Does Medicare Cover Oxygen Concentrators?

For individuals needing supplemental oxygen, an oxygen concentrator can be an important device that improves their quality of life. Medicare offers coverage for oxygen concentrators, recognizing their medical utility for eligible beneficiaries. This coverage is subject to specific criteria, including documented medical necessity and obtaining equipment from Medicare-approved suppliers. Understanding these requirements and financial responsibilities is key for beneficiaries.

Medicare Part B Coverage for Oxygen Concentrators

Medicare Part B covers oxygen concentrators as Durable Medical Equipment (DME). DME includes equipment that is durable, used for a medical reason, typically useful only to someone sick or injured, used in the home, and expected to last at least three years. For Medicare to cover an oxygen concentrator, a physician must deem it medically necessary.

Medical necessity is determined by specific criteria, often involving blood oxygen levels. Beneficiaries typically qualify if their arterial partial pressure of oxygen (PaO2) is at or below 55 mmHg, or their oxygen saturation is at or below 88% on room air, measured at rest, during exercise, or during sleep. A physician must provide a detailed prescription for oxygen therapy, specifying the flow rate and duration of use, and this prescription must be supported by recent test results. The equipment must be obtained from a Medicare-enrolled supplier.

Your Financial Responsibility

Beneficiaries are responsible for certain costs associated with Medicare-covered oxygen concentrators. Before Medicare begins to pay, the annual Medicare Part B deductible must be met. For 2025, this deductible is $257. After the deductible is satisfied, Medicare Part B typically covers 80% of the Medicare-approved amount for the equipment, leaving the beneficiary responsible for the remaining 20% coinsurance.

Oxygen equipment is generally rented under Medicare Part B for a period of 36 months. During this rental period, monthly payments cover the equipment, necessary accessories like tubing and filters, and maintenance and repairs. After the 36-month rental period, the supplier must continue to provide the equipment and any necessary supplies and maintenance for an additional 24 months, totaling five years, as long as the medical need for oxygen persists. Medicare Advantage Plans (Part C) are required to cover at least what Original Medicare covers, but they may have different cost-sharing structures or preferred provider networks.

Steps to Obtain an Oxygen Concentrator

Acquiring an oxygen concentrator through Medicare begins with a physician consultation. The physician will assess the need for oxygen therapy, conduct necessary medical tests to document oxygen levels, and provide a detailed prescription.

Next, find a Durable Medical Equipment (DME) supplier. Verify the chosen supplier is enrolled in Medicare to ensure coverage. Medicare has tools available to help beneficiaries locate approved suppliers.

The beneficiary will work with the Medicare-enrolled supplier, providing the physician’s prescription and required test results. The supplier is responsible for submitting claims to Medicare on the beneficiary’s behalf. This ensures equipment rental, supplies, and maintenance are properly billed and covered under Medicare Part B. After the initial 36-month rental period, the supplier continues providing equipment and services for up to five years. At this point, beneficiaries may be eligible for new equipment, initiating a new rental cycle.