Medical Oxygen Supplies Covered by Medicare

Medicare will generally cover the cost of your home oxygen supplies

Oxygen therapy
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If you require medical oxygen due to a condition like COPD, Medicare will generally cover the cost of your home oxygen supplies. To qualify, you must have a breathing condition that oxygen will improve. 

Not everyone who is short of breath needs oxygen. If your oxygen levels (as measured by your ABG's) show that you are chronically hypoxemic, meaning you have a long-term, insufficient supply of oxygen in your blood, then you are probably a good candidate for home oxygen.

 

There are many benefits that come with using home oxygen. Not only does using oxygen for at least 15 hours a day increase survival for those with COPD, it can help people with lung disease prevent heart failure, a common complication of the condition. 

Qualifying for Medical Oxygen and Home Oxygen Supplies

If you think you would benefit from home oxygen, you'll want to follow the following steps as outlined by Medicare. Before calling the oxygen supply company, make sure you have a written prescription from your doctor for the home oxygen equipment and supplies you'll need. This applies to the oxygen concentrator all the way down to the tubing. If you don't have a doctor's order, Medicare won't cover it. Make sure your prescription is signed and dated by your doctor.

Once that is in order, make sure your doctor has documented your need for oxygen in your medical record. Medicare will request your records before approving your home oxygen, and if your condition is not well-documented, they may deny your claim.

Make sure that your oxygen supply company has the order in hand before billing Medicare. They must also keep the order on file.

Your likelihood of being approved increases if you have: 

  • A severe lung disease or other condition that impairs your breathing. It must also be well-documented in your medical record.
  • A health condition that may be improved by using oxygen.
  • A PaO2 (as measured by arterial blood gasses) that is less than or equal to 55 mg Hg (normal is 75-100 mg Hg) and a documented oxygen saturation level of 88 percent or less while awake, or that drops to these levels for at least 5 minutes during sleep.
  • Tried alternative methods to improve your oxygenation, or they should have at least been considered and then deemed ineffective by your physician.

What Medicare Will and Won't Pay For

For Medicare to pay for oxygen and the additional supplies needed to administer it, you must have Medicare Part B coverage. Your doctor will need to write a prescription for the supplies, as well as the oxygen. Medicare is fairly generous when it comes to home oxygen equipment, and as long as you qualify, will pay for all or most of the following:

  • Oxygen
  • Oxygen concentrators and other systems that furnish oxygen
  • Oxygen tanks and other storage containers
  • Oxygen delivery methods, such as ​nasal cannulas, masks, and tubing
  • Portable oxygen containers if they are used to move about in the home

Like any insurance plan, however, there are some things Medicare won't pay for including portable oxygen that is used solely for sleep and portable oxygen that is used only as a back-up plan to a home-based oxygen system.

 

Talk to your health care provider if you think you need oxygen. If you have a pulse oximeter at home, you can measure your own oxygen saturation levels. Remember, oxygen is a drug and should never be used without a prescription.

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