Monday, November 21, 2022

Does Medicare Cover Portable Oxygen

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Understanding Medicare: FAQs on Supplemental Oxygen Medicare Coverage

In order to maximize your chance of insurance covering your portable oxygen concentrator, the first step is making sure your paperwork is in order. Your doctor should write an order for the POC, and also should include all of your relevant medical information such as test results, the severity of your disease, and how often you require oxygen. If your claim is denied, an appeal should fully document why you need a POC instead of an oxygen tank. Take your time writing out all the ways in which having a POC are necessary to maintain your quality of life, including both professional and personal examples. The more details you provide, the more likely you are to convince your insurance to cover your POC.

How Do Portable Oxygen Concentrators Work

Portable oxygen concentrators convert outside air into almost pure oxygen with the following steps:

  • Draws outside air into the unit
  • Filters the air to remove any contaminants
  • Compresses the filtered air
  • Passes the filtered and compressed air through a sieve bed that extracts the nitrogen
  • The resulting air is about 95% oxygen, which flows from the machine through tubing connected to the machine on one end and to a nasal cannula or face mask on the other end.

    For more information, the American Lung Association has a webpage with helpful videos showing how to use a portable oxygen concentrator.3

    When Is Home Oxygen Prescribed

    Your doctor may prescribe home oxygen if you have a medical condition that reduces blood oxygen levels. This is known as hypoxemia.

    Symptoms of hypoxemia include:

    • A pale or blueish tint to the lips and skin
    • Fast breathing or shortness of breath
    • Increased heart rate

    A wide array of health conditions may cause hypoxemia, including:

    • Chronic obstructive pulmonary disease
    • Cystic fibrosis

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    Medicare Part B Provides Coverage For Durable Medical Equipment Like Portable Oxygen Concentrators

    Although it helps pay for a variety of oxygen equipment and accessories, Medicare only covers portable oxygen concentrators under specific circumstances.

    The difference is in that word, “portable.” Medicare coverage for durable medical equipment specifically states that beneficiaries must require said equipment for use in the home. For Medicare to cover portable oxygen concentrators , your doctor must certify that you have a near-constant need for oxygen AND are mobile within your home. You must also meet all other requirements to qualify for an oxygen system.

    Who Should Use A Portable Oxygen Concentrator

    Is A Portable Oxygen Concentrator Covered By Medicare

    If you need supplemental oxygen , youre not alone. The American Thoracic Society estimates 1.5 million adults in the United States use oxygen therapy.4

    People with a variety of conditions may benefit from supplemental oxygen. According to the American Lung Association, these conditions include:5

    • Chronic obstructive pulmonary disease
    • Pulmonary fibrosis

    When your body is not getting enough oxygen, you might feel confused, weak, tired, or breathless. Low oxygen levels can also cause other health problems over time, according to the National Institutes of Health .6 Supplemental oxygen can help relieve these symptoms and improve your overall health.

    If you have a diagnosed need for extra oxygen but dont want to be tied to a stationary, in-home oxygen unit, you may enjoy the independence and freedom a portable oxygen concentrator can give you. Being able to go out with friends and family, travel, and/or enjoy activities outside of the house are all possible with portable oxygen concentrators.

    Because portable units are designed to be lightweight, they arent as powerful as stationary, in-home oxygen systems. As a result, the portable oxygen concentrators currently on the market can only provide an oxygen output of up to 3 LPMs. If your prescription is written for more than this amount, a portable unit wont meet your needs, so youll need to look for an in-home oxygen system instead.

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    Who Needs A Portable Oxygen Concentrator

    For seniors suffering from a chronic lung condition such as COPD or asthma, or those with a short term illness that affects their breathing, a portable oxygen concentrator is a must-have item. The machine draws in air and uses a filter, compressor, and sieve bed to purify it, providing 95% pure oxygen to the user.

    However, the cost of an oxygen concentrator can be prohibitive, with most models costing in the ballpark of $2500. One of the first questions you might ask is does Medicare cover Inogen portable oxygen concentrators? Unfortunately, the answer might be a little more complicated than you think.

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    Our Reviews Teams Customer Service Experience

    A member of our Reviews Team called the Oxygen Concentrator Store to learn more information about all of the brands and models in this list. It took less than 30 seconds to get a representative on the line, and he was friendly, helpful, and knowledgeable about every model we asked about.

    He shared that all of the portable oxygen machines sold through Oxygen Concentrator Store come with a free seven-day trial period. If you find the unit youve purchased has mechanical problems, is hard to use, or just isnt a good fit for you, simply call the store to receive a shipping label. Then you can send the unit back and exchange it for a different one.

    Shipping takes about three to five business days, but Oxygen Concentrator Store also offers two-day and overnight shipping.

    After sharing details of the various models over the phone, the representative offered to email the information as well and gave us his direct phone number for any future questions.

