How Much Does Medicare Pay for Portable Oxygen Concentrators?
Understand Medicare's coverage for portable oxygen concentrators, including eligibility, costs, and the steps to obtain one.
Medicare helps beneficiaries access necessary medical equipment, including portable oxygen concentrators. This article clarifies Medicare’s provisions for these devices, outlining coverage criteria, associated costs, and the process for obtaining them.
Medicare Coverage for Durable Medical Equipment
Portable oxygen concentrators are categorized by Medicare as Durable Medical Equipment (DME). DME is equipment that withstands repeated use, serves a medical purpose, is not generally useful to someone without an illness or injury, is appropriate for home use, and is expected to last at least three years. Medicare Part B covers DME when prescribed by a physician and deemed medically necessary. This means the equipment is needed to diagnose or treat an illness, injury, condition, or its symptoms, meeting accepted medical standards.
Specific Coverage for Portable Oxygen Concentrators
A doctor must certify that oxygen therapy is medically necessary for the patient’s treatment. This typically involves documentation of severe lung disease or insufficient oxygen levels (hypoxemia) where other treatments have not been effective.
Specific medical criteria must be met, often involving measurements of arterial partial pressure of oxygen (PO2) at 55 mmHg or below, or oxygen saturation at 88% or below. For portable oxygen systems, a blood gas study performed while the patient is awake or exercising is usually required, along with evidence that the patient can move around. Medicare typically covers oxygen equipment, including portable concentrators, as a rental rather than a purchase.
The rental period for oxygen equipment is generally 36 months, during which Medicare makes monthly payments to the supplier. After this 36-month period, the supplier must continue to provide the equipment, along with necessary maintenance and supplies, for an additional 24 months, totaling five years, as long as the medical need for oxygen persists. This coverage includes the oxygen equipment itself, as well as essential accessories like tubing and cannulas, and services such as oxygen contents and routine maintenance. It is important to ensure the equipment is obtained from a supplier enrolled in Medicare.
Patient Costs and Financial Considerations
When Medicare covers a portable oxygen concentrator, beneficiaries typically share in the cost. For 2025, the annual Medicare Part B deductible is $257. After this deductible has been met, Medicare generally pays 80% of the Medicare-approved amount for the rental of the oxygen concentrator and related supplies. The beneficiary is then responsible for the remaining 20% coinsurance.
Choosing a supplier who accepts “assignment” is important for managing out-of-pocket expenses. When a supplier accepts assignment, they agree to accept the Medicare-approved amount as full payment for the service. This means they can only charge the beneficiary the Medicare deductible and coinsurance. If a supplier does not accept assignment, they may charge more than the Medicare-approved amount, and the beneficiary would be responsible for the difference. Some beneficiaries may have supplemental insurance, such as Medigap policies, or Medicare Advantage plans, which can help cover these remaining out-of-pocket costs.
Steps to Obtain a Covered Portable Oxygen Concentrator
Obtaining a Medicare-covered portable oxygen concentrator begins with a medical evaluation. A doctor must conduct a face-to-face examination and then provide a prescription and certification of medical necessity. This documentation needs to include a detailed written order specifying the required oxygen equipment, the prescribed oxygen flow rate, and the duration and frequency of use.
The medical records must contain sufficient information to substantiate the necessity for the oxygen therapy. After the doctor provides the necessary documentation, the beneficiary needs to find a Medicare-approved Durable Medical Equipment supplier. The chosen supplier is responsible for submitting the claim directly to Medicare. The beneficiary typically does not file the claim themselves but ensures all required medical information is provided to the supplier.