How Medicare Covers DME And Oxygen Equipment?
Oxygen therapy equipment falls under the category known as “durable medical equipment” (DME), as doall necessary medical devices covered by medicare. Many other types of medical equipment also fall under this category. Things like hospital beds, wheelchairs, prosthetic equipment, and oxygen concentrators are all considered DME.
With Part B, Original Medicare will cover DME when your doctor deems it necessary and provides it foruse in your home. In this situation, nursing homes and hospitals providing you with Medicare-covered care will not qualify as your “home”.
If you are living in a long-term care facility, however, this facility can count as your "home", and your oxygen equipment could be covered under medicare. Also, if you are in a nursing home or other hospital setting, and they provide you with the equipment, the facility is responsible for paying for upkeep, repairs and replacements.
HMO or PPO Medicare Advantage Plans must cover the same items as original medicare. The costs will vary depending on which plan you choose. Depending on the plan, the costs might even be cheaper than Original Medicare. If you are already benefiting from a medicare advantage plan, contact them and ask how much DME will cost under their plan.
If you are switching to a new medicare advantage plan, be sure to call the new plan and ask for utilization management. They will tell you if your specific equipment will be covered and how much it will cost. If you are switching to Original Medicare, you can tell your supplier to bill Medicare as soon as your Medicare Advantage Plan is up.
You will also need to ask for a utilization plan if your insurance provider leaves the Medicare Advantage Plan. They will tell you what you need to do to get care under the original medicare benefits, or if you can switch to a different medicare advantage plan.
Under original medicare, your doctor will need to write a prescription for all the DME you will need. For some typs of DME, they may also have to write a separate letter directly to medicare, stating your need for the equipment. This certificate must be resubmitted whenever you need new equipment.
This document is known as a “certificate of medical necessity”. Your doctor and your supplier will work together to make sure all the proper paperwork is done and submitted to medicare.
In general, under Medicare part B, you would need to pay 20% of the amount approved by medicare, after you have met your deductible for that year. For the year of 2015 the deductible is $147. Medicare will then pay the remaining 80%. Medicare's approved amount is lower than the cost of the equipment. You might be required to pay less because medicare pays for certain types of equipment in different ways.
Sometimes equipment is set up to be "rented", or treated as a rental from the medical supply company. Such is the case with oxygen therapy equipment. There is often a specific time period attached to the rental period. For oxygen therapy equipment, this initial period lasts for 36 months.
After that 36 months, you will be done paying for your part of the equipment, and the contract will go on for another 2 years if you still need the equipment. The medical supply company will still be responsible for the maintenance and any repairs needed on the home oxygen equipment.