Medicare covers many medical equipment items that are used in hospitals and other healthcare facilities. These include blood pressure cuffs, wheelchairs, hospital beds, and even surgical tools. However, there are also some items that aren’t always covered by Medicare, including portable oxygen concentrators
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Since portable oxygen concentrators are recommended by physicians we often get asked: Are portable oxygen concentrators covered by Medicare?
In Short, the answer is yes on paper, but generally no when you try with insurance.
Robert Loyd – Local Medicare Agent
We’ve seen that very few local durable medical equipment providers will actually give you one through any form of Medicare coverage by claiming company policy or they do a bait and switch to give you an oxygen tank on dolly instead claiming they just don’t carry the portable oxygen concentrators after they receive the prescription.
There are ways to get them covered through Medicare and often the private market has some great solutions to this issue.
Below we will discuss why it’s so hard to get one through local providers, how to get one with Medicare coverage, and lastly how to get a portable oxygen concentrator if you don’t have Medicare or if you have a Medicare Advantage plan.
What is a Oxygen Concentrator?
There are two types of concentrators: a bigger model you can use at home, and a lighter, portable model you can use on the go.
The oxygen concentrator is a machine that filters out the nitrogen and other gases in the air around you, giving you purified oxygen through a thin tube.
There are two types of concentrators: a bigger model that can be used at home, and a lighter, portable model that can be taken on the go.
The concentrator requires electricity and air to work properly. If the power goes out, it won’t work until power is restored. It also needs to be cleaned every few weeks or so to prevent bacteria buildup in its internal parts.
An oxygen concentrator isn’t the same thing as an oxygen tank, which delivers liquid or gas oxygen. Instead, the concentrator is a machine that pulls in the air around you and filters out the nitrogen.
A thin tube runs from the device to your face, giving you purified oxygen through two open prongs below your nostrils. Some people use a facemask to get a higher concentration and flow of oxygen.
Portable Oxygen Concentrators
Portable oxygen concentrators are purse sized machines that deliver concentrated oxygen by compressing and purifying the surrounding air.
These are generally used in place of large oxygen tanks and home stationary oxygen concentrators when traveling.
They are lightweight and battery powered making them a favorite for anyone tired of dragging supplemental oxygen tanks around the house and in public.
What does Medicare cover for Portable Oxygen Concentrators?
- Medicare covers portable oxygen concentrators when they are prescribed for use at home.
- Medicare does not cover portable oxygen concentrators when used outside of the home.
- This includes situations where a patient uses them during travel, exercise, or other activities.
Medicare does cover medical equipment and oxygen devices but the key is they do not cover the cost to purchase this equipment outright.
They cover a rental agreement where oxygen equipment can be rented to you monthly for a 36 month agreement.
The problem for many suppliers is that in 2013 Medicare cut their reimbursement rates for oxygen equipment in half.
So, a company would have to purchase the equipment upfront and get paid piece by piece over the next 3 year at a rate that might not be profitable for them.
Hence why we see many companies accept prescriptions for these saying they will cover them but then only giving the patient oxygen tanks instead.
They can bill the whole amount up front for supplies that are ordered each month like oxygen tanks and the tubes needed to use it.
We often get told it is company policy to only allow a patient to get a portable oxygen concentrator when traveling long distance. One company told us they only allow a patient to have a portable oxygen concentrator for 3 days and they have to show proof that they are traveling out of town such that they would need it. It depends on the situation.
This is why we say it’s a yes and no answer to Medicare’s coverage of portable oxygen concentrators.
Even if you do get coverage for one from a company you will likely not have ownership of it until 3 years later.
Couple that with the issue that any changes in insurance (Medicare Advantage or Supplement) may trigger the company to repo their device back or reset the clock on you.
For this reason we have seen some companies get creative in getting these.
How to Get A Portable Oxygen Concentrator
We’ve heard from patients that it’s possible to get one without a
We can’t guarantee the quality of any of these products, and we don’t believe they’re medical grade, which is why they aren’t available through your doctor or medical supply company.
If you want a high-quality product from a reputable brand—and if you want it to be covered by insurance—you’ll need to see your doctor and get a
Amazon
It is possible to get a portable oxygen concentrator without a prescription here in the USA. There are some on Amazon. You will not find any reputable brands or high quality portable oxygen concentrators there though.
To get a quality portable oxygen concentrator from a reputable brand you will need to have a valid prescription from a medical doctor.
This is because portable oxygen concentrators are classified as a medical device under the Food and Drug Administration (FDA).
Therefore we cannot vouch if a portable oxygen concentrator sold through Amazon are medical grade. Yet, we have had plenty of patients get a portable oxygen concentrator from Amazon and have good results. We recommend you explore your options and see what fits.
Medicare
To get one covered through Medicare or to get a quality unit you will need the following on a prescription order or an application from the company you are purchasing through with as well as a your doctor’s diagnosis as to why you need supplemental oxygen.
Here is what you will need to show:
- A detailed description of all equipment necessities
- Your needed flow rate and if it is pulse or continuous flow.
- How long you’ll need to receive medical oxygen
- Date of the order
- Doctor’s signature
The type of concentrator used depends on the patient’s needs and their ability to use the machine. For example, some people may need small machines that can be carried around in a backpack or purse while others may need larger ones that sit on top of a desk or table at home or in the hospital.
Some common reasons why people need an oxygen concentrators include:
- You have a severe lung disease or you’re not getting enough oxygen.
- Your health might improve with oxygen therapy.
- Your arterial blood gas level falls within a certain range.
