Portable oxygen concentrators (POCs) are medical devices that filter nitrogen out of the air, making more oxygen available for people with low oxygen levels in their blood or tissues. This condition is common in people with cancer, multiple sclerosis, and lung, heart, bowel, and kidney diseases.
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Portable oxygen concentrators are a convenient method of oxygen delivery for people with low oxygen levels.
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Medicare may help cover the cost of renting a POC for up to five years in certain cases.
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Your doctor or healthcare provider must attest to your constant need for oxygen therapy at home.
Supplemental oxygen can help people with acute and chronic conditions breathe easier, sleep better, and experience a higher quality of life. If your health care provider determines that this therapy is medically necessary for you, Medicare may help pay for your POC and related equipment.
Does Medicare cover portable oxygen concentrators?
Yes, Medicare covers portable oxygen concentrators that practitioners prescribe for use in the home. You must be enrolled in Medicare Part B (Medical Insurance) or a Part C (Medicare Advantage) plan. POCs qualify as durable medical equipment (DME), which Part B pays for under certain conditions.
The DME supplier must also agree to offer you a portable concentrator. This equipment typically costs more than its stationary counterpart, although Medicare’s reimbursement is the same for either machine.
Your Medicare-approved healthcare provider must verify that you continually need supplemental oxygen and can move about on your own.
To be eligible for a portable oxygen concentrator through Medicare:
- Your doctor must determine that your body is not getting enough oxygen.
- Your arterial blood gas values fall within a certain range.
- Oxygen therapy may improve your condition.
- Alternative treatments have failed.
What portable oxygen concentrators are covered by Medicare?
Medicare does not specify or limit which type or brand of portable oxygen concentrator it will help pay for. As DME, the POC must be built to hold up with repeated, prolonged use. It must also be medically necessary and intended for home use.
- Get in touch with a licensed insurance agent for a consultation
- Discuss various plans to get the best Medicare coverage for you
- Receive plan comparisons online
- Offered plans come from Humana, Aetna, Cigna, BCBS, and many more
To qualify for Medicare coverage, a doctor, nurse practitioner, clinical nurse specialist, or physician assistant must prescribe the POC. The healthcare professional must accept assignment, meaning they will not charge more than the Medicare-approved amount for their service.
Further, you must obtain the POC from a Medicare-enrolled DME supplier who accepts assignment. If the supplier doesn’t accept Medicare as full payment, Medicare will not honor your claim. You can access a supplier directory on Medicare.gov or by calling 1-800-MEDICARE.
How much does Medicare pay for portable oxygen concentrators?
Medicare will pay 80% of your POC rental costs for 36 months. After meeting your Part B deductible, you pay 20% of the Medicare-Approved amount. This is the amount you pay before Medicare starts paying for your covered healthcare expenses.
The monthly rental payments cover the oxygen equipment and:
- Oxygen contents
- Tubing and supplies for delivering oxygen and oxygen contents
- Oxygen machine servicing, maintenance, and repairs
If you own your equipment, Medicare will help pay for oxygen, contents, and supplies for oxygen delivery if you meet the criteria for using a POC. You can also get coverage for a humidifier when used with an oxygen machine.
Speak with your healthcare provider for details on your out-of-pocket costs for a POC. What you will spend depends on the type of equipment, vendor, tank size, and other factors.
How to know if you qualify for Medicare coverage
To qualify for Medicare coverage of a portable oxygen concentrator, you must first be eligible for Medicare. Generally, you must be at least 65 years of age. You can be younger with a disability that makes you unable to work for a year, Lou Gehrig's disease, or terminal kidney disease.
You must be enrolled in Medicare Part B, which covers durable medical equipment (DME). DME refers to devices that are:
- Used for a medical reason at home
- Not useful for a healthy, uninjured person
- Expected to last at least three years
- Can hold up with repeated use
In this case, a hospital or nursing facility does not qualify as a home. If you’re in a skilled nursing facility, Medicare Part A will help cover any DME needed for up to 100 days.
Under what conditions will Medicare not cover oxygen therapy?
Medicare will not cover oxygen therapy and oxygen equipment for home use in these cases:
- Terminal illnesses, unless they hamper the ability to breathe.
- Severe peripheral vascular disease resulting in impaired circulation in extremities.
- If a person has angina pectoris but not hypoxemia (low oxygen in the blood).
- Breathlessness without evidence of hypoxemia or pulmonary heart disease.
Can I continue my rental after 36 months?
After the initial 36-month rental period, your supplier must keep providing oxygen equipment and related supplies for another 24 months if needed. If you still have a medical need for supplemental oxygen, your supplier must provide the equipment and supplies for up to five years. You will not incur any additional fees for these services.
Medicare will continue paying for a monthly delivery of gaseous or liquid oxygen contents. You will still be responsible for 20% of the Medicare-Approved amount.
The supplier that delivers this equipment owns the equipment during the 60-month (five-year) period. They must provide these items as long as you medically need them.
Your supplier is not required to provide oxygen and equipment after five years have passed. You can obtain replacement equipment from another Medicare-approved supplier if you still need supplemental oxygen.
Once a five-year period for your oxygen and oxygen equipment ends, a new 36-month payment cycle and a five-year supplier obligation cycle will begin.
If you are a Medicare beneficiary with heart, blood, or pulmonary conditions, you may be able to rent a portable oxygen concentrator to help increase your oxygen levels. Your healthcare provider and oxygen equipment supplier must be Medicare-registered and accept Medicare payment rates. You can access the equipment for up to five years through your Medicare Part B benefit.
FAQ
Do you need a prescription for a portable oxygen concentrator?
Yes, the FDA only allows the rental and use of oxygen concentrators with a prescription. Giving yourself oxygen without medical oversight might cause you to get too little or too much oxygen, which may damage your organs. Your healthcare provider can show you how much oxygen you need and for how long.
Is a portable oxygen concentrator the same as an oxygen tank?
No, these devices are different. Although a portable oxygen concentrator is like an oxygen tank, it is smaller and easier to carry and transport. A POC uses an electrical pump to compress the continuous supply of oxygen coming from the surrounding air. A tank holds a store of oxygen, meaning it must be replaced when it is depleted.
Will Medicare pay for a portable oxygen concentrator?
Medicare will not help you purchase a portable oxygen concentrator, but it offers a monthly rental benefit for such equipment. Medicare Part B gives you access to this durable medical equipment (DME) if your doctor prescribes it for use in your home. Your doctor must verify that the POC is a medical necessity and the only viable solution for your breathing difficulties.
- Springer Link. Hypoxia: molecular pathophysiological mechanisms in human diseases.
- Medicare. Oxygen equipment & accessories.
- FDA. Pulse Oximeters and Oxygen Concentrators: What to Know About At-Home Oxygen Therapy.
- Medicare. Does your provider accept Medicare as full payment?
- CMS. Home Use of Oxygen.
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