Your Medicare Coverage
Is my test, item, or service covered?
How often is it covered?
Medicare Part B (Medical Insurance) covers the rental of oxygen equipment as durable medical equipment (DME). If you 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
Under the above conditions, Medicare helps pay for:
- Systems for furnishing 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.
All people with Medicare are covered.
Your costs in Original Medicare
You pay 20% of the Medicare-approved amount.
Medicare pays suppliers a monthly fee for providing all medically necessary oxygen and oxygen equipment, including accessories and supplies like tubing or a mouthpiece. After 36 months of continuous use, Medicare stops making rental payments for the oxygen equipment, but, in almost all circumstances, you'll continue to get the oxygen equipment, accessories, and supplies from the same supplier with no rental charge until the end of the reasonable useful lifetime of the oxygen equipment (generally 5 years after the date that the equipment was delivered to you).
Medicare will only cover your DME if your doctor or supplier is enrolled in Medicare. If a DME supplier doesn't accept assignment, Medicare doesn't limit how much the supplier can charge you. You may also have to pay the entire bill (your share and Medicare's share) at the time you get the DME.
Competitive Bidding Program
If you live in or visit certain areas, you may be affected by Medicare's Competitive Bidding Program. In most cases, if you have Original Medicare and get competitively bid equipment and supplies in competitive bidding areas, Medicare will only help pay for these equipment and supplies if they're provided by contract suppliers. 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) before your rental payments stop. 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 because it 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.
If your current supplier doesn’t get a new contract, 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.
If your supplier doesn’t choose to grandfather, you’ll need to use a new contract supplier for Medicare to help pay for your equipment.
To find out how much your specific test, item, or service will cost, talk to your doctor or other 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, and the location where you get your test, item, or service.