments for several years, and Medicare will also pay to keep your equipment functioning properly. That means you may also be eligible for:
- Maintenance of your oxygen machine
- Servicing of your oxygen machine
- Repairs when needed
How long does Medicare pay for home oxygen?
The easy answer is that Medicare will continue to pay for your oxygen therapy and equipment as long as you have a medical need for it. Your doctor will set the initial dosage amount and duration but can extend your treatment if it’s medically necessary.
The more precise answer is that your oxygen therapy is available in five-year increments. Medicare will pay to rent your oxygen machine and equipment for the first 36 months. After that, your supplier will own the equipment but must continue to service and maintain it at no cost to you for the next 24 months. You’ll also receive any supplies and accessories you need for your treatments during this time. If you need oxygen tanks or canisters delivered to you, you’ll still be responsible for the 20% coinsurance for these services.
At the end of five years, Medicare will allow you to choose a new supplier and equipment. At that point, a new 5-year period will begin, starting with another 36-month rental window.
Typically, Medicare does not cover pulse oximetry when used in your home. Medicare may cover a pulse oximeter test administered by a doctor as part of your oxygen testing. These devices measure your oxygen saturation levels and cost as little as $10.
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