COPD Treatment Supplies Covered by Medicare

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 these therapies will improve.

Qualifying for Medical Oxygen

Not everyone who is short of breath needs supplemental oxygen. However, if your oxygen levels (as measured by a pulse oximeter at rest or with exertion, or an arterial blood gases test, called an ABG) show that you are chronically hypoxemic, meaning you have a long-term, insufficient supply of oxygen in your blood, you are probably a good candidate.

In order for Medicare to pay for oxygen and the additional supplies needed to administer it, you must have Medicare Part B coverage.

If your healthcare provider 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 practitioner for the home oxygen equipment and supplies you'll need, from the oxygen concentrator all the way down to the tubing. If you don't have a practitioner's order, Medicare won't cover the supplies. Make sure your prescription is signed and dated by your medical professional.

Once that is set, make sure your healthcare provider 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, that is well-documented in your medical record
• Another 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 mmHg (normal is 75 to 100 mmHg) and a documented oxygen saturation level of 88% 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 healthcare provider)

Oxygen Supplies

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 (coverage will depend on the amount of oxygen needed)
• 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.

Remember that the prescription your healthcare provider writes of oxygen must also specifically outline your need for related supplies.

Coverage Details

Under most circumstances, you'll be responsible for 20% of the Medicare-approved amount (which may be less than the supplier or healthcare provider actually charges). The Medicare Part B deductible will apply.

If approved for home-use oxygen through Medicare, you'll be renting equipment from a supplier for 36 months. 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, as well as replacement supplies such as tubing and mouthpieces (which should be changed out regularly). The supplier will still own the actual equipment you'll be using throughout the five-year total rental period.

The final amount you may owe depends on several factors, such as if you have alternate insurance, how much your healthcare provider or supplier charges, and whether you end up choosing to purchase (rather than rent) your items.

Qualifying for Pulmonary Rehabilitation

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

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

There is a limit on how many times patients can qualify for pulmonary rehab under the COPD diagnosis. Patients should talk with their doctor to decide if going to general physical therapy first is more worthwhile.

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 healthcare provider can determine and prove that CPAP therapy is helping your condition, you may be able to keep your CPAP coverage for longer. It is also important to see a physician 30 to 90 days after starting to use a CPAP device to document response to therapy and use of the device itself to maintain Medicare coverage of this benefit.

If you already own a CPAP machine, Medicare may cover CPAP supplies.

Coverage Details

Under Medicare Part B coverage, and after the deductible is met, you are responsible for 20% 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 an 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 healthcare provider recommends. In this case, you'll be responsible for paying some or all of costs out of pocket. Talk to your practitioner about which services you require and whether they'll be covered by your insurance.