When your doctor prescribes oxygen therapy, make sure you discuss your regular activities and hobbies so the prescription describes the oxygen delivery system that will work best for your lifestyle.

After you have a prescription, your insurance provider will contract with an oxygen supply company to deliver your oxygen and equipment. Once you receive that equipment, it can be challenging to get something different from the oxygen supply company.

Only your medical team can adjust your oxygen prescription, including how much oxygen you need and the type of equipment to use. Your care team must send your oxygen supplier a letter of medical necessity, a document that requests service and states your need for oxygen therapy. The letter should also address your mobility needs inside and outside your home.

If your oxygen requirements change or your doctor thinks you need different a different delivery system or equipment, they should update your certificate of medical necessity and send it to your oxygen supplier.

Medicare beneficiaries have five-year contracts with Medicare and their home oxygen suppliers. Medicare covers only your main source of oxygen, whether you choose a home concentrator or a more portable option. The contract works similarly to a car or property lease: the oxygen supplier owns the equipment and you pay a fee throughout the five-year period. If you and your supplier renew the contract, the process will begin again. The oxygen supplier always owns the equipment.

The contract begins the first month the supplier bills Medicare for your oxygen. In the first three years of the contract, the oxygen supplier receives payment for the equipment rental. In the last two years, the payment covers replacement tanks, hoses and other supplies. The oxygen supplier must maintain and repair the equipment and replace regulators, tubing, filters and other accessories for the length of the contract.

Medicare covers 80% of the charges billed by the oxygen supplier. You are responsible for the remaining amount. If you have a supplemental Medicare insurance plan, sometimes called a Medigap plan, the plan might offset or cover the remaining 20%. Ask your supplemental plan provider if it covers the 20% copay.

A drawback to the contract process is that it might be difficult to find a new provider if you want to change suppliers, especially later in the contract period. That’s because Medicare likely wouldn’t pay the new supplier a rental fee for the equipment until you reach the end of your five-year contract.

Your oxygen supplier must let you know when the end of your five-year contract approaches. You will need a new letter of medical necessity, which can include an updated evaluation of your oxygen needs.

As the end of the contract nears, make sure you talk with your care team about other types of oxygen systems that might work better for you. If you’re not happy with your current supplier, use this period to look for a new supplier. Don’t sign a new contract without discussing it with your prescribing physician.

Medicare requires oxygen suppliers to provide the equipment prescribed. If your oxygen delivery company tries to give you supplies that don’t match your prescription, work with your medical team to ensure you get what the prescription calls for.

Medicare-contracted oxygen suppliers:

• Can’t drop you as a customer or change your equipment or delivery system without approval from you and your doctor.
• Can’t change the terms of your contract to provide different equipment/modalities or reduce the number of tanks you receive.
• Must provide services if you move to a new area – either directly or by contracting with another supplier for the remainder of your contract.
• Must provide necessary oxygen equipment and accessories for the duration of your contract, including regulators, filters, masks and tubing.
• Must provide working equipment and repair broken equipment. However, a supplier can provide used or refurbished equipment as long as it works properly.
• Must honor changes in medical necessity if your physician decides your oxygen equipment no longer provides what you need. (Note: your physician must provide a new letter of medical necessity.)

The Centers for Medicare and Medicaid Services often don’t intervene when oxygen suppliers make changes without the prescribing physician’s approval. As with all medical appeals, you’ll need patience and determination while advocating for your oxygen needs.

1. Refuse all unapproved changes of equipment or coverage. You have the right to refuse removal of equipment from your home.
2. Give your supplier written notice of refusal, and ask for documentation of its proposed changes.
3. Let your physician know of any problems with your oxygen supplier, and ask your care team to share the most recent letter of medical necessity they’ve sent to your supplier.
4. File a Medicare complaint through 800-MEDICARE (633-4227). If problems persist, a Medicare representative can connect you with an ombudsman, whose can help you with Medicare-related complaints, grievances and information requests.
5. File an Americans with Disabilities Act complaint.

If you have private insurance, your oxygen access rights and the specifics of your coverage depend on your policy. Review your health benefits and contact your insurance provider to learn what your plan covers.

If your insurance plan doesn’t cover oxygen equipment, you might need to pay for it out of pocket. Ask your health care team about your options if your plan doesn’t cover oxygen equipment.