Discover The Best CBD Week Deals
If you purchase via links on our site, we may receive commissions. However, our experts carefully research and evaluate each product or service, ensuring it meets our quality standards.

Will Medicare Cover Portable Oxygen Concentrators?

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.

Key takeaways:

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:

  1. Your doctor must determine that your body is not getting enough oxygen.
  2. Your arterial blood gas values fall within a certain range.
  3. Oxygen therapy may improve your condition.
  4. 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.

Compare Top Medicare Plans From Major Carriers
On Apollo's Website

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


Leave a reply

Your email will not be published. All fields are required.

Comments

Sharon
prefix 8 days ago
Can I choose y different company for oxygen after 36 months? The oxygen tanks make my neck hurt. I needed surgery on my neck when I was diagnosed with lung cancer. Now at 67 I'm not having it done. I have talked to inogen over the 3 years since I had surgery but for some reason I couldn't get a portable oxygen concentrator. I need one with 2 batteries so bad so I can have a life.
William R. Barrett
prefix 2 months ago
My wife 82 years old has been on whole whole house for years and and on portable tanks for same amount of time. Here is the question? A tank will last 4 hours so you are confined to only 4 hours away from home which makes her not to be able to visit family overnight If you stayed overnight you would have to carry 6 tanks of oxygen and that would be for 24 hours. My wife and I have always been going places as I have been retired for a number of years and no longer able to do. Dr's order would be no problem. Also very difficult to attend grand daughter's basketball games due to seating in stands. We can't no longer able to travel away from for several days at a time. Our supplies keeps saying we are do not qualify. Maybe we should be illegal I worked for Federal Gov. for thirty years and would like to enjoy what is left of OUR life.