If you or someone you care about relies on oxygen equipment, figuring out if it is covered by Medicaid or Medicare can feel like a daunting task. Understanding what is included, what is not, and how your plan plays into it is essential for managing both your health and your budget. Let us break this down so you can clearly see what coverage is available and how it works.
Does Medicare cover oxygen equipment and accessories?
Yes, Medicare does cover oxygen equipment and accessories, but it is important to know the specifics. Coverage is provided through Medicare Part B, which treats oxygen equipment as durable medical equipment (DME). This includes items like:
- Oxygen concentrators
- Tubing, mouthpieces, or masks
- Portable oxygen tanks
- Liquid oxygen delivery systems
- Maintenance and servicing of equipment
However, you need to meet certain requirements to qualify. First, your doctor must certify that you have a medical condition requiring oxygen therapy. This usually includes a prescription and documentation showing your oxygen levels meet Medicare’s criteria.
How much does Medicare pay for oxygen equipment?
After you meet your annual Part B deductible, Medicare covers 80% of the approved cost for oxygen equipment and accessories. You are responsible for the remaining 20%, which is your coinsurance.
If you are renting the equipment, Medicare will cover the costs for a 36-month rental period, during which the supplier owns and maintains the equipment. If you still need oxygen therapy after that, the supplier must continue providing equipment and supplies for up to five years at no additional rental charge.
Does Medicaid cover oxygen equipment and accessories?
Medicaid coverage varies by state, but many Medicaid plans do provide coverage for oxygen equipment if it is deemed medically necessary. Typically, you will need:
- A prescription from your doctor
- Evidence that your oxygen levels fall within the qualifying range
- Prior authorization in some cases
Each state sets its own guidelines, so it is a good idea to contact your Medicaid office or your managed care plan to confirm what is covered.
What happens if your oxygen supplier changes or leaves the program?
If your supplier stops servicing your area or leaves Medicare’s program, they are required to notify you and help you transition to a new supplier. This ensures that you continue to receive the oxygen and supplies you need without disruption.
What to do if your oxygen needs change
It may happen that you change your need for oxygen therapy. The policies of Medicare and Medicaid make provision for changes like:
- Replacement of equipment: Your doctor may write a new prescription for you if you need a different equipment for oxygen delivery. Your supplier is obliged to supply the new equipment.
- Traveling needs: Portable oxygen concentrators are not covered by Medicare for travel by air. Some suppliers will rent the units, you can also work with external vendors that coordinate with the airlines.
How to get the most out of your coverage
Here are some practical tips for navigating oxygen equipment coverage:
- Work with your doctor: Ensure all required medical documentation is submitted.
- Choose an in-network supplier: This reduces your out-of-pocket costs.
- Understand your plan: Whether you are on Medicare, Medicaid, or both, knowing what is covered will help you avoid surprises.
By staying informed and proactive, you can get the oxygen equipment and care you need while minimizing unnecessary stress.
