Does Medicare Cover Portable Oxygen Concentrators?
As we age, our respiratory system does too. While it’s normal for our lung function to decline gradually, if you experience a sudden shortness in breath or difficulty breathing, you may have a respiratory condition. Many seniors with respiratory conditions rely on portable oxygen concentrators for maintaining healthy oxygen levels and alleviating symptoms.
Medicare covers a lot of durable medical equipment (DME), including portable oxygen concentrators. Read on to learn about criteria for coverage and how to make sure that Medicare pays for the equipment.
Key takeaways:
Medicare covers portable oxygen concentrators and any related accessories as long as your doctor prescribes them for you.
You’ll have a 5-year contract with a supplier for the equipment, and you may have to pay coinsurance for any maintenance and servicing in that time period.
If you still need the equipment after 5 years, you can choose to stay with your current supplier or pick a new one. Another 5-year obligation period will begin.
If you buy a portable oxygen concentrator, Medicare will help pay for any related materials you need.
What is a portable oxygen concentrator?
People may need a portable oxygen concentrator if they experience respiratory conditions like chronic obstructive pulmonary disease (COPD), emphysema, and other lung diseases that restrict airflow and cause breathing problems.
Portable oxygen concentrators are compact devices that take oxygen from the surrounding air and deliver it to you continuously—or in pulse-doses. These devices usually filter the air to remove dust, pollen, and other particles before you receive the oxygen.
Additional benefits include:
Improved blood oxygen levels
Enhanced mobility if respiratory conditions limit physical activity
Reduced risk of hospitalization
Portability
Continuous supply of oxygen without needing to refill tanks
Quiet operation
Does Medicare cover portable oxygen concentrators?
Medicare covers portable oxygen concentrators that your doctor says you need to make your life easier at home. You can rent the equipment with Medicare coverage. Additionally, if you own your own portable oxygen concentrator, Medicare will help cover necessary supplies and services.
These supplies and services can include:
Equipment that delivers oxygen
Containers that store oxygen (if applicable for the device you need)
Tubing, mouthpiece, and related materials
Humidifier, if you use it with your oxygen machine
Oxygen machine maintenance, servicing, and repairs
Eligibility requirements for portable oxygen concentrator coverage
You must meet the following eligibility requirements to receive coverage for a portable oxygen concentrator:
Your doctor believes you aren’t getting enough oxygen
Your health could be better with oxygen therapy
Your arterial blood gas levels are in a certain range
What do you pay for a portable oxygen concentrator with Medicare coverage?
If you don’t own your own equipment, you’ll rent (rather than purchase) your oxygen equipment. In this case, you’ll pay 20% of the cost of the oxygen equipment once you’ve met your Part B deductible. The renting schedule isn’t very straightforward, so we’ve outlined it below.
You’ll rent and pay a monthly fee for your oxygen equipment for the first 36 months. Your monthly payment covers the oxygen concentrator, accessories, and services.
After 36 months, your equipment supplier must provide you with the portable oxygen concentrator for an additional 24 months. As long as you continue to have a medical need for the equipment, your supplier must provide the supplies for up to 5 years.
If you still need the device past this 5-year timeframe, you can choose to stay with your supplier or pick a new one. Then, the 36-month payment period and 5-year obligation period starts over again.
Your only other potential cost is for at-home maintenance and service. You may have to pay additional coinsurance for maintenance up to once every 6 months your supplier comes to inspect and service the device in your home.
Steps to take to ensure Medicare coverage for a portable oxygen concentrator
Make sure that your doctor and equipment supplier both accept Medicare. This is especially important for people with Medicare Advantage plans since approved suppliers may be different depending on the policy you have. If you don’t rent from a supplier that accepts your insurance, you may have to cover more or the full cost of the equipment yourself.
Medicare coverage for renting a portable oxygen concentrator can be confusing! We understand that there are many rules and criteria to keep track of. If you need help understanding how Medicare covers any kind of durable medical equipment, call us at 855-900-2427 or book time to talk today.