Does Medicare Cover an Oxygen Concentrator?

An oxygen concentrator is a medical device that extracts oxygen from ambient air, providing a concentrated supply for individuals requiring supplemental oxygen therapy. This equipment is often prescribed for various respiratory conditions, and Medicare can provide coverage for its use. Understanding the specific conditions and procedures for coverage is important for beneficiaries.

Medicare Part B Coverage for Durable Medical Equipment

Oxygen concentrators are categorized by Medicare as Durable Medical Equipment (DME). DME includes items that are durable, used for a medical purpose, not generally useful to someone without an illness or injury, and used in the home. Medicare Part B, which is Medical Insurance, is the component of Medicare that provides coverage for DME, including oxygen equipment and supplies. For coverage to apply, the equipment must be prescribed by a doctor and deemed medically necessary for use in the beneficiary’s home.

Medicare typically covers oxygen equipment on a rental basis for a period of 36 months. During this rental period, Medicare makes monthly payments to the equipment supplier. After the initial 36-month rental period, the supplier is required to transfer ownership of the oxygen equipment to the beneficiary.

Once ownership is transferred, Medicare will continue to cover payments for oxygen contents, such as liquid oxygen or oxygen gas, and for necessary maintenance and servicing of the equipment for the remaining period of medical need. This arrangement ensures that beneficiaries have continued access to their oxygen therapy even after the rental period concludes. This coverage framework applies to a range of oxygen equipment, including concentrators, liquid oxygen systems, and oxygen tanks.

Establishing Medical Necessity for Oxygen Therapy

Medicare requires specific medical documentation to establish the necessity of oxygen therapy. A licensed physician must prescribe the oxygen equipment, and this prescription must be supported by medical evidence demonstrating a severe lung condition or other medical need. The physician’s order typically specifies the oxygen flow rate and the duration of use.

Beneficiaries generally need to undergo tests such as arterial blood gas studies or pulse oximetry readings, which measure oxygen levels in the blood. These test results must fall below certain thresholds established by Medicare to qualify for coverage, indicating chronic hypoxemia. The therapy must be for use in the beneficiary’s home, and the physician must certify that other medical or surgical interventions have been tried and failed, or are not appropriate, before oxygen therapy is considered.

A “Certificate of Medical Necessity” (CMN) is a crucial document that the treating physician and the oxygen supplier complete and submit to Medicare. This certificate details the medical diagnosis, the results of blood oxygen tests, and the prescribed oxygen flow rate and duration. The CMN confirms that the oxygen therapy is reasonable and necessary for the beneficiary’s condition, providing the basis for Medicare’s approval. Regular follow-up appointments with the doctor are often necessary, and the physician may need to recertify the medical necessity of the oxygen therapy periodically to ensure continued coverage.

Obtaining Your Oxygen Concentrator

Once medical necessity for oxygen therapy has been established and documented, the next step involves obtaining the equipment from a Medicare-approved supplier. Beneficiaries can locate approved suppliers through Medicare’s official website or by consulting their physician or local Medicare resources. It is important to confirm that the chosen supplier accepts Medicare assignment, meaning they agree to accept Medicare’s approved amount as full payment and will only charge the beneficiary the Medicare deductible and coinsurance.

The supplier will work with the beneficiary’s physician to obtain all necessary prescriptions and medical documentation, including the Certificate of Medical Necessity. After verifying coverage, the supplier is responsible for submitting the claim directly to Medicare on the beneficiary’s behalf. This process ensures that the billing is handled correctly according to Medicare regulations.

Upon approval, the supplier will arrange for the delivery and setup of the oxygen concentrator in the beneficiary’s home. They also provide detailed instructions on how to properly use and care for the equipment. The supplier is typically responsible for maintaining and servicing the oxygen concentrator throughout the rental period, addressing any issues or malfunctions that may arise.

Understanding Patient Costs

Beneficiaries enrolled in Original Medicare typically incur certain out-of-pocket costs for oxygen concentrator coverage. Medicare Part B has an annual deductible, which beneficiaries must pay before Medicare begins to cover its share of approved medical expenses. For 2025, the Part B deductible is $240. After the deductible has been met, Medicare generally pays 80% of the Medicare-approved amount for the oxygen equipment and supplies.

This means that the beneficiary is responsible for the remaining 20% coinsurance. For example, if the Medicare-approved monthly rental for an oxygen concentrator is $100, the beneficiary would pay $20 each month after meeting their deductible. The 36-month rental period is a significant aspect of cost, after which the equipment ownership transfers to the beneficiary, but they still pay for oxygen contents and maintenance.

Supplemental insurance plans, such as Medigap policies, can help cover some or all of these out-of-pocket costs, including the Part B deductible and coinsurance. The specific coverage provided by a Medigap policy depends on the plan type selected by the beneficiary. Beneficiaries should review their policy details to understand their potential financial responsibilities.

Medicare Advantage Plans and Oxygen Concentrators

Medicare Advantage (Part C) plans are offered by private insurance companies approved by Medicare, and they must provide at least the same level of benefits as Original Medicare, including coverage for Durable Medical Equipment (DME) like oxygen concentrators. While the core coverage is comparable, the specific rules and costs associated with obtaining an oxygen concentrator under a Medicare Advantage plan can differ from Original Medicare. These plans often utilize a network of providers and suppliers, meaning beneficiaries may need to obtain their oxygen concentrator from a supplier within their plan’s network.

Many Medicare Advantage plans require prior authorization for DME, including oxygen concentrators, before coverage is approved. This means the plan needs to review and approve the medical necessity documentation before the equipment is provided, and failure to obtain prior authorization could result in higher out-of-pocket costs or denial of coverage. The cost-sharing structure, including deductibles, copayments, and coinsurance amounts, may also vary significantly from Original Medicare.

While cost-sharing can differ, all Medicare Advantage plans have an annual out-of-pocket maximum. Once this maximum is reached, the plan pays 100% of covered healthcare services for the remainder of the year. Beneficiaries enrolled in a Medicare Advantage plan should contact their specific plan directly to understand their exact coverage details, network requirements, prior authorization procedures, and cost-sharing responsibilities for oxygen concentrator therapy.