Does Medicare Cover a Portable Oxygen Concentrator?

Medicare, the federal health insurance program for individuals aged 65 or older, certain younger people with disabilities, and those with End-Stage Renal Disease, helps cover various healthcare services and medical equipment. Understanding Medicare coverage for portable oxygen concentrators is important for beneficiaries, as these devices play a significant role in managing respiratory conditions. This article clarifies how Medicare addresses their coverage.

Understanding Medicare Coverage for Durable Medical Equipment

Medicare covers Durable Medical Equipment (DME), which includes items that are durable, used for a medical reason, useful only to someone sick or injured, used in the home, and expected to last at least three years. Portable oxygen concentrators are classified as DME by Medicare.

Medicare Part B is responsible for covering DME. For covered DME, Medicare Part B pays 80% of the Medicare-approved amount after the beneficiary meets the annual Part B deductible. The beneficiary is responsible for the remaining 20% coinsurance. For 2025, the annual Medicare Part B deductible is $257.

Requirements for Portable Oxygen Concentrator Coverage

Medicare coverage for a portable oxygen concentrator requires a physician’s prescription for home use. The physician must determine that oxygen therapy is medically necessary for treating severe lung disease or other conditions causing hypoxemia. Qualifying medical conditions include chronic obstructive pulmonary disease (COPD), cystic fibrosis, or severe heart failure.

Medical evidence, such as blood gas studies or pulse oximetry readings, is necessary to demonstrate this need. To qualify, specific oxygen saturation levels must be met, such as an arterial oxygen partial pressure (PaO2) at or below 55 mm Hg or an oxygen saturation (SaO2) at or below 88% while at rest on room air. The physician must also confirm medical necessity and that other treatment measures are not appropriate for the patient’s condition.

Steps to Obtain a Covered Portable Oxygen Concentrator

After meeting the medical criteria, a beneficiary must obtain their portable oxygen concentrator from a Medicare-approved Durable Medical Equipment (DME) supplier. These suppliers must be enrolled in Medicare and accept assignment, meaning they accept the Medicare-approved amount as full payment. The supplier works with the prescribing physician to gather necessary documentation, including a detailed written order and, if required, a Certificate of Medical Necessity (CMS-484) form. The DME supplier submits the claim directly to Medicare.

Medicare covers oxygen equipment, including portable oxygen concentrators, on a rental basis. Medicare makes monthly rental payments to the supplier for 36 months. After this 36-month rental period, the supplier must continue to provide the equipment, supplies, and maintenance for an additional 24 months, up to a total of five years, as long as the medical need continues. This monthly rental fee covers the equipment, oxygen contents, and any required maintenance or servicing.

Financial Responsibilities and Other Medicare Options

Beneficiaries using Original Medicare are responsible for out-of-pocket costs. After meeting the annual Part B deductible and paying a 20% coinsurance for the Medicare-approved amount, this coinsurance may be a recurring monthly payment for rented equipment. Supplemental insurance, such as a Medigap policy, can help cover these expenses, including the Part B deductible and coinsurance.

For beneficiaries enrolled in a Medicare Advantage Plan (Part C), coverage for portable oxygen concentrators must be at least equivalent to Original Medicare. However, Medicare Advantage Plans may have different cost-sharing structures, require specific in-network suppliers, or necessitate prior authorization for DME. Beneficiaries should consult their plan documents or contact their plan provider to understand their financial responsibilities and requirements.