Summary: Medicare covers portable oxygen concentrators when they are deemed medically necessary to treat lung or respiratory conditions once specific criteria is met. However, you may be responsible for out-of-pocket costs up to 20% if you do not have secondary coverage to Original Medicare. Estimated Read Time: 4 min
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Medicare coverage for portable oxygen concentrators is available when your doctor deems it necessary to treat a lung or respiratory condition. Portable oxygen concentrators are more difficult to receive coverage for as they can be considered a luxury for use outside of your home. To receive Medicare coverage for portable oxygen concentrators, your doctor must state that you need constant oxygen therapy outside of your home.
A portable oxygen concentrator can serve as a source of relief for those with severe asthma, COPD, emphysema, or other respiratory diseases. Additionally, Medicare covers oxygen therapy in a hospital or at home when you meet specific criteria. Below we discuss the requirements necessary to qualify for Medicare coverage for portable oxygen concentrators.
What is a Portable Oxygen Concentrator?
Portable oxygen concentrators are medical devices that are used to provide oxygen therapy to individuals who require supplemental oxygen. Unlike traditional oxygen tanks, which need to be refilled and replaced regularly, portable oxygen containers produce oxygen on demand from the surrounding air.
Portable oxygen concentrators are lightweight, compact, and easy to carry, which makes them an excellent option for individuals who require oxygen therapy while traveling, working, or being outside the home.
Does Medicare Cover Portable Oxygen Concentrators?
Original Medicare covers portable oxygen concentrators when certain conditions are met. Medicare Part B covers home oxygen therapy, which includes both stationary and portable oxygen equipment.
To be eligible for a portable oxygen concentrator through Medicare you must first be diagnosed with a medical condition that requires oxygen therapy, such as COPD, emphysema, or pulmonary fibrosis. You also must have a written order from your doctor stating that oxygen therapy is necessary.
In addition to these requirements, you must also meet certain oxygen saturation levels to receive Medicare coverage for portable oxygen concentrators. Oxygen saturation levels are measured using a device called a pulse oximeter, which clips onto your finger and measures the amount of oxygen in your blood. In order to qualify for coverage, your oxygen saturation level must be below 88% while at rest, or below 90% while engaging in an activity.
If all criteria are met, Medicare will provide coverage for the rental of a portable oxygen concentrator. Medicare Part B will cover 80% of the cost of the equipment (if you have met your Part B deductible for the year), and then you will be responsible for paying the remaining 20% out-of-pocket unless you have a Medigap plan in place.
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A popular portable oxygen concentrator is Inogen One. Inogen One Medicare coverage is the same as other portable oxygen concentrators. However, your out-of-pocket costs may be higher than generic machines.
Remember, Medicare will only cover devices rented from a Medicare-approved supplier.
Does Medicare Cover Oxygen Therapy?
Oxygen therapy, as well as oxygen therapy tank accessories, are covered under Medicare Part B. Oxygen equipment and all accessories are considered Durable Medical Equipment. Medicare Part B covers the rental and use of DME for beneficiaries to use within their homes.
Medicare covers storage containers for oxygen, tubing, other oxygen accessories, and units that provide oxygen. Also, if the oxygen machine works with a humidifier, this may have coverage.
For Medicare to cover oxygen equipment and supplies, beneficiaries must have the following:
- Have a prescription from your doctor.
- Have documentation from your doctor showing you have a lung disorder preventing you from receiving enough oxygen and that other measures have not been successful in improving your condition.
- Proof of gas levels in your blood from your doctor.
It’s more cost-effective to rent your oxygen equipment from a participating DME supplier. Your rental payments will be paid for up to 3 years. After that, the supplier will still own the equipment. However, they must still supply oxygen to you for an additional 24 months. If you still need oxygen therapy after five years, you can renew your contract with the supplier or find a new one.
If you use an oxygen concentrator, your Part B benefits will cover the cost of servicing your equipment every six months once the 36-month rental window has ended.
