Dear Marci,
A few years ago, Original Medicare covered some of the costs of a walker I was prescribed for use in my home. My doctor recently gave me a prescription for oxygen equipment. Is this durable medical equipment like my walker, and will Medicare help pay for it?
– Samir (Dearborn, MI)
Dear Samir,
Yes, oxygen equipment is considered durable medical equipment (DME), and Medicare will help cover its costs.Specifically, Medicare Part B covers DME as long as the equipment is:
- durable, meaning you can use it again
- to help your medical condition
- meant for use in your home, although you are also allowed to use it outside of the home
- likely to last for three years or more
It is important to note that Medicare only pays for DME if you get it from the right kind of supplier. For Original Medicare, this depends on where you live. If you live in a region that is part of the competitive bidding demonstration, you will have to get your DME from a supplier that participates in the program. If you live in a region that is not part of the demonstration, you must get your DME through a supplier that has approval from Medicare. You can find a Medicare-approved supplier by visiting www.medicare.gov/supplier. Note that if you have a Medicare Advantage Plan you should contact your plan to find a certified supplier.
Although supplier restrictions are the same for oxygen equipment as for other types of DME, other coverage rules are different so the process for getting your oxygen equipment will be different from the process you used for getting your walker. Click here if you want to learn more about how Medicare pays for DME.
Unlike other types of DME, oxygen equipment is always rented in a five-year cycle. Medicare will pay the supplier a monthly rental fee for the first 36 months. The fee includes all equipment, oxygen, and supplies. You must pay 20 percent of each month’s rental fee. For the next 24 months, the supplier must allow you to keep the equipment, but Medicare rental payments stop. You pay no more rental fees, although the supplier still owns the equipment. Also, if you use oxygen tanks or cylinders, you must pay a 20 percent coinsurance for liquid or gaseous oxygen each month.
Finally, at the end of five years, you will have the choice to either get new oxygen equipment from your supplier or change to a different supplier.
Throughout this five-year period, the supplier must keep your equipment in good working order. During the first 36 months of the rental period, the supplier must provide you with supplies and maintenance free of charge. During the last 24 months of the rental period, providers are allowed to bill you for in-home maintenance visits every six months.
– Marci