Medicare Qualification Guidelines for Portable Oxygen

Elderly Americans and those who are disabled who can receive Medicare, the federally administered health-care program. Many members of the elderly and disabled population are particularly at risk for diseases and illnesses that may cause breathing problems. Portable oxygen is one treatment for many of these diseases, and for those who are qualified, Medicare covers it.

Durable Medical Equipment

Medicare classifies portable oxygen as durable medical equipment (DME). DME is a class of supplies that are reusable, used in primarily in the home, and help alleviate an illness or a symptom of an illness. Portable oxygen, wheelchairs and hospital beds are also examples of DME. DME is covered under Medicare's Part B benefit.

Diagnosis Qualifications

In order for Medicare to cover portable oxygen, the beneficiary must suffer from and beofficially diagnosed with a disease that causes difficulty in breathing, such as emphysema. Then the beneficiary's doctor must prescribe the portable oxygen, either through writing a prescription or a certificate. When writing this, the doctor must declare the item medically necessary, and in some cases, Medicare may require particular tests or examinations be performed before it will accept the diagnosis and cover the item.

Supplier Qualifications

What Medicare will cover depends on where the beneficiary rents the portable oxygen from. For Medicare to cover any portion of the bill, the beneficiary must go to a Medicare-certified supplier. Furthermore, if the beneficiary goes to a supplier that accepts Medicare assignment, which means accepting Medicare payment as full, then Medicare pays 100 percent of the costs, and the beneficiary needs to pay nothing out-of-pocket. If the supplier does not accept assignment, then Medicare covers 80 percent and the beneficiary or her supplemental insurance must cover the remaining 20 percent.

Renting Oxygen

Renting portable oxygen works very differently than other types of DME. While the beneficiary typically “rents-to-own” DME from suppliers, a beneficiary is never qualified to own the portable oxygen equipment, but instead is always renting it from the supplier. Medicare covers a rental fee for 36 months which is subject to any co-insurances if it is rented from a supplier that does not take assignment. After 36 months, there is no longer any rental fee, but the beneficiary is still technically renting the equipment from the supplier. Beneficiaries are qualified to keep the item for another two years before needing to rent a new one (portable oxygen equipment is only good for five years). The beneficiary is responsible for purchasing any oxygen tanks or cylinders required from the supplier.

Qualifying for Repairs

The supplier must provide routine cleanings and upkeep of the equipment to keep it in good working condition. If the equipment ever needs repairs, the supplier should provide the repair service and any parts needed to make the repair at no cost when the supplier takes assignment. If the supplier does not take assignment, then the beneficiary or their supplemental insurance is responsible for 20 percent of the cost.

References

• Medicare Interactive: What Is Durable Medical Equipment (DME)?
• Medicare Interactive: Will Medicare Cover Repairs and Maintenance of My Durable Medical Equipment (DME)?
• Medicare Interactive: When Can I Rent Durable Medical Equipment (DME) and When Must I Buy It?
• Medicare Interactive: When Will Medicare Pay for Durable Medical Equipment (DME)?
• Medicare Interactive: What Does not Qualify as Durable Medical Equipment (DME)?

Resources

• Medicare & You Handbook 2010
• Medicare.gov
• Medicare Interactive