    He also said even if we didnt buy a unit from Oxygen Concentrator Store, he would be happy to answer questions and provide help in the future. We were very pleased with the customer service experience it felt like we were learning about portable oxygen concentrators rather than enduring a high-pressure sales call.

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    Does Medicare Cover Home Oxygen Equipment

    An oxygen concentrator and other oxygen equipment can qualify as durable medical equipment that is covered by Medicare Part B if you meet certain conditions.

    Medicare covers oxygen equipment rentals for use in your home, including equipment such as:

    • Systems that provide oxygen
    • Tubing, masks, mouthpieces and other supplies and accessories that deliver oxygen
    • Servicing, maintenance and repairs of equipment and supplies

    Medicare may also cover humidifiers if used along with your oxygen equipment.

    Buying An Oxygen Concentrator Out

    Understanding Medicare: Changing Your Medicare Oxygen Provider

    We realize the purchase of medical equipment is an important decision. As such, we recommend considering the following precautions:

  • Always make sure the unit being sold will meet your medical needs. While the smallest and lightest technology may be nice, your medical condition may require a different unit. The sale of all concentrators legally requires a doctors prescription. If a prescription is not required for purchase, you are likely not dealing with a reputable dealer.
  • Purchase from an accredited organization The best way to verify you are doing this is to only purchase from a nationally accredited agency. Any accreditation will be very visible on a companys marketing material. If it is not there, there is a reason. The top agencies approved by the US Government that actually inspect and verify sites include:
  • Accreditation Committee for Health Care :
  • Healthcare Quality Association on Accreditation :
  • The Joint Commission:
  • Check Reviews and Better Business Bureau reports. It should be a red flag if a business is not minimally accredited by the BBB .
  • Try before you buy any reputable dealer will provide you with an opportunity to use and try the unit without penalty. Never order a unit that cannot be returned if the box is open.
  • Renting:

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    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. Thats the raw cost. Now, it is possible to get one covered completely for free. If you have original Medicare or Medicare and a supplement 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.

    Rent A Portable Oxygen Concentrator Instead Of Buying One

    Some people need supplemental oxygen and already have an in-home unit, but they may want to rent a portable oxygen concentrator for an upcoming trip or other time away from home. Or you may want to rent a unit for a few weeks to see if its a good fit for your needs.

    While renting may not be a good choice if you have a long-term requirement for oxygen therapy, it could be a great fit for someone who needs a portable oxygen concentrator temporarily. This may include people who are recovering from COVID-19, pneumonia, or another short-term respiratory illness.

    Not all portable oxygen concentrators are available to lease, but certain models are. For example, the Oxygen Concentrator Store offers Inogen and Respironics units for rental starting at $210 per week.

    Renting can save you thousands of dollars up front, especially considering Medicare Part B will pay for the rental of portable oxygen concentratorsas well as some other types of oxygen equipment.

    Talking to your doctor about how long youll need to use supplemental oxygen can help you decide whether its best to rent or buy a portable oxygen machine.

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    Can You Get Too Much Oxygen From An Oxygen Concentrator

    Yes, it is possible to get too much oxygen from a concentrator or other oxygen delivery system. Geriatric nurse practitioner Christopher Norman shared his expertise regarding this important point of oxygen therapy: As I tell everyone, oxygen is a medicationits only available with a prescription, and theres good reason for this. Just like any medication , too much can be harmful, too little is unlikely to be beneficial, and making adjustments with the amount is often best done with the help of someone knowledgeable . Knowing how to properly use your supplemental oxygen equipment is crucial to successful use of this medication, said Norman.

    Its a good idea to bring your new portable oxygen concentrator to your next doctor appointment to make sure the device is appropriate, working properly, and the settings are correct.

    Have questions about this review? Email us [email protected]

    What Types Of Oxygen Assistance Devices Does Medicaid Cover

    Is A Portable Oxygen Concentrator Covered By Medicare

    While there are several types of oxygen support devices on the market, Medicaid prefers some of them even if they are not the most comfortable for the user. In general, you may expect to receive the standard oxygen tank while being completely covered by Medicaid .

    If you want to be more mobile and comfortable, Oxygen Concentrators are a good option because they are compact enough to fit in your backpack. However, they are more expensive and considered a luxury item in medicine, therefore Medicaid may refuse to cover entire costs.

    This means you should call your health insurance provider or a Medicaid representative to learn more about your alternatives.

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    Portable Oxygen Concentrators: Does Insurance Cover Them

    For many patients, living with chronic obstructive pulmonary disease or a similar condition, oxygen therapy can be essential. Portable oxygen concentrators are becoming more commonplace these days, and favored for their ease of use. Unlike traditional oxygen tanks, portable concentrators are small, lightweight, and dont require continual changing out. While these units offer superior convenience, they are still not considered to be the standard of care in oxygen therapy for COPD patients, and therefore may not be covered by health insurance.