How Much Does Oxygen Cost with Medicare?
Medicare Part B covers your outpatient oxygen services. However, your equipment must be rented, not purchased.
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Once you meet the Medicare Part B deductible, you will receive 80% coverage for oxygen services, and you’ll only cover 20%. However, your costs can vary based on the equipment you need and where you rent it from.
What Does an Oxygen Rental Include with Medicare?
Medicare oxygen rentals allow you to rent equipment for 36 months. You will receive all necessary supplies, equipment, and oxygen for the duration of your rental.
Each month you will be supplied with tubing, oxygen concentrate (or liquid oxygen, depending on your device), and any service or repairs needed for your equipment.
Can I Continue My Medicare Oxygen Rental After 36 Months?
If you have rented oxygen through Medicare for 36 months and are still in need of services, your medical supplier must continue to provide you with the necessary equipment for up to five years.
After the five years are up, your need for oxygen will need to be reevaluated. If you are still in need of oxygen services, you can either renew your rental or choose a new supplier to receive your oxygen supplies from.
How to Get Coverage for Oxygen Therapy Under Medicare
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Sources:
MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.
- Oxygen Equipment & Accessories, Medicare. Accessed March 2023.
https://www.medicare.gov/coverage/oxygen-equipment-accessories
I have a current physician’s prescription for the use of an oxygen concentrator when sleeping. My DME provider provides the equipment. Recently I asked for a portable unit so I could exercise outside the home. I have been getting worse. My physician retested me and told me, I do qualify. He sent the prescription to my DME providers. They told me it is a Medicare rule that I must use portable O2 tanks, 8 per month for 3 months and then get a new prescription before they would provide a portable oxygen concentrator. Carrying even a small tank is heavy and I have a very bad back but if that is the rule I will comply but mi can’t find information on that rule. Also a concentrator operates differently that straight flow oxygen. Is my DME provider telling me the truth?
Hi Jill, do you have Original Medicare or a Medicare Advantage plan? This discrepancy could be due to your specific coverage. However, if you have questions about your specific coverage it is always good to contact your carrier directly. Typically, Medicare will help cover some of the costs for portable oxygen, but without knowing the exact coverage you have it is difficult to give a direct answer to this question.
If my father is just finishing his 2nd year on an oxygen concentrator rental and he wants to change from a Humana Medicare replacement plan to an United Health Care Medicare replacement plan. Does the rental continue as its current 21st month with the new UHC Medicare replacement plan, or can the rental start over at month #1 so he could get a new concentrator or even change DME suppliers if he wants too. What does the law allow?
Thomas, the rental would start over with the new insurance carrier. It is likely that you would need to change suppliers if his current supplier is not in-network for his new plan.
I am the PCA for my life partner with CP and now has hypercapnia caused by the CP from shallow breathing over her lifetime. Medicare is paying or renting her oxygen concentrator, ventilator, and 02 tanks. We recently had a power outage for almost 2 days and the 02 tanks on hand was sufficient as she is on 3 liters continuous and this is only as of Jan 2021. I couldn’t get anymore tanks from the oxygen supplier and had no idea if her settings on the regulator could have been reduced to 2 or even 1 during this emergency or not. I would like to know if Medicare would pay for a portable battery oxygen concentrator that would only be used in a power outage like a Inogen one G5 or Claire Freestyle Comfort or the like that have the most hours per battery charge?
I was told by my oxygen company that Medicare only pays for 2 cords for each month. I have always asked for more so I would always have them in hand and wouldn’t have to call so often. I need to know if this is true and when this took effect. I have been on oxygen for many years and not till these past few months since I moved to Ma. I have had trouble. I have Medicare and a supplemental
Hi Kathleen. Is your supplemental a Medigap or Medicare Advantage plan?
As a respiratory therapist of nearly 20 years and someone who works in the Home Respiratory DME Roma I can tell you this is accurate. Most companies don’t enforce it because tubing costs little to nothing but occasionally you do have companies or service locations who are a little stingy. Hope that helps,
Your friendly neighborhood respiratory therapist
Wade, thank you so much for your expert advice!
