Chronic Obstructive Pulmonary Disease (COPD) can make breathing challenging, but an oxygen concentrator can help improve your quality of life. If you’re eligible for Medicare, understanding how to navigate the process can make accessing this essential equipment easier. Let’s uncover the steps to get a COPD oxygen concentrator with Medicare, ensuring you have the support you need.
Step 1: Understand Medicare Coverage for Oxygen Therapy
Medicare Part B covers durable medical equipment, including oxygen concentrators, if they are medically necessary. For COPD patients, this typically involves testing to demonstrate low blood oxygen levels. Your doctor must prescribe oxygen therapy, detailing why it’s essential for your condition.
Coverage includes:
- 80% of the equipment rental cost.
- A portion of maintenance and supplies.
- Regular assessments to confirm continued need.
You are responsible for the remaining 20%, along with the annual Part B deductible. Portable oxygen concentrators (POCs) are often not fully covered, but exceptions may apply depending on your medical needs and supplier availability.
Step 2: Meet Eligibility Requirements
To qualify for Medicare-covered oxygen therapy, you must meet specific criteria that demonstrate your medical need. This includes having a confirmed diagnosis of COPD or another condition requiring oxygen therapy.
Additionally, your blood oxygen levels must measure 88% or lower during rest, sleep, or physical activity, as determined by pulse oximetry or arterial blood gas tests. Your doctor must also complete and sign a Certificate of Medical Necessity (CMN), which outlines your oxygen requirements and the expected duration of use.
Step 3: Work with an Approved Supplier
Medicare requires you to use a supplier enrolled in its program. Locate an approved provider through the Medicare website or by asking your doctor for recommendations. Be aware that suppliers must follow Medicare’s Competitive Bidding Program rules, which aim to lower costs for patients.
When selecting a supplier:
- Confirm they offer the specific oxygen concentrator you need.
- Check if they provide both portable and stationary options.
- Verify their compliance with Medicare guidelines.
Some companies, like Inogen, offer POCs and help patients navigate the Medicare process to determine eligibility and coverage.
Step 4: Navigate the Rental Process
Medicare typically covers oxygen concentrators on a rental basis. Once approved, the supplier will deliver the equipment and provide instructions for use. The rental agreement lasts 36 months, during which the supplier maintains and services the device. After this period, Medicare may cover continued use, though the specifics depend on your ongoing medical needs.
Keep in mind:
- Regular follow-up with your doctor is necessary to ensure continued coverage.
- You must adhere to the rental terms, including proper maintenance and use.
What to Do If Medicare Does Not Fully Cover POCs
Portable oxygen concentrators are a convenient option for many COPD patients, allowing mobility and ease of travel. However, because Medicare often prioritizes stationary units, you may face out-of-pocket costs for a POC. In such cases:
- Explore financing options through suppliers like Inogen.
- Check for supplemental insurance that can cover remaining costs.
- Investigate financial assistance programs from nonprofit organizations.
Learn More Today
Obtaining a COPD oxygen concentrator with Medicare involves understanding eligibility requirements, coverage details, and working with approved suppliers. By following these steps, you can access the equipment you need to improve your quality of life.
While navigating Medicare may seem daunting, resources like Inogen can provide helpful support, ensuring you breathe easier with confidence.