Breathing disorders like asthma and emphysema affect millions of people in the United States each year. Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death.People with a breathing or lung disorder who is approaching age 65 may be wondering: does Medicare cover oxygen?
Medicare provides care and treatment for most illnesses whenever it is medically necessary. Home oxygen therapy is one treatment that Medicare may pay for if your doctor deems that is medically necessary.
Let’s review how Medicare covers oxygen and other treatments for lung disorders:
There is also a voluntary drug program to help out with the costs of outpatient prescription medications.
Original Medicare: Part A
When Medicare was created in 1965, Congress broke the coverage into two main parts that still exist today. Part A covers hospital benefits and Part B covers outpatient benefits.
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 as well.
Original Medicare: Part B
Part B will cover your outpatient medical needs. This includes things like preventive care, appointments with a Medicare doctor, lab tests, outpatient surgeries, cancer treatments and also durable medical equipment (DME).
Oxygen therapy and its related equipment fall under the DME benefit of Part B.
Oxygen therapy helps to increase the amount of oxygen that your circulatory system delivers to your lungs. Medicare doctors might prescribe this therapy for people with COPD, emphysema, severe asthma, pneumonia and other respiratory disorders.
While oxygen may certainly be used while you are in the hospital, many people also use it at home. A Medicare-approved DME provider can deliver it pre-packaged in tanks. You can also get an oxygen concentrator which will pull oxygen from the air for you.
It’s important to note that Medicare’s guidelines require you to 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. He or she 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.
The doctor also needs to confirm that other measures have been tried without success and that he or she feels oxygen treatment will improve your health.
We should also mention that Part B has a preventive care benefit to help Medicare beneficiaries stop smoking. Since smoking is the leading cause of COPD and many other respiratory illnesses, Medicare Part B’s smoking cessation benefit provides as many as eight cessation sessions each year and may cover nicotine patches as well.
Obtaining Oxygen under Medicare
Beneficiaries in some areas must use suppliers who participate in Medicare’s competitive bidding program for DME. You can find these suppliers using Medicare’s provider directory.
Most of the time beneficiaries will rent their oxygen equipment. Your monthly rental payment will cover not only the oxygen but also the related accessories such as tubing, masks, and nasal cannulas.
After 3 years, your rental payments will end but your supplier still owns the equipment. That supplier must continue to supply oxygen for an additional 24 months.
If after 5 years you still need oxygen therapy, your first supplier is not required to continue supplying oxygen. However, you can find a different supplier or renew your rental contract with the first supplier.
For people who use an oxygen concentrator, Medicare will pay for maintenance of your equipment and servicing visits every six months after 36-month rental period has ended.
Does Medicare cover portable oxygen concentrators?
Unfortunately, Medicare will not cover a portable oxygen concentrator if it is already providing a monthly rental benefit for oxygen. They will provide a portable oxygen benefit in the form of smaller liquid tanks, however.
Medicare provides one payment for oxygen therapy to your provider. Providing you a portable oxygen concentrator is much more expensive for the DME supplier than it is for them to supply you with oxygen tanks. Therefore, nearly all suppliers will opt to provide the cheaper portable oxygen tanks over the portable concentrator.
Remember, Medicare pays them the same dollar amount for their services either way, so there is no financial incentive for them to provide the portable concentrator. You can, however, purchase one on your own if you wish.
Does Medicare cover alternative therapies for breathing disorders?
We often get questions from Medicare beneficiaries about alternative care. Some Medicare beneficiaries may wish to pursue alternative therapies to treat their breathing disorder. Unfortunately, Medicare generally does not pay for alternative or holistic care options such as acupuncture or massage therapy.
Your Medicare Cost-Sharing for Oxygen
Medicare does not pay 100% of your costs for oxygen therapy (or any illness, for that matter). You are responsible for a small Part B deductible each year. After that is met, Medicare pays 80% of the approved amount of oxygen.
It’s important to realize that there is no limit on the total dollars that you might spend under Part B in any year. For this reason, many beneficiaries enroll in Medigap plans when they are first eligible for Medicare coverage. These plans help to cover the deductibles and coinsurance that you would otherwise pay.
Medigap plans, also called Medicare supplements pay after Medicare. They also let you access Medicare’s nationwide network of providers. This means you can choose from over 800,000 providers for your care. Medigap plans have monthly premiums but very predictable back-end spending.
Some Medicare beneficiaries opt for a Medicare Advantage plan instead of Original Medicare and a supplement. People who enroll in an 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.
Alternative Therapies for Breathing Disorders
Some Medicare beneficiaries may wish to pursue alternative therapies to treat their breathing disorder. Unfortunately, Medicare generally does not pay for alternative or holistic care options such as acupuncture or massage therapy.
Do you need help with finding the right coverage to help you pay for the gaps in Medicare? We can help. Call us today at 1-855-732-9055