What type of cords are you referring to? I do know Medicare doesn’t pay for supplies for oxygen at all that is part of the amount that is received for the rental each month that the company is responsible for providing.
I have an Inogen portable oxygen concentrator and a stationary Inogen constant flow oxygen concentrator paid thru Medicare. (I pay a little over $400.00 per year co-pay) However, Inogen will only send me 16 Cannulas TOTAL per YEAR for 2 machines. That is only 8 Cannulas per machine per year! That means changing either Cannula every 6 to 7 weeks! Why is this when you are recommended to change these every 1 to 4 weeks max? This is unhealthy…, is there anything that I can do????
Hi Daniel! Yes, reach out to your doctor regarding the issue. They should be able to submit additional documentation to Medicare with an updated treatment plan that will give you enough cannulas to change them every 1 to 4 weeks, whichever your doctor prescribes.
My mother recently was dx with stage 4 lung cancer and is on oxygen. We have had difficulty with the company her pulmonologist referred. I have asked to change companies and was told if the original script was over 30 days we would be locked into using the incompetent company for FIVE years! This can not be true, is it?
Hi Marcy! This is a little bit out of my expertise, however, I’ve never heard of this being a rule before. I would find a new DME company that you want to use and ask them if that is true. You may be able to ask her doctor for a new script as well.
Medicare testing is only good for 30 days and original set up however you can transfer to another company as long as they send all of the testing. Most companies will only allow you to transfer within the first year due to how insurance payouts happen. Your physician can send a prescription with the testing to another company if you are that dissatisfied.
Your friendly neighborhood respiratory therapist
We live in Florida…my husband has COPD and has fluid around his lungs. I have been told that in order to get Oxygen his level must be 88 or below. His is 94 but he is suffering and cannot breath at all most of the times. Uses his nebulizer and Symbicort and still cannot breath. What can I do to get him Oxygen for home use….he cannot go anywhere because of this condition…not even to a store.
Hi Marguerette. I’m sorry your father is having so much trouble breathing. His oxygen levels should be below 88 if he is struggling that much. Has he seen his primary care physician for this issue yet? Telehealth appointments may be available to him so that he can be examined and prescribed oxygen therapy at home. They may send him something that can test his oxygen levels from home.
I would recommend having an overnight oximetry test performed to see what his saturation level is at night when he sleeps. We usually see nocturnal saturations before daytime saturations and that will at least get him on oxygen and sleeping at night. His oxygen saturation still has to go below 88%.
Your friendly neighborhood respiratory therapist
I was originally placed on oxygen for nocturnal hypoxia 3L . After being hospitalized with Covid-19, in December/January, I was d/c’d on oxygen 3L 24 hrs per day. I’m still using my home concentrator with a very long tubing. This creates a terrible hazard, as I trip, get wrapped around the tubing, and it catches on cabinet knobs etc. This is a broken hip/rib waiting to happen! They have provided me with tanks for outings which are cumbersome and run out too quickly! What if anything can I do to qualify for a PORTABLE LIGHTWEIGHT Concentrator. I was completely independent prior to Covid! This oxygen delivery is what is keeping me homebound and in an invalid mode that I wish to shed!! Please advise. I think I have been on my current concentrator 3-4 yrs. with a very lax DME supplier.
Hi Diane! Have you tried contacting your DME supplier to see what your options are? Depending on how lax they are, you can rent a portable oxygen concentrator instead of having it purchased through Medicare. A DME supplier will rent the oxygen supplies to you and then bill Medicare a monthly fee for reimbursement of the rental. AeroFlow Healthcare has great information on this topic.
Does Medicare treat a patient differently if they are in Hospice care or Palliative care? My wife has a prescription for 5/10 l/minute (at rest/moderate motion) but needs an increase to 10/15 l/min. That requires two concentrators used together. We have been told by a hospice provider that Medicare will only pay for 1 concentrator and no reserve tanks. Can this be right?
