Medicare y las botellas de oxígeno: ¿Cubre Medicare la terapia de oxígeno?

A veces, el uso de una botella de oxígeno puede ser necesario para determinados problemas de salud. Pero, ¿cubre Medicare las botellas de oxígeno? Sí, Medicare cubre el uso de un tanque de oxígeno y los suministros médicos que lo acompañan. No obstante, existen normas y estipulaciones que determinan si Medicare cubre la oxigenoterapia y en qué medida.

This resource will explain everything Medicare beneficiaries need to know about Medicare and oxygen tanks, including rules, regulations, costs, and more.

La oxigenoterapia utiliza distintos tipos de máquinas y equipos de oxígeno para tratar diversas afecciones pulmonares y respiratorias. Algunos de estos problemas de salud son:

• Fibrosis quística

• EPOC

• Neumonía

• Insuficiencia cardiaca

• Enfermedad pulmonar

• Apnea del sueño

Sistema de gas comprimido

These oxygen machines are small, pre-filled tanks. These can be delivered on a weekly basis, depending on the amount of oxygen needed. There are also home-fill systems that can be filled overnight from the concentrator. This type of oxygen tank must be used alongside an oxygen conserving device or regulator (OCD).

Sistema de oxígeno líquido

A liquid oxygen system consists of a small, refillable tank. It can be filled from its reservoir as needed.

Concentrador de oxígeno portátil

Portable oxygen concentrators (POC) are portable, electric devices that can be worn on the patient’s back or wheeled around. It requires no tanks and no filling. This portable tank can also be brought on airplanes.

As a reminder, Original Medicare only consists of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Original Medicare does not include prescription drug coverage. If a Medicare beneficiary wants coverage for prescription drugs, they would need to enroll in Medicare Part D or a Medicare Advantage plan.

Medicare covers oxygen tanks and home oxygen equipment under Medicare Part B. This is because Medicare considers oxygen tanks to be durable medical equipment (DME), which Medicare Part B covers.

¿Cómo se puede optar a la cobertura?

Para tener derecho a la cobertura de Medicare para la oxigenoterapia a domicilio, existen tres requisitos básicos:

• You must be enrolled in Part B

• You must have a medical need for oxygen

• You must have a doctor’s order specifically for home oxygen

If you fulfill these coverage qualifications, then Medicare will help cover the cost of your home oxygen equipment, supplies, and more.

Medicare covers oxygen tanks and stationary oxygen equipment under Medicare Part B. This is because Medicare considers oxygen tanks to be durable medical equipment (DME), which Medicare Part B covers.

¿Qué se considera necesidad médica?

Medical necessity is most notably determined by whether a person’s condition causes them to experience hypoxemia, which is low levels of oxygen in the blood.

Se sabe que algunas afecciones, como la insuficiencia cardíaca, provocan hipoxemia y podrían considerarse médicamente necesarias.

Las afecciones que causan dificultad para respirar pero no dan lugar a niveles sanguíneos de oxígeno más bajos no suelen considerarse médicamente necesarias y no estarían cubiertas.

Additionally, your doctor’s diagnosis must include your specific condition, how much oxygen you need, and how often you need it. If your diagnosis only requires you to have oxygen on an as-needed basis, it’s unlikely Medicare will provide coverage.

¿Qué es un equipo médico duradero?

Durable medical equipment (DME) is medical equipment a doctor prescribes for home use. DME is covered under Medicare Part B. Types of durable medical equipment include:

• Medidores de azúcar en sangre

• Tiras reactivas de azúcar en sangre

• Elevadores de pacientes

• Camas de hospital

• Caminantes

• Sillas de ruedas y scooters

• Equipos de oxígeno y accesorios

While Medicare Part B provides coverage for DME, there are specifics involved for each type of medical equipment. Also, not every type of oxygen equipment, accessories, and supplies is covered by Medicare.

¿Cuáles son los costes de Medicare de la oxigenoterapia a domicilio?

Medicare covers the rental of oxygen equipment, contents, and supplies, so long as the following conditions are met:

• Un médico declara que el beneficiario padece una enfermedad pulmonar grave o no recibe suficiente oxígeno.

• A patient’s health would improve with oxygen therapy

• The patient’s arterial blood gas level falls within a certain range

• Otras terapias alternativas no han funcionado

Si se cumplen estas condiciones, Medicare paga lo siguiente:

• Sistemas que suministran oxígeno

• Recipientes que almacenan oxígeno

• Tubos y accesorios de oxígeno relacionados para el suministro de oxígeno y su contenido

Medicare will also cover a humidifier if it is used due to the oxygen machine.

