With more than 11 million people diagnosed with chronic obstructive pulmonary disease (COPD), the use of oxygen therapy is quite common. However, COPD is not the only condition that might cause a patient to require the use of a portable oxygen tank.
Many seniors who suffer from conditions such as asthma and emphysema also rely on oxygen therapy. Medicare Part B offers a durable medical equipment (DME) benefit that allows these beneficiaries to obtain their necessary oxygen equipment.
However, there are many requirements and limits within Medicare-covered DME. Educating your patients on these rules will make obtaining the DME a much smoother process for both of you.
Oxygen DME Requirements and Limits
To make sure your patient’s oxygen equipment is properly covered under Medicare, first, you need to write a prescription for the equipment. You will also need to prove that the DME is medically necessary.
You can do this by documenting that the patient doesn’t receive enough oxygen to his or her lungs. You will have to test the levels of gas in your patient’s blood to confirm that the levels are below average. Confirmation that other therapies and treatment have been tried and have failed to improve your patient’s health will also need to be provided.
Once the documentation has been processed, you will need to send your patient to a Medicare-approved DME supplier. It’s usually most cost-effective if they find a supplier who accepts Medicare assignment as well, that way they aren’t charged excess charges. The rest is up to the patient to handle.
Oxygen DME Limits
Medicare only provides a renting option for oxygen equipment. The rental fee covers the oxygen equipment and equipment accessories such as masks, tubing, and machine maintenance.
Once the equipment has been rented for 36 months, the rental payments stop. However, the patient still doesn’t own the equipment. The supplier is required by Medicare to continue to supply the patient with accessories for their equipment and maintenance for at least two more years. After the five years is up, the patient may restart the process with the same supplier or find a new one.
Costs with Medicare
Medicare has approved pricing for each type of DME. Medicare will pay 80 percent of this approved amount, and the patient will owe 20 percent. The patient is also responsible for an annual $185 Part B deductible.
If the patient uses a supplier that doesn’t accept Medicare assignment, then the patient could pay a higher rental payment than what they’d pay at a supplier who does accept assignment. However, if the patient has a Medigap plan that covers the Part B cost-sharing amounts, then they won’t have to worry about paying any of this.
The only Medigap plan that covers the Part B deductible, copay, coinsurance, and excess charges,is Plan F. Consequently, Plan F will no longer be available to new Medicare beneficiaries as of January 1, 2020. Any Medigap plan that covers the Part B deductible will have the same rules.
Although Plan F won’t be available to new enrollees, Plan G will be. Medigap Plan G covers everything except the Part B deductible. This means that your patient will only have to worry about paying the Part B deductible before obtaining their oxygen therapy equipment.
Portable Oxygen Concentrators
If the patient is already using their oxygen rental benefit through Medicare, Medicare won’t pay for a portable oxygen concentrator. However, your patient may be able to receive portable oxygen in small liquid tanks through Medicare.
Because the amount Medicare will pay the supplier for portable tanks and portable concentrators is the same, most DME suppliers will provide the patient with the tanks since they are less expensive to supply.
However, if your patient would rather have a portable oxygen concentrator, they can purchase one without going through Medicare. For other questions about oxygen therapy equipment coverage under Medicare, you can contact a local Medicare-approved DME supplier.