Hi Russell! Firstly, I’m so sorry you’re dealing with this. Since this sounds like something that would be handled in a case-by-case scenario, I would contact Medicare directly WITH the hospice care provider either on the phone via 3-way call or physically with you. This will help you get the problem resolved much quicker and avoid he said she said and going back and forth.
If a Medicare patient is at the end of their 5 Year RUL for their oxygen equipment and is needing oxygen supplies but has not yet been to their doctor to re-qualify for the Oxygen. Can the providing Oxygen supplier refuse to deliver Oxygen supplies to that patient until he/she is requalified for their Oxygen?
Hi Michelle! The oxygen equipment is a prescription, so the Durable Medical Equipment supplier could possibly deny you the supply of the prescription is not up to date. However, if you call the physician they may renew the prescription without having you come into the office or do the exam possibly virtually with Telehealth.
Hello
I am having the same problem. I have a 33 year old child that has severe cerebral palsy. Total care 24/7 by us. 2 months old mentally and physically. He has needed oxygen since he was 8. My durable medical supplier wants a new prescription. My pulmonary drs nurse wants us to go to the office. Per cms guidelines 5/12/2021 it does not need to be clinical for certification. The nurse refuses to work with me. I have numerous videos of him below 88 with his pulse ox that is on him continuously. He is the worse at night. The reason I video him.
Am I reading the new guidelines wrong? He does not have to gointo the office or do they waive certification during Covid? He cannot get vaccinated because of an adverse reaction to other immunizations and any respiratory infection will put him in an ICU. Covid would kill him. I live in Georgia.
Thank you
Hi Tina! I’m so sorry you’re battling with your child’s nurse over this. I would recommend you request a telehealth appointment as an alternative to going into the office. If his nurse denies your request, then I would highly recommend finding another nurse.
My husband suffers from CHF. He uses a Cpap for sleep but often wakes unable to breathe. I have had to call an ambulance4 times in 4 months and he has been hospitalized from 2-7 days to stabilize his oxygen levels. Once he is on oxygen, his saturations levels improve to above 95%. We are trying to get Medicare to approve portable home oxygen so these ambulance and hospital trips are unnecessary We keep being told that because his sat level is not consistently 88 or below, he doesn’t qualify.. it’s like a catch 22. We cannot sustain the cost of this life saving oxygen out of pocket. What recourse might we have?
Hi Joyce! I’m so sorry your husband is suffering from CHF. It is true that his sat level needs to consistently be 88 or below to qualify for home oxygen. What parts of Medicare does your husband have? Does he have a Medigap plan? Would you be considered lower income? If so, you may qualify for a Medicare Savings Program to help cover your out-of-pocket costs.
Hi Joyce,
Just ran across your situation and thought I’d give you a couple options to help your husband get oxygen. He can qualify for portable and concentrator by a spot check of his O2 sat being 88% or below. This has to be done in a chronic stable state (not in an emergency situation) at a Drs. visit or in patient hospital stay.
Another option would be an exercise test at a Drs. visit or hospital stay. Again, he needs to be in a chronic stable state. The first documented sat needs to be at rest (setting) on room air. The second documented sat needs to be ambulating on room air. The third documented sat needs to be ambulating with oxygen applied to show improvement. As long as he desats to 88% or below, he would qualify for Oxygen.
In both the above cases the desaturation does not have to be consistent. Just documented by chart notes or test results.
The actual best route to take would be a titrated sleep study because he uses a CPAP. He would have to go into a sleep center, they would optimize the CPAP usage to show that his Obstructive Sleep Apnea is treated and then document his oxygen sats. This test would be the most accurate to see what is going on with him while he’s sleeping. His oxygen sats need to be below 88% for 5 minutes (does not have to be 5 continuous), with a minimum sleep time of 2 hours.
Without knowing your husbands situation at all, he may need more therapy for his sleep problems. Maybe his settings need changed. Maybe he needs to be considered for a BiPap. The sleep study would answer those questions for you.
