Medicare, in setting guidelines for oxygen qualification, aims to ensure that people truly need oxygen. So, they set the qualification threshold at 88%. If your oxygen saturation is 88% or less while resting or with exertion, you qualify for home oxygen therapy.
In this case, I have no issue with the guideline—it makes sense. However, qualifying for nighttime or sleep oxygen is a different story. During the day, a saturation of 88% means you qualify for oxygen. But at night, you not only need to drop below 88%, it also has to remain that low for a minimum of five minutes.
For example, in a study we did last night, a patient's SpO2 dipped to 83%, which is considered low. But because of Medicare’s nighttime oxygen requirements, this person doesn’t qualify for oxygen. Even if their SpO2 dropped to 70%, they wouldn’t qualify unless it stayed below 88% for at least five minutes.
I believe this is a flaw in the system. Granted, lower oxygen levels during sleep are often considered normal, but setting a time-based threshold seems unnecessarily rigid. Perhaps Medicare could instead adopt a threshold like 85%—and if anyone’s SpO2 falls below that, even briefly, they should qualify for nighttime oxygen therapy. This would account for those whose saturation dips significantly, even if the drop doesn’t last the full five minutes.
Truly, Medicare does not always have the patient’s best interests in mind when setting qualification policies. What seems to guide their decision-making more is how they can save money. While the guidelines ensure that only those who really need oxygen get it, the rigid thresholds—especially for nighttime oxygen—can leave some patients without necessary support. It seems less about patient care and more about cutting costs.
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