- Other alternative measures have failed.
Once your doctor has cleared you for Medical Oxygen, you could get it from a local durable medical equipment vendor, directly from a manufacturer, or through a distributor.
There are advantages and disadvantages to each. Things like cost, warrantee, financing, trade up programs, and insurance coverage will vary between each.
If you go through a local durable medical equipment company remember that you may only be allowed to rent it through the Medicare agreement. You will still have to pay 20% or the rental cost monthly if you have straight Medicare only.
Distributors
Lastly you could go through a distributor like Respshop and Healthy Products For You.
Purchasing through these companies is a lot like purchasing a Medicare insurance plan through a broker. You will get the same product and manufacturer warranty as purchasing direct, plus they will often have trade-in programs for old units, more financing options, and a variety of models to choose from depending on your needs and budget.
How much will a Portable Oxygen Concentrator Cost?
If we do not account for insurance it will run you anywhere from $1000-2000 depending on what model and accessories you get. That’s the raw cost. Now, it is possible to get one covered completely for free.
Health Plans that Cover Oxygen Concentrators
If you have original Medicare or Medicare and a supplement (Medigap) you can likely get a portable oxygen concentrator for free or highly discounted if you purchase it through one of the distributors above.
Many of the distributors will often do a courtesy billing to Medicare. You will have to arrange your payment for the device first, either through financing or full payment. If Medicare pays the distributor they will reimburse you with whatever payment comes through.
It is common for Medicare to require you to have a home oxygen system set up to be able to bill for a portable oxygen concentrator. This may bring the overall price up to $4000 or so but we often see that Medicare will pay up to $5500 for oxygen devices. This means you may have to take liability for the full cost to get your equipment but that Medicare will likely pay for all of your purchases within 6 months once billing is processed.
The final advantage is that you will not need any recurring purchases.
If you get oxygen tanks from a local durable medical equipment vendor then you will need to order oxygen tanks monthly for as long as you require oxygen.
With both the home and portable concentrator units purchased through these distributors you will never have to order reoccurring oxygen. The machines are all electric and generate oxygen without the need for anything other than to replace a filter and some hoses every once in a while.
What if I have a Medicare Advantage plan?
If you have a Medicare Advantage plan you will not be able to get any reimbursement from Medicare. Since your Health Plan is primary, if you want any insurance coverage you will only be able to order oxygen supplies from a local durable medical equipment vendor that is in network for your plan.
If you do not want to use your insurance or do not like your options in your network, you can always purchase your equipment outright. You will still need the prescription and other requirements listed above but you can purchase a portable oxygen concentrator out right from any of the vendors above.
Things to Consider when Purchasing Oxygen Devices
Accessories
You may be interested in getting certain accessories for your portable oxygen concentrator. Things like extra batteries, carry bags, car chargers, and more. Some of these items can get very expensive. If you are interested in getting accessories we recommend you check out places like Amazon and Ebay. You will find that things are much better prices and often there are some creative things like this floral carry bag HERE.
Warrantees
Check out what warranties each vendor offers. Some will only allow the manufacturer’s warranty. If you are buying a used or refurbished portable oxygen concentrator then there may not be a warranty left on it. Many places will only offer a 30 day warranty on used and refurbished devices. Other vendors may actually have a warranty of their own such as an Extended Warranty.
Financing
Many places offer their own financing. You can apply directly with them. A few even offer financing through popular options like PayPal Credit and Affirm.So if you have a previous history with those places it may make getting approved very easy.
Renting
Almost any company mentioned in this article will allow you to rent equipment from them. If a local durable medical equipment company will not rent you one you can use most of the ones here. It may be a slightly cheaper rate than if you were finance one, but because renting a portable oxygen concentrator has the same Medicare reimbursement rules for these vendors as the local guys they will likely give you a used and older model. Depending on your needs this may be beneficial to you.
Frequently Asked Questions:
A quality portable oxygen concentrator can range anywhere from $1000-3000 depending on model and brand. Depending on your situation you may be able to get one for $0. If you have Original Medicare as your primary insurance, then you may be able to purchase a portable oxygen concentrator from one of the vendors above and get it fully reimbursed by Medicare.
Medicare does cover medical equipment and oxygen devices but the key is they do not cover the cost to purchase this equipment outright. They cover a rental agreement where oxygen equipment can be rented to you monthly for a 36 month agreement. Many local medical equipment providers will not rent you one due to low reimbursement from Medicare. It is possible to get one paid for by medicare by purchasing both a home and portable oxygen concentrator from a company outright and then be reimbursed after that company submits the claim to Medicare.
Yes you can purchase a portable oxygen concentrator as long as you have a prescription
from a medical doctor to do so. Once your doctor has cleared you for Medical Oxygen, you could get it from a local durable medical equipment vendor, directly from a manufacturer, or through a distributor.
Yes, Medicare will cover the rental of an Inogen oxygen concentrator. They may also be able to get it covered through Medicare with a 20% coinsurance. If you have a Medigap plan you may even be able to get your oxygen concentrator for $0, depending on what plan you have.
You can buy them from local durable medical equipment suppliers as well as online stores like: Respshop, Health Products For You, Inogen, and more.
No. Portable oxygen concentrators are considered a medical device under the FDA. The person you sell it to will need a prescription
and there is some paperwork involved in the sale. It’s more akin to selling a gun to another person where a third party would likely need to help facilitate the sale. Hence, why you will see many listings on the Facebook Marketplace, Offerup and others taken down for breaking the guidelines. You may be able to sell it back to a medical equipment company.
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