Irregardless, the 88% or below does not have to be consistent (with the exception of the 5 minute rule for sleep study and it can be cumulative). Your doctor or CPAP supplier should be able to help you with getting him qualified if needed.
Hope this helps. You’re not caught in a catch 22! Just need the correct documentation and testing. Best wishes – Toni Murphy DME supplier/biller for 20 plus years.
Toni thank you so much for this information!!!
I work a clinical care coordinator at a ILD clinic. We see patients from many parts of California at sea level. My doctor has ordered our patient a higher flow oxygen concentrator due to progression of her disease process. She lives at 5600 ft elevation. It was my understanding due to Covid-19 and assisting in reducing patients exposures that CMS has waived the requirement for saturation testing results to prove patient requires 4 lpm oxygen to maintain saturations above 90%. Is this true?
Hi Bill! Clinicians can provide remote patient monitoring services for patients, no matter if it is for the COVID-19 disease or a chronic condition. For example, remote patient monitoring can be used to monitor a patient’s oxygen saturation levels using pulse oximetry. I would contact Medicare directly to find out if saturation testing has been waived.
What is the required service period for oxygen equipment
Hi Richard! Oxygen customers are allowed 36 months or three years with their equipment before it is required that they recertify their disease state.
My ‘2nd’ dad has been on oxygen for over 5 years. If he passes away will we be required to turn his oxygen machine back in?
Hi Sandy! If your father has been using the equipment for more than five years, you won’t have to return it. Anything less I would contact the Durable Medical Equipment company to see if they want you to return it. You would not return it to Medicare, but the company he purchased the equipment from who accepted payment from Medicare.
Does Medicare cover liquid oxygen? Recently diagnosed with PF and need oxygen 24/7. Looking for optional portable to use instead of oxygen tanks.
Hi Karen! Yes, Medicare will cover liquid oxygen. Your doctor will specify the type of oxygen delivery system to be used. (i.e., gas, liquid, or concentrator) They must sign the completed form CMS-484.
Does Medicare cover oxygen therapy if you did a CPET test and it shows you have low VO2?
Hi Judy! Your doctor will be able to answer this question.
I suffer from severe chronic daily headaches. I learned that oxygen treatments are often helpful for pain relief. Is Medicare paying for these treatments? From what I learned it takes several treatments.
If your doctor finds the treatment is medically necessary, then Medicare will cover it. How much is covered depends on what parts and plans of Medicare you’re enrolled in. Let me know if you have any more questions!
I am a heart failure patient and my doctor has put me on oxygen at night. At the beginning I was told I would be on oxygen for the rest of my life. Now my oxygen supplier is telling me I need to be re-evaluated annually or Medicare will not cover it. My doctor disagrees. What do you say?
Hi Elisabeth! Your supplier is correct. Since oxygen is a prescription, you’re required to get re-evaluated annually to have your prescription renewed each year.
I am a pulmonary physician. I have a national virtual medical practice that does cash py consults and often get referral from concentrator vendors. If I see a patient using my telemedicine portal and they ask me for a prescription for an oxygen concentrator (they are already on oxygen prescribed by thier own physician) do I have to have “documentation or proof” that they have COPD, pulmonary hypertension, pulmonary fibrosis etc or can I take the patients word for it? I usually just make sure I ask the patient about thier underlying diagnosis, what oxygen liter flow they are on and that thye are mobile and will benefit from buying a concentrator.
Hi Jagdeep! Great question. Since your patient has already been prescribed an oxygen concentrator from their previous physician, you most likely won’t have to provide documentation or proof that the patient has been diagnosed with one of the conditions you listed. I would still recommend you have this documentation sent over from your patients’ previous physician so you have it on record just in case. However, if your patient has a reversible condition, such as Pulmonary Hypertension, CMS may require that you submit documentation or proof that they still have this condition after a certain amount of time and still need an oxygen concentrator. I hope this helps!