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woman receiving oxygen, what medicare covers for oxygen therapy

What Does Medicare Cover for Oxygen Therapy?

Oxygen therapy is used by doctors and hospitals to help improve a patient’s blood oxygen level to promote healing and fight infection. It’s often used to treat breathing disorders like asthma, emphysema, pneumonia and chronic obstructive pulmonary disease (COPD). COPD is the third leading cause of death in the United States, which means many Americans may rely on oxygen therapy as a life-sustaining treatment method.

When is oxygen therapy necessary?

Oxygen therapy can increase your blood oxygen levels and help you feel less fatigue and shortness of breath. It’s usually administered through tubes or a face mask.

Doctors may prescribe you in-home oxygen therapy if you have one or more of the following conditions:

  • COPD
  • Heart failure
  • Pneumonia
  • Sleep apnea
  • Severe asthma
  • Cystic fibrosis

Your doctor may order blood tests (like arterial blood gas test or pulse oximetry test) to determine if you need oxygen therapy.

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What does Medicare cover?

Oxygen therapy equipment is covered by Medicare as durable medical equipment (DME). After you’ve met your deductible ($185 for 2019), Part B will cover equipment and supplies for oxygen therapy. Medicare will cover 80 percent of expenses, and you’ll be responsible for the remaining 20 percent.

In order for Medicare to cover your costs, you must meet the following requirements:

  • Your doctor says you have a severe lung disease and/or you’re not getting enough oxygen
  • Your health could potentially improve with oxygen therapy
  • Your arterial blood gas levels need to be higher
  • Other treatments to improve your condition have failed
  • Your doctor accepts Medicare assignment
  • You use a Medicare-approved supplier

Any oxygen therapy administered as part of inpatient treatment in a hospital will be covered by Part A.

If you’re a smoker with breathing disorders, the Part B smoking cessation benefit may provide up to eight smoking cessation sessions each year as well as nicotine patches.

How does oxygen equipment rental work?

Unless you own your own oxygen therapy equipment, you’ll need to rent it from a Medicare-approved supplier. The supplier may rent you the equipment for 36 months. If your doctor feels that you need to continue this treatment, you can continue to rent the equipment for up to five years. Once those five years are over, the supplier is no longer obligated to rent the equipment to you, and you will need to find another supplier and begin a new rental period.

Oxygen therapy equipment includes:

  • Tubes or a mouthpiece
  • Oxygen contents
  • Maintenance
  • Servicing
  • Repairs

Remember, there is no out-of-pocket limit for Original Medicare. If you need oxygen therapy, you may consider enrolling in a Medigap plan (which covers copays, coinsurance, and deductibles) or a Medicare Advantage plan (which has an out-of-pocket limit).

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