COPD Treatment Supplies Covered by Medicare

Medicare will generally cover the cost of your home oxygen supplies

Oxygen therapy
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If you have chronic obstructive pulmonary disease (COPD), Medicare will usually cover several different therapies, ranging from home-use oxygen, pulmonary rehabilitation, and continuous positive airway pressure devices (CPAP). To qualify, you must have a breathing condition that oxygen, rehabilitation, or CPAP will improve.

Qualifying for Medical Oxygen and Supplies

Not everyone who is short of breath needs supplemental oxygen, but if your oxygen levels (as measured by an arterial blood gases test or ABG) show that you are chronically hypoxemic, meaning you have a long-term, insufficient supply of oxygen in your blood, then you are probably a good candidate for home oxygen therapy.

If your physician thinks you would benefit from home oxygen, you'll want to follow the steps as outlined by Medicare. Before calling the oxygen supply company, make sure you have a written prescription from your doctor for the home oxygen equipment and supplies you'll need. This applies to the oxygen concentrator all the way down to the tubing. If you don't have a doctor's order, Medicare won't cover it. Make sure your prescription is signed and dated by your doctor.

Once that is in order, make sure your doctor has documented your need for oxygen in your medical record. Medicare will request your records before approving your home oxygen, and if your condition is not well-documented, they may deny your claim. Make sure that your oxygen supply company has the order in hand before billing Medicare. They must also keep the order on file.

Your likelihood of being approved increases if you have: 

  • Severe lung disease or other condition that impairs your breathing, such as COPD. It must also be well-documented in your medical record.
  • A health condition that may be improved by using oxygen.
  • A PaO2 (as measured by arterial blood gasses) that is less than or equal to 55 mm Hg (normal is 75-100 mm Hg) and a documented oxygen saturation level of 88 percent or less while awake, or that drops to these levels for at least five minutes during sleep.
  • Tried alternative methods to improve your oxygenation, or they should have at least been considered and then deemed ineffective by your physician.

Qualifying for Oxygen Supplies

In order for Medicare to pay for oxygen and the additional supplies needed to administer it, you must have Medicare Part B coverage. Your doctor will need to write a prescription for the supplies, as well as the oxygen. Medicare is fairly generous when it comes to home oxygen equipment, and as long as you qualify, will pay for all or most of the following:

  • Medical-grade oxygen
  • Oxygen concentrators and other systems that furnish oxygen
  • Oxygen tanks and other storage containers
  • Oxygen delivery methods, such as nasal cannulas, masks, and tubing
  • Portable oxygen containers if they are used to move about in the home
  • A humidifier for your oxygen machine

Like any insurance plan, however, there are some things Medicare won't pay for, including portable oxygen that is used solely for sleep and portable oxygen that is used only as a back-up plan to a home-based oxygen system. For these, you'll need to use your own funds.

Coverage Details

Under most circumstances, you'll be responsible for 20 percent of the Medicare-approved amount (which may be less than the supplier or doctor actually charges). The Medicare Part B deductible will apply. The final amount you may owe is dependent on several factors, such as if you have alternate insurance, how much your doctor or supplier charges, and whether you purchase or rent your items.

If approved for home-use oxygen through Medicare, you'll be renting equipment from a supplier for 36 months, but after that point, your supplier must provide you with the equipment for up to an additional 24 months without charge, as long as you still need it. Your monthly payments to the supplier will pay for routine maintenance, servicing, and repairs and new supplies such as tubing and mouthpieces to be changed out regularly. The supplier will still own the actual equipment you'll be using throughout the five-year total rental period.

If you happen to own your oxygen equipment, Medicare will help pay for oxygen contents, delivery, and supplies, as long as the proper criteria (listed above) is met.

Qualifying for Pulmonary Rehabilitation

If you have moderate to severe COPD, Medicare covers comprehensive pulmonary rehabilitation services, performed in either the doctor's office or a hospital outpatient setting. These services help you lung function and breathing and work to better your quality of life with COPD. You'll need a referral from your physician before applying for Medicare coverage.

After meeting your Part B deductible, you'll be responsible for 20 percent of the Medicare-approved amount if the rehabilitation is performed in a doctor's office. If you receive rehabilitation treatment at a hospital, you may also be responsible for a per-session copayment.

Qualifying for CPAP Devices

If you've been diagnosed with obstructive sleep apnea (which is a common comorbidity with COPD and other lung conditions), you may be eligible for a three-month trial of CPAP therapy through Medicare. If you and your doctor can determine and prove that CPAP therapy is helping your condition, you may be able to keep your CPAP coverage for longer.

If you already own a CPAP machine, Medicare may cover a replacement CPAP machine rental cost and CPAP supplies.

Coverage Details

Under Medicare Part B coverage, the deductible applies first, and then you are responsible for 20 percent of the Medicare-approved amount for machine rental plus the cost of tubing and other supplies. If you're eligible for a trial period longer than three months, Medicare will cover your machine rental for 13 months, after which point, you'll own the machine.

Be sure that you're renting a CPAP machine from a Medicare-registered supplier. Otherwise, you may have to pay both your share and Medicare's share if the supplier is not enrolled in Medicare and accepting assignment.

A Word From Verywell

Before embarking on a new form of therapy for COPD, it's important to know that your Medicare coverage may not fully cover all of the services your physician recommends. In this case, you'll be responsible for paying some or all of costs out-of-pocket. Talk to your doctor about which services you require and whether they'll be covered by your insurance.

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