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Oxygen therapy is used to treat certain conditions. For example, if you are experiencing trauma or illness that lessens your ability to breathe, you may need oxygen therapy.
You may also need oxygen therapy if the chemistry in your blood changes. It can be used at home or during your stay at a skilled nursing facility.
If you or a loved one is in a nursing home and needs this type of therapy, a common question you likely have is, “Does Medicare cover oxygen in a nursing home?” In this article, we answer that question in clear, plain English. You will also find the average costs of oxygen therapy for those who have to pay for it out of pocket.
Does Medicare Cover Oxygen In A Nursing Home?
The short answer is yes; Medicare will cover the cost of oxygen therapy in a nursing home. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your oxygen therapy in a nursing home. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for oxygen therapy in a nursing home. Parts A and/or B provide coverage for your oxygen therapy in a nursing home if it is considered medically necessary. The operation must also be first ordered by your healthcare provider for Original Medicare to provide coverage.
Coverage for oxygen therapy in a nursing home is provided by Medicare Part A. Medicare Part A provides coverage for many medical services and equipment used in a nursing home. Medicare Part A’s coverage will change the longer you stay in a nursing home. Your benefit period will reset after 60 consecutive days of being released in a nursing home.
For the first 20 days, Medicare Part A will cover 100 percent of the costs of your stay in a nursing home. For days 21 to 100, Medicare will still provide coverage for your stay in a nursing home, but you will pay a copayment each day you are there. After 100 days, Medicare Part A will no longer provide coverage.
On the other hand, coverage for oxygen therapy in an outpatient setting, as well as oxygen equipment, is provided by Medicare Part B. Medicare Part B considers oxygen equipment as durable medical equipment. or DME. Once approved, Medicare Part B covers 80 percent of the costs of oxygen equipment. You will pay for the remaining 20 percent.
Part C Coverage for Oxygen In A Nursing Home
Medicare Advantage plans (Medicare Part C) also provide coverage for oxygen therapy in a nursing home. This is because these plans must cover all the same treatments and services that Original Medicare covers. Though Part C plans will cover additional benefits as well. What each Part C plan covers and what you will have to pay out of pocket for the coverage will vary from plan to plan.
How Much Does Oxygen Therapy Cost?
The cost of hyperbaric oxygen therapy (HBOT) can be over $100 in a HBOT clinic if you have to pay for it yourself. On the other hand, in a hospital setting, it can cost over $1,000.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover the Vectra DA test?