If you have recently been prescribed supplemental oxygen and receive Medicare benefits, you may be wondering, “Are portable oxygen concentrators covered by Medicare?” The answer depends on a few factors, which we will outline here to give you a clearer understanding of Medicare oxygen requirements and what it takes to get portable oxygen concentrator Medicare coverage. Read on below to find out how to get your portable oxygen concentrator covered by Medicare.
Does Medicare Pay for Oxygen?
Medicare does not cover the cost of purchasing an oxygen concentrator; that said, when you ask, “Are portable oxygen concentrators covered by Medicare?” the answer is: Sometimes. Medicare may cover oxygen equipment rental costs if you are eligible for Medicare and approved for therapeutic oxygen use. You will need a doctor’s prescription stating that you need medical oxygen, followed by meeting other certain conditions. [1]
Answering “Are portable oxygen concentrators covered by Medicare?” clearly can be difficult. Here’s what you should know.
Are You Eligible for Medicare?
Before you ask, “Are portable oxygen concentrators covered by Medicare?” make sure you qualify for Medicare. If you are 65 or older, you have a documented disability or you have end stage renal disease, you are eligible for Medicare.[2] From there, see your doctor to ensure you meet all the criteria for getting your portable oxygen concentrator covered by Medicare.
Getting the Right Information From Your Doctor
Once you confirm that you qualify for Medicare, see your doctor to get sufficient documentation for Medicare oxygen requirements. Your doctor will need to complete a certificate of medical necessity and compile a detailed written order that includes all of the following:[3]
- Your full legal name
- The date of the prescription and order
- A thorough description of all required oxygen equipment, including the recommended oxygen delivery system and all necessary accessories
- Your prescribed flow rate, as well as whether you will require pulse dosing or continuous flow
- The amount of time you will need supplemental oxygen and frequency of need (typically, you must have a 24/7 need for oxygen therapy to qualify for portable oxygen concentrator Medicare coverage)
- Your doctor’s signature
Once you have this paperwork, you can submit it to Medicare, where you will either be approved or denied.
Medicare and Oxygen Therapy: Do You Qualify?
So, when does Medicare pay for oxygen? When it comes to Medicare and oxygen therapy, the Medicare oxygen requirements are not completely clear cut. You can be denied coverage, and left wondering, “why won’t Medicare pay for oxygen concentrators?” As such, it is essential that your doctor confirms that you meet the requirements below and documents your eligibility thoroughly, as described above.
Medicare will help pay for your supplemental oxygen equipment if you meet the following requirements and receive a prescription for medical oxygen from your doctor. The requirements include:[4]
- Documentation from your doctor that you have a severe lung disease or that you are not currently getting enough oxygen
- Evidence that your health will be improved by oxygen therapy
- An arterial blood gas level that falls within a certain (low) range
- Evidence that alternative measures have failed
Getting Oxygen Equipment Covered After Qualifying for Medicare
Once you determine your eligibility, you will need to find a Medicare-approved supplier of oxygen and apply with them to determine what your total costs will be. If you are wondering, “why won’t Medicare pay for oxygen concentrators in full?” the answer is that Medicare rarely covers 100% of your medical bills. As the leading health insurer for people 65 and older, providing this coverage is expensive, and the funding comes from taxpayers. However, Medicare usually covers part of your medical expenses if you qualify.[5]
If the conditions above are met, Medicare will cover up to 80% of the cost for the rental of oxygen equipment from an approved oxygen supplier for 36 months. This includes the oxygen delivery system, any required oxygen storage containers, tubing and other related oxygen accessories required to deliver the oxygen to the patient. Oxygen machine maintenance, servicing and repair costs can also be included for a portable oxygen concentrator covered by Medicare. You will still pay 20% of the Medicare approved cost for your oxygen supplies, and your Part B deductible will still apply if you have one.
After 36 months, you are eligible to continue to rent your oxygen therapy supplies from your same provider for another 24 months, up to a total of 5 years, as long as you can demonstrate medical need for oxygen. You will need to continue to show that your health is dependent upon the portable oxygen concentrator Medicare coverage you have been receiving. After that time, you can renew your oxygen equipment rental agreement, though your provider is not required to continue providing service to you after the initial 5 years.[1] This can make things difficult as you must go through a contracted Medicare provider for your rental agreement. So how can you make your portable oxygen tank Medicare experience as easy as possible? Call a supplier that has plenty of experience going through the Medicare process.
Call Inogen for Your Free Medicare Eligibility Check
If you have asked, “Are portable oxygen concentrators covered by Medicare?” then you have likely also asked, “Is Inogen covered by Medicare?” The great news is that rental costs of an Inogen One model are covered by Medicare if you are eligible.
At Inogen, we understand that navigating the Medicare oxygen requirements can be daunting, so we want to help make it as easy as possible. We offer a free Medicare Eligibility Check to help you learn whether you qualify to have your costs covered. We also recommend visiting the medicare.gov to better understand your coverage. Call us today at 1-855-694-6643 to learn more—let us help you through this process and breathe better sooner.
Frequently Asked Questions: Medicare and Portable Oxygen Concentrators
Why won’t Medicare pay for oxygen concentrators?
Medicare does not cover the full cost of purchasing an oxygen concentrator primarily because they have determined that it is more cost-effective for them to cover monthly rentals instead.[6] As such, the answer to “why won’t Medicare pay for oxygen concentrators” is that they will cover part of the cost of the rental, but not purchasing because they have deemed it too costly.
If you decide you want to own your equipment, you should plan to purchase your portable oxygen concentrator on your own. Even if you purchase your portable oxygen concentrator independently, you may still qualify to have certain oxygen equipment—like cannulas, tubing, emergency oxygen canisters or a humidifier—covered. Inogen can help you learn more about what costs may be covered for you. Give us a call for more information.
SOURCES
- “Oxygen Equipment & Accessories.” Medicare.gov, U.S. Centers for Medicare & Medicaid Services, Accessed 13 May 2021, Oxygen Equipment Coverage (medicare.gov)
- “Who Is Eligible for Medicare?” HHS.gov, U.S. Department of Health & Human Services, 21 Aug. 2015, Who is eligible for Medicare? | HHS.gov
- “National Coverage Determination (NCD) for Home Use of Oxygen (240.2).” Medicare Coverage Database, U.S. Centers for Medicare & Medicaid Services, Accessed 13 May 2021, NCD – Home Use of Oxygen (240.2) (cms.gov)
- https://www.medicare.gov/coverage/oxygen-equipment-accessories
- “Why Doesn’t Medicare Reimbursement Cover 100% of My Medical Bills?” EHealth Medicare, EHealthInsurance Services, Inc, 13 May 2021, www.ehealthinsurance.com/medicare/resources/why-doesnt-medicare-reimbursement-cover-100-of-my-medical-bills
- Sherrell, Zia. “Oxygen Equipment and Therapy: Medicare Coverage, Eligibility, Costs.” Medical News Today, MediLexicon International, 26 June 2020, www.medicalnewstoday.com/articles/does-medicare-cover-oxygen#supplies-and-equipment
