Medicare Rules and Oxygen Therapy FAQ

How do I get my oxygen therapy equipment covered by Medicare?

This is the first and most important step, because you won't be able to change the type of equipment or delivery system for 5 years. Your doctor will help you decide which oxygen therapy delivery system is best for your condition and your lifestyle. Then you can take your prescription to the medical supplier and get a certificate of medical necessity, which they would then present to medicare.

What types of oxygen delivery systems are available?

There are two main types: gaseous and liquid oxygen. For delivery systems, there are stationary oxygen concentrators, which filter oxygen from the ambient air, and can only run on AC power. Portable oxygen concentrators can run or charge up a battery on AC or DC power, depending on the model. There are also refillable oxygen tanks, as well as special tanks that can be filled at home with a home fill system.

How does Medicare work when covering supplemental oxygen?

Medicare goes on a 5 year contract with your medical supply company. The first 36 months, the supplier is paid for the rental equipment. The last 24 months of the 5 year contract, the supplier is paid only for necessary accessories, such as hoses and refilled tanks. Medicare pays 80% of the charges, and you are responsible for paying the supplier 20%.

Does the patient get to keep the equipment after the contract is up?

No. After medicare rule changes, the supplier will own the equipment throughout the contract, as well as afterwards.

Will I be able to get replacements after the first 36 months?

The oxygen supplier is responsible for providing replacements, as well as repairs and maintenance during the whole 5 year contract. The services and repairs are required to come at no charge. The supplier will bill medicare for the accessories.

What will I not be able to do under this contract?

You won't be able to make unnecessary (or what medicare deems as unnecessary) changes to what equipment you are getting. It may also be difficult to change to a different supplier later in your contract.

Is used or refurbished equipment covered under Medicare?

No. The hour meter must be well under 200 hours. The only way your supplier can provide you with used equipment, is for a temporary use while a repair is being made on your other equipment.

What if I need different equipment after the start of the contract?

If your doctor finds it necessary to upgrade your equipment, they will need to send a new letter of medical necessity to the medical supplier, and they will give you the equipment you need. There will be no changes to the contract.

What should I do at the end of my contract?

Your doctor will send a new letter of medical necessity, and your medical needs might be released to make sure you will be getting all the equipment you need. This might also involve going to a new supplier, if they cannot provide you with the equipment or services you need now.

What if the supplier goes out of business during the 5 year contract?

Since you are in a contract with them, it's their responsibility to send you a 90-day notice, and assist you in finding a new supplier that will meet your needs.

Will Medicare pay for a portable oxygen concentrator?

Yes, if the medical order states that it is your prime source of oxygen for regular use. For example, if you also want to get a stationary oxygen concentrator in addition to your portable model, you would have to pay for the stationary unit out of pocket.

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