If you are an individual who needs oxygen therapy, you must have several questions regarding your Medicare coverage. The answer is quite complicated and, at times, depends on the type of equipment you need for oxygen therapy. Medicare coverage for oxygen therapy became increasingly complex after a change in Medicare’s reimbursement rates slashed by 50%.
The rate cut leads to multiple oxygen equipment suppliers, unable to continue their contracts at high prices. Providers were facing little to no return on their investments because they were paid far too less. But before analyzing where the problems started, let’s first understand the equipment and the type of patients who can qualify for Medicare for oxygen therapy.
There are three types of equipment required for patients undergoing therapy:
Liquid Oxygen Systems: These systems involve installing one oxygen reservoir that houses the bulk of the liquid. They come with a portable extension though its portability is limited to your home, and it requires constant refills.
Compressed Gas Systems: These are the most common systems used in oxygen therapy. Massive tanks are filled with concentrated oxygen that is delivered to your home. They come with tubing that is 50 feet in length, and the device itself comes with a regulator that conserves oxygen and only delivers it in pulses instead of a constant stream.
Portable Oxygen Concentrators: These systems are the most convenient as they are the most mobile. They are as light as a backpack and come with only 7 feet of tubing. They can be carried around easily, which means that you can still travel and walk around even if you are on oxygen therapy. These systems are electrical and do not require tanks to fill them up.
Who Can Qualify For Medicare?
The following are the general criteria to qualify for Medicare coverage for oxygen therapy:
- You must have a doctor or physician order oxygen therapy after being diagnosed with the qualifying medical condition.
- Specific tests that show the requirement for oxygen therapy. The results of these tests must fall in a particular range.
- The physician or doctor must specify the duration, amount, and frequency of oxygen you need. If you have a condition that calls for an as-needed basis, then Medicare coverage does not apply.
- To qualify for a POC, you must require oxygen 24/7
- Certain cases may require you to show that you have tried alternatives to oxygen therapy and that these alternatives have failed to lower your condition’s severity.
- Your rental equipment can only be bought from a provider that is a Medicare participant. This provider must also be willing to accept the assignment of equipment.
If you are above 65 years of age and fulfill all the above criteria, you can qualify for Medicare coverage. However, whether you will get a POC or not is another matter.
Due to the slashing of reimbursement rates by 50% by Medicare, oxygen equipment suppliers ended up being paid less. This essentially meant that any oxygen equipment supplier would get a low return on their rental because Medicare’s reimbursement rates wouldn’t allow them to make a profit or at least break even. Suppliers ended up having to cover the costs of POCs first and then bill Medicare, which then leads to huge losses.
As of now, you require a Medicare-approved oxygen equipment supplier, which is hard to find. But if you are lucky enough to get one, you need a physician’s written order. This order will include:
- Your full name
- The equipment you require
- Your pulse flow rate or your continuous flow rate
- The duration for which you’ll need supplemental oxygen
- The order date
- The physician’s signature
Once these are submitted, your application is processed. Do not be disheartened by rejected applications, as these are usually due to an error in paperwork. While this does restart your application from the first stage, you must remember to keep getting your test reports from the doctor so that all your diagnostics and lab analysis reports are entirely up to date.
Once your application is accepted, and you qualify for all the necessary criteria, then you are eligible to rent your POC for 36 months or three years. If you require supplements beyond this period, the supplier will comply for 24 months or two years. To use the POC beyond this period will require a renewed rental agreement with the supplier.
Medicare coverage for oxygen therapy is needlessly complicated when it comes to POCs because of their high demand. Suppliers get the short end of the stick with the low reimbursement rates from Medicare, resulting in them being discouraged from supplying this equipment. A few reliable suppliers are still prioritizing the patient’s needs that you can reach out to help you.