    But that doesnt mean you should give up, and continue using those bulky, clumsy oxygen tanks! It never hurts to attempt to get your insurance company to cover a portable oxygen concentrator instead. It could be the best decision you ever make. These lightweight units can provide a level of freedom and independence that could dramatically improve your quality of life, even with COPD.

    If you are unsuccessful at getting your primary insurance provider to cover your POC, there may be other options for you:

    Oxygen therapy allows you to stay active and engaged with your life, even with COPD. So, if youve been wondering if portable oxygen concentrators are covered by insurance, consider the tips presented in this post. And if you have questions, please reach out to us at Portable Oxygen Solutions and let us assist you!

    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:1,2

    • 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
    • Your doctors signature

    Once you have this paperwork, you can submit it to Medicare, where you will either be approved or denied.

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    What Type Of Portable Oxygen Concentrator Is Best

    Portable oxygen concentrators are not one size fits all. Your oxygen needs, lifestyle, and budget will all affect which device is the best choice for you. A few of the most reliable portable oxygen concentrators that have received the best customer reviews include the Inogen One G4 and G5, and the Invacare Platinum.

    How Much Do Portable Oxygen Concentrators Cost

    Understanding Medicare: Facts About Medicare Coverage of Oxygen

    Portable oxygen concentrators cost between $4,000 and $4,500 from the manufacturer, although you can often find them in the range of $2,500 to $4,000 from online retailers such as the Oxygen Concentrator Store and others. Used portable oxygen concentrators are even less expensive, at a cost of $800 to $2,000.

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    How Do I Qualify For Coverage

    Lets explore the criteria you must meet for Medicare to cover your home oxygen therapy rental equipment:

    • To ensure your oxygen therapy is covered under Medicare Part B, you must be diagnosed with a qualifying medical condition and have a physicians order for oxygen therapy.
    • You must undergo certain tests that demonstrate your need for oxygen therapy. One is blood gas testing, and your results must fall into a specified range.
    • Your doctor has to order the specific amount, duration, and frequency of oxygen you need. Orders for oxygen on an as-needed basis dont typically qualify for coverage under Medicare Part B.
    • To qualify for coverage, Medicare may also require your doctor to show that youve tried alternative therapies, such as pulmonary rehabilitation, without complete success.
    • You have to get your rental equipment though a supplier that participates in Medicare and accepts assignment. You can find Medicare-approved suppliers here.

    How Much Does It Cost To Rent A Portable Oxygen Concentrator

    You can actually rent a portable oxygen concentrator instead of having it purchased through Medicare. A DME will rent oxygen supplies to you and then bill Medicare a monthly fee for reimbursement of the rental.

    Prices vary based on equipment cost and monthly reimbursement rates. Some DMEs will finance the equipment to you with a low monthly cost. This involves you paying a fixed amount out of pocket based on the price of the portable oxygen concentrator you would like to rent and your Medicare reimbursement rate.

    Medicare rules have made this process a little complicated. Oxygen supplies are limited to a 36 month and according to Medicare guidelines, the equipment must be maintained for 5 years.

    This can cause suppliers to be picky about the equipment they provide depending on how long youve been on oxygen therapy. Companies will usually only be willing to supply a small portable oxygen if youre towards the beginning of your rental period so the monthly reimbursements from Medicare will cover their costs. This is still the case for some providers even if youre willing to pay a monthly rental fee.

    Also, if you rent go through with a rental option you will probably be sent a used portable oxygen concentrator with a shorter lifespan. Also, you wont be building equity in your machine, because you wont get to keep it. Thats why some DMEs will allow you to finance a brand new POC through them with monthly payments.

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    Portable Oxygen Concentrator Medicare Insurance

    Many Medicare beneficiaries who have needs for oxygen equipment, including POC, have always sought to know the government-controlled healthcare stance on oxygen tanks and concentrators. Some of the common questions asked have been in the following directions are there Medicare Supplement Plans with 100% Portable Oxygen Machine Coverage? If there are, is it on all Portable oxygen concentrators, or are there certain Prices of Portable Oxygen Concentrator Covered by Medicare? We will be answering all of these questions to clear the air on how far Medical care coverage goes and if they cover POCs.

    Medicare beneficiaries have always had durable equipment such as wheelchairs covered by the health system, and this was also the case for medical oxygen tanks and concentrators. However, the whole game changed after the healthcare reimbursement rate was cut down by 50 percent in 2013. Medicare still funds the supply of oxygen equipment but only a part of it.

    According to Medicare, there are specific criteria that must be satisfied by patients before they can be considered eligible for oxygen equipment, including POCs. If the requirements are met, they will help cover part of the cost. The conditions are outlined below:

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