Does insurance covers oxygen in USA?

Oxygen Durable Medical Equipment (DMA) Insurance Coverage

Oxygen equipment & accessories

Medicare Part B (Medical Insurance) covers the rental of oxygen equipment and accessories as durable medical equipment (DME) that your doctor prescribes for use in your home.

If you need/own your own equipment, Medicare will help pay for oxygen contents and supplies for the delivery of oxygen when all of these conditions are met:

• Your doctor says you have a severe lung disease or you’re not getting enough oxygen.
• Your health might improve with oxygen therapy.
• Your arterial blood gas level falls within a certain range.
• Other alternative measures have failed.

If you meet the conditions above, Medicare helps pay for:

• Systems that provide oxygen
• Containers that store oxygen
• Tubing and related supplies for the delivery of oxygen and oxygen contents

Medicare may also pay for a humidifier when it’s used with your oxygen equipment.

Where to get oxygen supplies included in the Competitive Bidding Program when you travel:

If you live permanently in an area participating in the program and
travel to an area participating in the program,
you may go to a Medicare contract supplier for the area you traveled to for items included in the program.

Your costs in Original Medicare about oxygen

You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

If you have Medicare and use oxygen, you’ll rent oxygen equipment from a supplier for 36 months.

After 36 months, your supplier must continue to provide oxygen equipment and related supplies for an additional 24 months.

Your supplier must provide equipment and supplies for up to a total of 5 years, as long as you have a medical need for oxygen.

The monthly rental payments to the supplier cover not only your oxygen equipment, but also any supplies and accessories like:

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

What happens after I rent my oxygen equipment for 36 months?

• Your supplier must continue to maintain the oxygen equipment (in good working order) and furnish the equipment and any necessary supplies and accessories, as long as you need it until the 5-year period ends. The supplier can’t charge you for performing these services.
• If you use oxygen tanks or cylinders that need delivery of gaseous or liquid oxygen contents, Medicare will continue to pay each month for the delivery of contents after the 36-month rental period.
• The supplier that delivers this equipment to you in the last month of the 36-month rental period must provide these items, as long as you medically need them, up to 5 years. The supplier owns the equipment during the entire 5-year period.
• If your medical need continues past the 5-year period, your supplier no longer has to continue providing your oxygen and oxygen equipment, and you may choose to get replacement equipment from any supplier.
• A new 36-month payment period and 5-year supplier obligation period starts once the old 5-year period ends for your new oxygen and oxygen equipment.

Competitive Bidding Program

If you live in or visit certain areas, you may be affected by Medicare’s Competitive Bidding Program. In most cases, Medicare will only help pay for these equipment and supplies if they’re provided by contract suppliers when both of these apply:

• You have Original Medicare.
• You get competitively bid equipment and supplies in competitive bidding areas.

Contract suppliers can’t charge you more than the 20% coinsurance and any unmet yearly deductible for any equipment or supplies included in the Competitive Bidding Program.

If you’ve been renting your equipment for 27 to 35 months when contracts start in your area and you switch to a Medicare contract supplier

You may have to pay for renting the equipment for a few months longer than expected (from one to nine months beyond the 36-month period). This will result in additional months of Coinsurance. However, the amount you pay may be lower than before because the amount you’ll pay will be based on the new payment rates under the Competitive Bidding Program. Talk with your new supplier about how this affects you.

If you’ve been renting your equipment for 36 months

You don’t need to do anything. Your current supplier must continue to provide your equipment at no additional rental charge until the equipment needs to be replaced. This is because the equipment has reached the end of its reasonable useful lifetime. When your old equipment needs to be replaced because it’s too old, you must get replacement equipment from a contract supplier.

Note about your oxygen supplier

If your current supplier isn’t a Medicare contract supplier, you may still be able to stay with that supplier if they decide to participate in the program as a “grandfathered” supplier.

Suppliers that don’t get Medicare contracts can decide to become “grandfathered” suppliers.
This means a supplier may continue to rent equipment to you if you were renting the equipment when the program started.
This rule applies to oxygen, oxygen equipment, and certain rented equipment. You may continue using the “grandfathered” supplier until the rental period for your equipment ends.

If you start renting additional equipment from a “grandfathered” supplier after the program starts, Medicare won’t pay for the new equipment.

If you’re renting equipment that’s eligible for grandfathering, your supplier will let you know in writing 30 business days before the program begins whether it will or won’t become a “grandfathered” supplier.

What happens if my supplier decides not to become a grandfathered supplier?

You need to decide whether to continue to rent from your current supplier and pay all the costs, or switch to a Medicare contract supplier.

A supplier that doesn’t have a contract and decides not to become a grandfathered supplier is required to notify you and pick up the item from your home after the program starts. Your supplier must notify you these 3 ways before it can pick up the item:

• The supplier must send you a letter at least 30 business days before the program starts telling you that it will no longer provide rental items to you after a certain date. This letter will tell you the date that a Medicare contract supplier must start to provide you with the rented item.
• The supplier must call you 10 days before picking up the item to make arrangements for pick up at an agreed upon time.
• The supplier must call you again 2 business days before picking up the item.

A supplier that isn’t grandfathered can’t pick up a medically necessary item before the end of the last rental month for which the supplier is eligible to get a rental payment.

If you change to a Medicare contract supplier, your old supplier should work with the contract supplier so there isn’t a break in service. Keep the pickup slip or other documentation from the old supplier that shows you no longer have the item.

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

• Other insurance you may have
• How much your doctor charges
• Whether your doctor accepts assignment
• The type of facility
• Where you get your test, item, or service

Durable medical equipment (DME) coverage
Medicare Part B (Medical Insurance) covers Medically necessary durable medical equipment (DME) if your doctor prescribes it for use in your home.

What happens if the equipment I have is no longer effective for me?

Your doctor may decide that your oxygen equipment is no longer effective for you. If so, he or she may notify the oxygen supplier with a new letter of medical necessity for different equipment. The oxygen supplier must provide you with equipment that fits your needs. It should address your mobility needs both inside and outside your home.

Can my oxygen supplier change my equipment or the number of tank refills I get each month?

Your supplier can’t change the type of equipment or number of tank refills you get unless your doctor orders a change. If you find you need more tank refills, ask your doctor to submit an updated letter of medical necessity to your supplier.

What happens if my oxygen supplier goes out of business or leaves the program during my rental period?

Suppliers leaving the program must give you a 90-day notice in writing, telling you that they can no longer provide oxygen therapy services. This notice must be one of these:

• A letter notifying you of their intent to stop oxygen therapy services, including the date when they’ll stop services.
• A letter to a new supplier you’ve chosen, transferring responsibility for oxygen therapy services to the new supplier on a specific date.

Work with your supplier to find a new oxygen supplier in your area, and request that they send a letter to the new supplier on your behalf. This will ensure you’ll have continuous service and your medical records will be transferred to the new supplier within 90 days.

What if my supplier tells me they’ll no longer provide liquid oxygen?

• If your supplier tells you they’ll no longer provide your prescribed therapy, and you haven’t completed your 5-year contract, you can:
  Get the oxygen supplier to put their intentions in writing.
• File a complaint.