Does Medicare Pay for a Portable Oxygen Concentrator?

Medicare helps millions of people manage healthcare costs, including those for necessary medical equipment. This federal health insurance program provides coverage for various medical services and supplies, often classifying them as Durable Medical Equipment (DME). DME includes items that are reusable and serve a medical purpose in the home.

Medicare Coverage for Oxygen Equipment

Medicare Part B provides coverage for oxygen equipment, including portable oxygen concentrators, when deemed medically necessary. As Durable Medical Equipment (DME), these devices must be durable, capable of withstanding repeated use, and primarily serve a medical purpose. They must also be useful only to someone ill or injured, used in the home, and expected to last at least three years.

Medicare covers oxygen equipment, including portable concentrators, through a rental arrangement rather than purchase. The initial rental period spans 36 months. After this period, the supplier must continue to provide the equipment, along with necessary accessories and services, for an additional 24 months, totaling five years, as long as there is a continuing medical need for oxygen. This arrangement ensures ongoing access without further rental payments during the extended period.

Qualifying for Coverage

To qualify for Medicare coverage of a portable oxygen concentrator, a physician must certify that the oxygen therapy is reasonable and necessary for treatment. The medical necessity must be documented through specific diagnostic tests, such as arterial blood gas studies or oxygen saturation tests. These tests demonstrate that an individual has a severe lung disease or is otherwise oxygen-deficient.

The Centers for Medicare & Medicaid Services (CMS) outline specific oxygen saturation levels that qualify for coverage. For example, coverage may be approved if an individual’s arterial partial pressure of oxygen (PaO2) is 55 mmHg or less, or their oxygen saturation is 88% or less, while at rest and breathing room air. Alternatively, if PaO2 is between 56-59 mmHg or oxygen saturation is 89%, and there are additional conditions like dependent edema suggesting congestive heart failure, coverage might apply. Desaturation during sleep or exercise, documented, can also establish medical necessity.

A comprehensive physician’s order is required, detailing the diagnosis, the specific type of oxygen equipment needed, the prescribed flow rate, and the frequency of use. This documentation must support that the individual’s condition might improve with oxygen therapy. The medical record should include the patient’s history, physical examination findings, and diagnostic test results to support the need for the equipment.

Steps to Obtain Your Oxygen Concentrator

Once medical necessity and documentation are complete, work with a Medicare-approved Durable Medical Equipment (DME) supplier. Beneficiaries can find suppliers through Medicare’s official website or by asking their doctor for referrals. Confirm the chosen supplier accepts Medicare assignment, meaning they accept the Medicare-approved amount as full payment.

The supplier will handle claim submission to Medicare, and in some cases, may need prior authorization before providing the equipment. The individual will need to sign necessary paperwork, including a written order for the DME, which must include the beneficiary’s name, a description of the item, and the treating practitioner’s signature and date. Upon delivery, the supplier may conduct an initial assessment to ensure the equipment is set up correctly and the individual understands its operation.

Your Financial Responsibility

Even with Medicare coverage, individuals have certain financial responsibilities for portable oxygen concentrators. After meeting the annual Medicare Part B deductible, which is $257 in 2025, Medicare pays 80% of the Medicare-approved amount for Durable Medical Equipment. The beneficiary is responsible for the remaining 20% coinsurance.

This 20% coinsurance applies to the monthly rental payments for the oxygen equipment. If a supplier does not accept Medicare assignment, the individual might incur higher out-of-pocket costs. Supplemental insurance plans, such as Medigap policies, or Medicare Advantage plans (Part C), may help cover this 20% coinsurance, potentially reducing the beneficiary’s financial burden. It is advisable for individuals to check with their specific plan provider to understand their coverage details and any additional benefits for DME.