Medicare Guidelines & Oxygen

Recent changes in Medicare's guidelines affect patient ability to switch suppliers if they require portable medical oxygen for longer than 36 months.

History

• The Medicare Improvements for Patients and Providers Act of 2008, which went into effect in January 2009, repeals a prior act and permits the supplier to retain ownership of the oxygen equipment following the first 36-month rental period, rather than transferring title to the patient.

Significance

• The supplier is required to provide all the same items and services after the 36-month rental period for up to 2 additional years without charging Medicare or the beneficiary.
  Finding new suppliers after the 36 month rental period may be difficult because the new supplier would receive no monthly rental payments for the equipment.
  If the patient chooses to purchase his own oxygen equipment instead of renting, Medicare will not reimburse the lump sum.

Eligibility for Coverage

• Medicare will help pay for oxygen in cases with diagnosed lung disease when alternative methods were not effective.
  Additionally, blood oxygen must be 55 mmHg or less, or saturation 88 percent. If blood oxygen is between 56 and 59 mmHg and saturation is 89 percent, the patient still meets requirements if she exhibits symptoms of low tissue oxygen.

Items Supplied

• Oxygen supply systems (including oxygen concentrators), oxygen storage containers, oxygen and supplies for its delivery, such as tubing.

Payment

• Medicare pays 80 percent of the Medicare-approved amount. A secondary insurance may pay the additional 20 percent that is patient responsibility.

Considerations

• Moving may be difficult for Medicare patients who require prolonged oxygen therapy.