Home oxygen therapy is a prescribed medical treatment that supplements the air you breathe with a higher concentration of oxygen gas. This treatment is necessary for individuals experiencing hypoxemia, a state where arterial blood oxygen levels are below normal, often due to chronic lung or heart conditions. The goal of supplemental oxygen is to raise these low levels to support bodily function and improve quality of life. Because oxygen is regulated as a prescription drug, obtaining it for home use requires a formal medical process and documentation of a specific medical need before equipment can be supplied.
Medical Mandate: Obtaining the Prescription
The process of securing home oxygen begins with a physician who must formally document the medical necessity for the treatment. This documentation relies on objective clinical testing to confirm the patient’s blood oxygen levels fall below established thresholds. Common qualifying criteria include an arterial partial pressure of oxygen (PaO2) at or below 55 mm Hg, or a pulse oximetry reading (SpO2) at or below 88% while resting and breathing room air.
Testing may also be required during periods of exertion or sleep, as some individuals only desaturate during these times. For example, a patient may qualify if their SpO2 drops to 88% or lower during a six-minute walk test or sustained periods during the night. The physician uses these results to write a comprehensive prescription that dictates the exact parameters of the therapy. This prescription must specify the flow rate, measured in liters per minute (LPM), the duration of use (such as continuous, nocturnal, or only with activity), and the precise delivery device, like a nasal cannula or oxygen mask.
Understanding Your Equipment Options
Once the prescription is obtained, the next step involves selecting the appropriate physical system to deliver the prescribed oxygen. Three primary types are available for home use.
Oxygen Concentrators
Oxygen concentrators are the most common choice, relying on electricity to filter and concentrate oxygen from the surrounding air, meaning they never run out of supply. They operate using two delivery methods: continuous flow, which provides a steady stream of oxygen regardless of the user’s breathing pattern, and pulse dose, which delivers a timed bolus of oxygen only when the machine senses the user is inhaling.
Continuous flow is often necessary for high-flow prescriptions or use during sleep, as shallow breathing may not reliably trigger the sensor in a pulse dose unit. Pulse dose units are preferred for efficiency, making them smaller, lighter, and giving them longer battery life for portable use.
Compressed Gas and Liquid Systems
A second option is the compressed gas system, which uses oxygen stored under high pressure in metal tanks, requiring regular delivery and exchange of full tanks for empty ones. Liquid oxygen systems offer a third alternative, storing oxygen in a super-cooled liquid state within specialized containers.
The benefit of liquid oxygen is its high density, allowing a greater volume of oxygen to be stored in a smaller space compared to compressed gas tanks, making portable units lighter and longer-lasting. However, liquid oxygen is extremely cold, posing a risk of frostbite, and it slowly evaporates over time, meaning it must be used or it will be lost to the air.
Navigating Acquisition and Costs
After receiving the prescription, the patient must work with a Durable Medical Equipment (DME) supplier, the company responsible for providing the physical equipment and oxygen contents. If using health insurance, the choice of supplier is often restricted to those in-network. Insurance coverage, including Medicare and private plans, typically requires prior authorization to confirm the prescribed equipment is medically covered.
For Medicare beneficiaries, special rules apply to oxygen equipment, which is always rented on a five-year cycle. Medicare pays the supplier a monthly rental fee for the first 36 months, covering the equipment, supplies, maintenance, and oxygen contents. The patient is responsible for a 20% coinsurance payment after meeting the Part B deductible. After the initial 36-month rental period, Medicare payments cease, but the supplier must continue providing the equipment and necessary supplies for an additional 24 months, totaling a five-year service commitment. If the medical need continues beyond this period, a new rental cycle begins.
Essential Safety and Maintenance Protocols
Using home oxygen requires strict adherence to safety and maintenance protocols, as concentrated oxygen intensely supports combustion, increasing the risk of fire. All oxygen equipment, including concentrators and tanks, must be kept at least six feet away from any heat source, such as gas stoves, fireplaces, and space heaters. The prohibition on smoking near the equipment is the most important safety rule, as a tiny spark can cause a flash fire in an oxygen-rich environment.
Patients must only use water-based lotions and creams on their face and hands, as petroleum-based products are flammable and should never be used near the delivery device. Oxygen concentrators require proper ventilation and should never be placed against walls, curtains, or in confined spaces, nor should they be plugged into extension cords. Compressed gas tanks must be stored securely in an upright position to prevent falling and rupture. Routine maintenance is also necessary, including checking the battery backup system and regularly cleaning or replacing the nasal cannula, mask, and concentrator filters as instructed by the DME supplier.