Getting a hospital bed or home oxygen through Medicare

Start with the problem the equipment needs to solve. Is a bed needed for medically necessary positioning? Is prescribed oxygen difficult to use, unavailable for a trip or too expensive? Tell the clinician and supplier the specific problem so they can check the order, documentation and equipment together.

Medicare Part B covers hospital beds as durable medical equipment when prescribed by a doctor or other treating provider for use at home and the requirements are met. Your prescriber and supplier must be enrolled in Medicare. Ask which bed and accessories the order supports, whether the arrangement is rental or purchase, and what you would pay for any requested upgrade. Do not assume every bed advertised as a hospital bed is covered.

Medicare's oxygen benefit has medical-necessity, testing and documentation requirements. The prescribing clinician and supplier must check the applicable criteria. A diagnosis, a home oximeter reading or an equipment advertisement does not establish coverage by itself. CMS's oxygen coverage policy explains the detailed requirements and exceptions.

For covered home oxygen, the monthly rental includes necessary supplies and accessories, including cannulas and tubing. If the fit is poor or the equipment is not meeting your needs, ask the supplier to review it and involve the prescribing clinician. Ask them to confirm a suitable accessory for your prescribed setup before purchasing a replacement yourself. Coverage of necessary supplies does not establish that a particular brand or size is in stock.

A portable oxygen system may be covered when its criteria are met. That does not guarantee a particular portable concentrator or reimbursement for a retail purchase. Ask the clinician and enrolled supplier which equipment meets your prescribed needs and which options they can provide under your coverage. CMS describes separate criteria for portable oxygen.

Give the supplier and prescribing team the length and details of a typical trip, including travel, waiting and the journey home. Ask them to help you plan around the exact device and prescribed settings. Do not reduce prescribed oxygen to make a battery last longer; discuss any changes with the prescribing clinician.

• Is this device suitable for my prescribed oxygen needs during this activity? Can you show me how to use it and recognize an alarm?
• What battery runtime should I expect for this device at my prescribed settings, and should this battery be checked?
• Which batteries, car adapters and chargers are approved for this exact model?
• What backup arrangement should I have if the battery runs out, the equipment stops working or the appointment runs late?
• If I need oxygen at the destination, who will arrange and confirm it before I leave? Do not assume the clinic, hotel or transport provider can supply it.

If finding an affordable ride is a separate barrier, tell the clinic's care coordinator or social worker and ask about local options. Plan the equipment and the ride together. Asking these questions does not guarantee that a particular service or backup is available.

Medicare generally pays oxygen-equipment rental for 36 months. The supplier furnishing the equipment in month 36 must continue necessary equipment, accessories, maintenance and repairs through the five-year useful lifetime, while you continue to need oxygen. Some oxygen contents and servicing can still have coinsurance after rental payments end. See Medicare's rental and servicing explanation.

During the initial rental period, a supplier change may be possible, but switching does not start a new 36-month rental. After month 36, the servicing supplier has continuing obligations. Before changing companies, confirm your options with the current supplier, a potential new supplier and 1-800-MEDICARE (1-800-633-4227). Keep service in place while an alternative is confirmed. CMS's oxygen policy article explains rental and supplier responsibilities.

If the supplier does not resolve a problem, ask for its complaint process and call 1-800-MEDICARE for help understanding your options. If you have Medicare Advantage, also contact your plan about its supplier network, authorization, costs and complaint process. Do not assume that changing a supplier or obtaining a different accessory will be approved.

With Original Medicare, after the Part B deductible, you generally pay 20% of the Medicare-approved amount for covered equipment when the supplier accepts assignment. Ask whether the supplier will accept assignment for every rental month. Other insurance may reduce your share, but it does not always pay it in full. The hospital-bed and oxygen coverage pages explain the cost conditions. For Medicare Advantage, confirm your specific plan's costs and requirements.

1. 1.Ask the supplier exactly what is holding up the order: missing documentation, a coverage decision, equipment availability or something else.
2. 2.Ask the prescriber's office to address any clinical or documentation questions directly with the supplier. Request a clear next step and a contact person.
3. 3.Confirm the expected delivery or repair arrangements, setup instructions, your costs and whom to call if there is a problem. If equipment is needed for discharge, tell the discharge team before leaving.
4. 4.If there is a denial, request the written reason and follow the notice's instructions and deadlines. Ask what can be corrected and whether an appeal is needed; do not assume resubmission will resolve every denial.

Navigate Care can help coordinate questions, records and follow-up with your clinician, supplier and insurer by phone or video. The navigator does not prescribe or fit equipment, deliver oxygen, visit the home or guarantee coverage. When practical barriers interfere with care, ask your provider whether Community Health Integration may be appropriate. Eligibility, a qualifying provider visit and consent are required; ongoing navigation may have costs. A free introductory call is separate from those services.