How Medicare and Insurance Works for Oxygen Therapy

Many people with COPD and other chronic medical conditions need to use oxygen therapy on a daily basis. In many cases, medicare will cover all or most of the costs of oxygen therapy equipment, as long as the requirements are met. Private health insurance plans work the same way, but it depends on the company, and which medical supply companies accept policies with which companies.

With all of the requirements and variables involved in getting your oxygen therapy equipment covered, you might have plenty of questions. In this mini online guide, we will try to answer as many of your potential questions as possible. We would be happy to answer any questions in our custom service department.

How does medicare cover home oxygen equipment?

Medicare views home oxygen equipment (tanks, accessories needed, portable oxygen concentrators and stationary oxygen concentrators) as Durable Medical Equipment (DME). The equipment used must meet durability requirements. For example, the equipment must be new and in proper working order.

The DME in question also has to be a proven and well-documented treatment for a medical condition that you have. For example, medicare will cover a portable oxygen concentrator that you will use on an ongoing basis, because it is the treatment used for severe COPD.

As with most medical insurance coverage, you will be responsible for a portion of the costs. Medicare will cover 80%, while you will be responsible for the remaining 20%. You will also still be responsible for the annual deductible.

What types of respiratory equipment are covered by medicare?

These types of respiratory diseases can have the proper equiment automatically covered by medicare: restrictive thoracic disorders (i.e., progressive neuromuscular diseases or severe thoracic cage abnormalities), severe chronic obstructive pulmonary disease (COPD), or central sleep apnea or Complex Sleep Apnea. If you have obstructive sleep apnea, you will need to meet another requirement as well.

Medicare will also cover replacements that you will need, such as new filters, cannulas, masks and tubing. As long as you have undergone the proper testing and the tests have been well documented in your medical records, you can have your oxygen therapy equipment covered by medicare.

Nebulizers are covered to treat COPD, or to deliver specific medications for other conditions, like cystic fibrosis, brochiectasis, pneumocystosis and other conditions that make it hard to breathe.

Oxygen is covered if you have consistently low blood oxygen levels from COPD, as indicated by the appropriate tests ran by your pulmonary specialist. Generally, your saturation must be at or below 88% at rest or for more than 5 minutes while you're sleeping, and your mmHG is at or below 55. These are severe conditions, and will require the use of oxygen equipment at home.

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