When it comes to Medicare costs, Medicare pays 20% of the Medicare-approved amount for the rental of the aforementioned supplies. The Part B deductible also applies.

Do note, it is important for beneficiaries to confirm coverage and costs with their healthcare provider and their insurance company. There are a variety of factors that contribute to exact pricing, such as:

• Otros seguros de enfermedad

• Doctor’s fees

• Si el médico y el proveedor aceptan la asignación de Medicare

Medicare beneficiaries who use oxygen will need to rent oxygen equipment from a supplier for 36 months. After this 36-month rental period, the oxygen supplier must continue to supply the beneficiary with oxygen equipment and supplies for an additional 24 months. In total, the DME supplier must provide supplies for a total of five years, so long as the medical need for oxygen persists.

The supplier will bill Medicare a monthly rental payment. These rental payments cover more than just the oxygen equipment, however. The rental payments also go towards:

• Tubing or a mouthpiece

• Contenido de oxígeno

• Mantenimiento de la máquina de oxígeno

• Mantenimiento de máquinas de oxígeno

• Reparación de máquinas de oxígeno

Qué más hay que saber sobre el alquiler de equipos de oxígeno

El proveedor médico debe mantener el equipo de oxígeno alquilado en buen estado de funcionamiento mientras el beneficiario lo necesite durante el periodo de alquiler de 36 meses, así como durante el periodo adicional de alquiler de 24 meses si procede. Durante estos periodos de alquiler, el proveedor es propietario del equipo de oxígeno.

In the event that a Medicare beneficiary has a medical necessity for oxygen therapy after the five years have passed, the DME supplier no longer has to continue providing the oxygen and oxygen equipment. In this scenario, the Medicare beneficiary may choose to get replacement equipment from a different supplier.

From there, a new 36-month payment period, and five-year supplier obligation period, starts as soon as the old five-year period ends for new oxygen and oxygen equipment.

Existen determinadas situaciones en las que los equipos y suministros de oxígeno tendrán normas de cobertura de Medicare diferentes. Por ejemplo, si el equipo de oxígeno deja de ser eficaz, el proveedor de equipo médico duradero cierra, etc.

Alquiler frente a propiedad de equipos

There are pros and cons to deciding whether to rent or own oxygen equipment when using Medicare to help cover the costs.

A beneficiary must determine which option will be most cost-effective over time. If renting equipment, Medicare will cover 80% of the costs for five years, or the length required for a supplier to provide oxygen and equipment. After five years, if the need for oxygen persists, a person can switch to a new supplier and start the five-year period again. Additionally, the supplier must keep the equipment in acceptable condition, so any issues or repairs will fall to the supplier.

If a person owns or wants to own oxygen equipment instead of renting, Medicare will cover the oxygen content and supplies as long as it’s considered medically necessary. In some cases, DME suppliers may allow a person to finance an oxygen machine through monthly payments, allowing you to own the equipment once fully paid.

It’s up to the beneficiary to decide which option is the most cost-effective solution.

What If A Beneficiary Already Has Their Own Equipment?

If a Medicare beneficiary already has their own oxygen therapy equipment, Medicare will assist in paying for oxygen contents and supplies if it is deemed medically necessary.

Medicare Advantage plans, also known as Medicare Part C or MA plans, may include prescription drug benefits. MA plans are a type of Medicare supplement plan and are provided by private insurance companies that are Medicare-approved. Medicare Part C plans consist of the standard Medicare coverage (Medicare Part A and Medicare Part B), in addition to other healthcare benefits including vision, hearing, and prescription drugs. Exact benefits will vary per plan. MA plan beneficiaries should confirm extra benefits with their insurance company.

Because MA plans include Medicare Part B, this means that oxygen tanks would be covered under an MA plan as durable medical equipment. Exact costs will vary.

Los seguros complementarios de Medicare, también conocidos como Medigap o MedSupp, son planes complementarios de Medicare que ayudan a"fill in the gaps” of Original Medicare.

Medigap policies are sold by private insurance companies and help pay some out-of-pocket costs such as deductibles, coinsurance, and copays. This means a Medigap plan may help reduce costs for oxygen therapy and equipment.