Whether you’re new to supplemental oxygen or a veteran user, understanding how Medicare pays for your oxygen and what your responsibilities are is of utmost importance.
To help you navigate this territory, the Pulmonary Fibrosis Foundation (PFF) offers a helpful overview in its step-by-step guide to supplemental oxygen.*
How it works
If you have a medical need for supplemental oxygen, Medicare Part B covers your oxygen equipment and accessories. You’ll sign a five-year contract with the following stipulations:
- You will pay 20% of the amount approved by Medicare. Medigap assistance may be available to help pay the 20% for which you’re responsible.
- You will rent your equipment from a supplier for the first 36 months of the five-year cycle.
- The supplier will continue to provide equipment, tank refills, and accessories for the remaining 24 months.
- The supplier will provide service and repair for the entire five-year cycle, except in specified circumstances (e.g., emergency situations).
- If your supplier refuses to provide equipment or services, you should:
- Make them put their intentions in writing
- File a complaint at 1-800-MEDICARE (1-800-633-4227)
Those with a Medicare Advantage Plan should have coverage of supplemental oxygen. If you have this type of plan, it’s recommended that you confirm the specifics of your supplemental oxygen coverage.
How are changes handled?
Some changes we can anticipate and some we can’t. Here’s what you need to know about the most common scenarios.
- Your needs change. If your oxygen needs change during the five-year contract cycle, get re-tested. Your physician will update your Certificate of Medical Necessity. While the supplier must provide equipment and services to meet your current medical needs, they cannot alter the type or amount of deliverables without your doctor’s order.
- You move to a new city or state. If you move after the initial 36-month rental period, your existing supplier should help you secure a supplier in your new location. If you move during the initial 36-month rental period, you can either ask your present supplier for help in locating a new supplier or you can check Medicare’s supplier directory.
- The contract ends. At the end of the five-year cycle, your supplier is no longer obligated to provide your oxygen equipment and accessories, or service equipment. Your doctor will need to complete a new Certificate of Medical Necessity regardless of whether you choose to remain with your supplier or switch to a new one.
An oxygen supplier isn’t required to give you a particular brand of equipment—only the type of oxygen indicated by your doctor. Be sure your healthcare provider determines that the supplier’s equipment meets all of your needs before you commit to a five-year Medicare contract.
To learn more, refer to the PFF’s Medicare Patients’ Oxygen Rights brochure. (A Spanish version is available here.)
*Pulmonary Fibrosis Foundation. Oxygen Basics: A step-by-step guide to using supplemental oxygen [Digital booklet]. https://www.pulmonaryfibrosis.org/docs/default-source/programs/educational-materials/oxygen-basics/oxygen-basics-booklet.pdf
Spanish version: https://www.pulmonaryfibrosis.org/docs/default-source/programs/educational-materials/oxygen-basics/oxygen-basics-booklet-esus.pdf