“Are portable oxygen concentrators covered by Medicare”? This is by far the most common question that we receive so if you’re wondering if they are covered, have no fear because you’re not alone! At this point in time the answer is a bit more complicated than a simple yes or no answer continue reading and we can help! In this guide we will break down how Medicare coverage on oxygen systems and provide you with a couple facts that will allow you to answer the question for yourself.
Let’s begin by talking about how you get your oxygen. Most patients who require oxygen therapy start with a solution that has been “provided” to them through Medicare, Insurance, or a combination of the two. Medicare dictates that if you qualify you are entitled to ONE home oxygen solution and ONE portable solution. In most cases the “home solution” is a large stationary concentrator that plugs in at home and the portable solution is a couple oxygen tanks (aka cylinders) that must be refilled on a regular basis.
Chances are that you are already familiar with some of these basic solutions provided through Medicare and have deemed them unsatisfactory for one reason or another which is why you are out researching new solutions. In the next section we will briefly describe modern portable and home oxygen concentrators and why more and more patients are choosing these instead of what is provided through Medicare.
Portable oxygen concentrators (POCs) first became available about 17 years ago. They operate in a similar fashion to as the home oxygen concentrators in that they take room air and convert it to a medical grade.
Since their creation, POCs have become smaller, lighter, and more powerful. They were designed to provide oxygen patients with unrivaled freedom and independence. The greatest benefit of POCs is that they never run out of medical grade oxygen and will continue to provide oxygen as long as it has a power source. This power source can be its rechargeable lithium ion battery, an AC outlet (standard wall plug-in), or a DC outlet (cigarette lighter in a car).
Home Oxygen Concentrators
Most oxygen patients are familiar with the standard stationary concentrator. As a quick review, these machines run off of AC power only and tend to be more robust than POCs (offering flow rates of 1-10LPM). Stationary concentrators are designed to be used in the home and can be used with extended tubing to offer patients mobility in their home. As technology has progressed these machines have become lighter, quieter and more energy efficient however many Medicare providers still supply outdated models that are loud, clunky, and power consumptive. New machines can be up to 25 decibels quieter, consume as little 125 watts, and as light as 8 lbs.
Medicare & Insurance Coverage
As stated above, if you are a current oxygen therapy patient, it is probable that your current solutions were provided through Medicare, insurance, or perhaps a combination of the two. So now that we have taken care of the basics let’s address if Medicare will cover your oxygen solution, namely a POC. To answer this question, let’s take a look at a couple facts that are the same for ANYONE who is looking to have Medicare cover their oxygen needs.
1). Medicare coverage on oxygen equipment is mainly provided through a long-term, monthly rental contract that spans five years. The equipment is rented through a Medicare provider. This provider is contracted through Medicare to provide you your oxygen equipment for all five years and is reimbursed on a monthly basis by Medicare for only three of those years.
2). The contracted provider is expected to provide the patient with ONE solution for home use (home concentrator) if the patient only needs oxygen for sleeping/home use and or a portable solution (tanks or a POC) if it is deemed that the patient requires oxygen therapy 24 hours a day or for activity. If a patient wants a second solution for either home or portable use the provider is NOT obligated to provide it and in most cases will not.
3). Your Medicare provider has no obligation to provide you with any particular type of equipment and is not required to provide you with a portable oxygen concentrator regardless of you or your doctor’s requests. The most common solution provided to patients is the stationary unit and the refillable oxygen tanks. The best way to start is to ask your provider if they will provide you with the equipment of your request.
4). Medicare will NOT provide you reimbursement for any out-of-pocket expense, nor will it pay for the short term rental or purchase of a portable oxygen concentrator.
5). If you have supplemental insurance they may be willing to reimburse you for some if not all of the purchase or rental of a POC.
Based on the above facts, it is our recommendation to start by talking to your current Medicare/Insurance provider to see if they will provide you with the equipment you are requesting.
Purchasing an Oxygen Concentrator Out-Of-Pocket
If you have spoken to your provider and they say deny to provide the unit you request the answer to the Medicare coverage questions is – NO.
The good news is that purchasing your own oxygen concentrator allows you to take control of your healthcare by giving you the ability to choose the best concentrator for your medical and lifestyle needs.
If you have made the choice to purchase an oxygen concentrator out of pocket visit our local showroom in South Florida where you can touch, feel, and try an oxygen concentrator before you buy!
You could also consider renting a oxygen unit for a day, over the weekend, or for a few weeks to see how the unit fits with your needs and lifestyle. If you like the unit, keep it, and we’ll apply your first week’s rental costs (minus shipping) toward the purchase of the unit. Call for 1-800-941-1402 for details!