Is Oxygen Therapy Covered By Insurance?

Find out if your lung relief can be backed by insurance. 

Medical bills are becoming increasingly more expensive to pay off. When it comes to conditions such as Chronic Obstructive Pulmonary Disease (COPD), it’s certainly not an exception to a high cost that can burn a hole in your savings. 

Having a condition like COPD can cause problems for your airflow that might make it hard to breathe regularly — an action that most people take for granted. In America, almost more than 15 million people are affected by it every day alone. To experience some relief, many end up turning to a form of oxygen therapy with a DME, or durable medical equipment. Such pain-relieving devices include home oxygen concentrators, portable oxygen concentrators, or other related machines, which make it possible for people with COPD to maintain an active lifestyle. 

However, these devices come at a cost., and it’s not a small one either. That’s why most people instantly wonder if such DME is covered by insurance. 

While it certainly is available, it’s often hard to obtain due to the fact that oxygen tanks are considered “luxury items.” However, before you quickly give up your research and settle with a less-than-quality piece of equipment, you should consider the many ways you’re possibly able to receive some form of coverage or alternative. Without further ado, let’s dive right into your potential options to bring some much-needed relief into your airflow. 

Does Medicare Cover Oxygen Therapy & Equipment?

The answer is a yes, but only if certain qualifications are met. Because oxygen equipment falls under the DME category, Medicare covers some of the cost under Part B. Take a look at the following qualifications to determine your eligibility: 

  • Your health will improve with oxygen therapy
  • Your arterial blood gas levels are low
  • Other alternative treatment measures have failed
  • Your doctor confirms that you have a severe lung disease, like COPD, asthma, or pneumonia

In most insurance cases, Medicare will try to find plenty of excuses to deny you coverage. That’s why you’ll want to be completely prepared in the information you present and how you approach the reimbursement process. Getting a written certificate of medical necessity (CMN) from your doctor containing the severity of your disease and how often you’ll need oxygen is a must. If that claim is denied, it’s your chance to file an appeal which details how having the disease is impacting both your professional and personal life. 

Once you’re finally accepted and you’ve paid your deductible, Medicare will generally cover 80 percent while you’ll have to supply the rest of the cost out of pocket. 

Payment Plans & Alternatives

Let’s say in the worst-case scenario, Medicare and all other medical insurance providers refuse to give you coverage. They not only deny your initial claim, but your appeals as well. 

In those cases, plenty of companies that supply DME, and oxygen therapy equipment are willing to form a payment plan with you by splitting up the large cost into more manageable monthly payments. You might also want to consider opening up a medical credit option such as CareCredit or look into The Partnership for Prescription Assistance if you face a certain financial hardship. 

In the end, an oxygen therapy device can greatly improve the lifestyle you’re able to experience if you live with a lung-affecting condition. No matter what happens with insurance, there are always plenty of options you can explore to get the relief that you need. 

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.