Medicare e le bombole di ossigeno: Medicare copre l'ossigenoterapia?

A volte, l'uso di una bombola di ossigeno può essere necessario per alcune condizioni di salute. Ma Medicare copre le bombole di ossigeno? Sì, Medicare copre l'uso di una bombola di ossigeno e delle relative forniture mediche. Tuttavia, esistono regole e clausole che stabiliscono quanto e se Medicare coprirà l'ossigenoterapia.

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

L'ossigenoterapia utilizza diversi tipi di macchine e apparecchiature per l'ossigeno per trattare varie condizioni polmonari e respiratorie. Alcuni di questi problemi di salute includono:

• Fibrosi cistica

• BPCO

• Polmonite

• Insufficienza cardiaca

• Malattie polmonari

• Apnea notturna

Sistema a gas compresso

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 di ossigeno liquido

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

Concentratore di ossigeno portatile

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.

Come ci si qualifica per la copertura?

Per avere diritto alla copertura Medicare per l'ossigenoterapia domiciliare, ci sono tre requisiti fondamentali:

• 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.

Che cosa si intende per necessità medica?

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.

Alcune condizioni, come l'insufficienza cardiaca, sono note per causare l'ipossiemia e potrebbero essere considerate necessarie dal punto di vista medico.

Le condizioni che causano respiro affannoso ma che non comportano una riduzione dei livelli di ossigeno nel sangue non sono generalmente considerate necessarie dal punto di vista medico e non sono coperte.

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.

Che cos'è un'apparecchiatura medica durevole?

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:

• Misuratori di glicemia

• Strisce reattive per la glicemia

• Sollevatori per pazienti

• Letti ospedalieri

• Camminatori

• Sedie a rotelle e scooter

• Attrezzature e accessori per l'ossigeno

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.

Quali sono i costi Medicare per l'ossigenoterapia domiciliare?

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

• Il medico dichiara che il beneficiario è affetto da una grave malattia polmonare o non riceve abbastanza ossigeno.

• A patient’s health would improve with oxygen therapy

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

• Altre terapie alternative non hanno funzionato

Se queste condizioni sono soddisfatte, Medicare paga quanto segue:

• Sistemi che forniscono ossigeno

• Contenitori che immagazzinano ossigeno

• Tubi e relativi accessori per l'ossigeno per la somministrazione di ossigeno e del suo contenuto

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:

• Altre assicurazioni sanitarie

• Doctor’s fees

• se il medico e il fornitore accettano l'incarico 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

• Contenuto di ossigeno

• Manutenzione della macchina per l'ossigeno

• Assistenza alle macchine per l'ossigeno

• Riparazione di macchine per l'ossigeno

Cosa c'è da sapere sul noleggio di apparecchiature per l'ossigeno

Il fornitore medico deve mantenere l'apparecchiatura per l'ossigeno a noleggio in buone condizioni di funzionamento per tutto il tempo in cui il beneficiario ne ha bisogno durante il periodo di noleggio di 36 mesi e il periodo di noleggio aggiuntivo di 24 mesi, se applicabile. Durante questi periodi di noleggio, il fornitore è proprietario dell'apparecchiatura per l'ossigeno.

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.

In alcune situazioni, le apparecchiature e le forniture di ossigeno sono soggette a regole di copertura Medicare diverse. Ad esempio, se l'apparecchiatura per l'ossigeno non è più efficace, se il fornitore di DME ha cessato l'attività, ecc.

Noleggiare o possedere un'attrezzatura

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.

Le assicurazioni integrative di Medicare, note anche come Medigap o MedSupp, sono piani integrativi di Medicare che aiutano"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.