What Does Medicare Cover For Portable Oxygen Concentrators
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 cover them but then only giving the patient oxygen tanks. They can bill the whole amount up front for supplies that are ordered each month like oxygen tanks and tubes. 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 that they are travelling out of town such that they would need it.
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Does Medicare Cover Portable Oxygen Concentrators
While Medicare covers small liquid portable tanks, oxygen concentrators are not part of the coverage. Oxygen concentrator devices are much more expensive.
This is why suppliers choose to cover the smaller portable oxygen tanks instead since its much more cost-effective. Medicare will only approve one payment for oxygen therapy.
Does Medicare Cover Inogen
Inogen is a portable oxygen concentrator, which is a device that is used for oxygen therapy. Oxygen therapy involves using a medical device to provide individuals with more oxygen, helping the patient breathe better. Medicare may cover Inogen and other oxygen therapy tools if you meet specific criteria.
How Does Inogen Work?Inogen provides a much needed boost of oxygen for individuals with a variety of health conditions, including chronic obstructive pulmonary disease , asthma, heart failure, pneumonia, sleep apnea, and much more. These conditions can cause the lungs to absorb oxygen less effectively, making the 21 percent oxygen in the air insufficient. Oxygen therapy provides these patients with additional oxygen that can be used for as many hours each day as needed.
When most people think of oxygen therapy, they picture the giant metal oxygen tank getting pulled around on a small dolly, but, Inogens portable oxygen concentrators provide a much more mobile option, allowing you to take your oxygen anywhere with ease.
Inogens systems are designed to allow their users to continue to live an active lifestyle. These tanks are lightweight, making them great for traveling or running errands around town. Their small size also allows you to leave the house without having to lug around a giant tank.
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Caire Freestyle Comfort Portable Concentrator
This is a small, compact, and lightweight POC that you can take it wherever you go. It is designed to be quiet to maximize the user-friendliness of the machine. You may contact the supplier since they offer installment plans for the unit.
Hence, here are some amazing features of this portable concentrator unit:
- Price: $2,495
- Battery life: 4-hour battery life
- FAA approved: YES
- Accessories: includes Freestyle Comfort, small 8 cell battery, power supply with AC input cable, carry bag and strap, vehicle power cord, cannula and manual
What Does Oxygen Equipment Rental Include
Medicare oxygen equipment is rented for 36 months. In addition, medical equipment suppliers must furnish the oxygen equipment and related supplies for an additional 24 months if necessary.
Your monthly rental includes the following oxygen accessories and services:
- Tubing or mouthpiece
- Oxygen contents, including liquid oxygen and oxygen concentrate
- Maintenance of the oxygen machine
Medical suppliers must provide both the equipment and related supplies for up to 5 years, assuming you continue to have a medical need for oxygen.
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Portable Oxygen Concentrator Frequently Asked Questions
This is a question best left to your doctor. When prescribing you portable oxygen, he will inform you of the amount of oxygen youll require, and hell likely recommend some specific models that he has experience with.
Amie has been writing about senior care products and services for the last decade. She is particularly passionate about new technologies that help improve the quality of life for seniors and their families. Seeing her parents and grandparents age made Amie ask herself, Would this be good enough for my loved ones? In her spare time, Amie enjoys outdoor adventures and spontaneous road trips. Learn more about Amie here
Can I Change Homecare Providers To Get A Portable Oxygen Concentrator
Again, the answer is a bit complicated. Your Medicare oxygen benefit runs on a 5-year cycle. During the first 3 years, your homecare provider can bill Medicare the full benefit amount for your home and portable equipment. They receive about $125 per month for all oxygen equipment. During the final 2 years, they can only bill Medicare for the maintenance on the equipment, so they receive even less.
Any company that may provide a portable oxygen concentrator would need to take advantage of the full 5-year cycle in order to recoup enough cost to cover their expenses. Thus, they would need to be able to bill Medicare within the first couple months of your initial need for oxygen, or at the beginning of your next 5-year cycle. Timing is everything.
Also, keep in mind that oxygen equipment falls under Medicares competitive bidding which is geographic in nature. Most likely there are several homecare companies that have won the bid for your area and only those companies can bill Medicare on your behalf.
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Will Medicare Advantage Offer Coverage For Oxygen Therapy
Advantage plans must cover the same health services and equipment that Medicare includes. Fortunately, oxygen falls within this category. However, costs associated with coverage may vary since these plans are through private insurance companies.
The best bet is to contact the carrier to determine the coverage criteria for oxygen therapy. The carrier is the one who sets how much they cover. So, they may cover it, but they may cover less than what Medicare wouldve covered.
Details For Using Oxygen Dme
When it comes to oxygen equipment, Medicare will pay for you to rent this durable medical equipment. Your rental covers both the oxygen equipment and the other necessary accessories such as tubing, mouthpieces, and masks.
After 3 years, Medicare will stop paying the rental fee, but the Medicare supplier must still continue to supply you with both maintenance and accessories to go with your equipment for the next 2 years. The supplier cannot invoice you for these services. Finally, at the end of 5 years, the DME supplier doesnt have to continue providing your oxygen equipment or the maintenance required for it. At this point, you will start over on a new 3- year period either with the same DME supplier or a new one, if you prefer.
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Are Inogen Oxygen Concentrators Covered By Insurance
Medicare covers up to 80% of the cost of renting an Inogen One G3 oxygen concentrator. Inogen oxygen concentrators may also be covered by private insurance plans, so check your policy for more details. If youre not eligible for Medicare or your health insurance plan doesnt cover Inogen oxygen concentrators, theyre available for purchase, too. Financing is available through the company.
Look For A Financing Option
Youll find some oxygen suppliers offer a financing option that lets you spread the cost of purchase. This can be a good way to ease the financial burden while still knowing youll own the equipment once its paid off. If you want to go for a financing deal, be sure to check the small print and make sure you can comfortably afford the repayments.
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How Much Does It Cost To Rent An Oxygen Concentrator
Costs can vary significantly depending on what kind of oxygen concentrator you want to rent, what kind of insurance coverage you have and whether or not you meet the criteria to have your rental covered by insurance. Generally speaking, renting an oxygen concentrator can cost anywhere from $35 to $225 per week, depending on your individual insurance coverage.
Frequently Asked Questions About Durable Powers of Attorney for Health Care. LawHelp.org , D.C. Bar Pro Bono Center, 11 May 2015, www.lawhelp.org/dc/resource/frequently-asked-questions-about-durable-powe.
Choosing a Health Care Agent. Cigna, Cigna, 8 Dec. 2019, www.cigna.com/individuals-families/health-wellness/hw/medical-topics/choosing-a-health-care-agent-aa114352.
DeGenaro, Steve. O2 Orders 101. Healthcare Quality Association on Accreditation, Healthcare Quality Association on Accreditation, 4 May 2017, info.hqaa.org/hqaa-blog/o2-orders-101.
National Coverage Determination for Home Use of Oxygen . Centers for Medicare and Medicaid Services, United States Department of Health and Human Services, 14 Aug. 2020, www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=169.
Oxygen Equipment & Accessories. Medicare.gov, United States Department of Health and Human Services, 14 Aug. 2020, www.medicare.gov/coverage/oxygen-equipment-accessories.
Medicare Advantage Plans Can Cover Oxygen Concentrators
Medicare Advantage plans cover all the same benefits as Original Medicare and may also offer additional coverage for things like dental, vision, prescription drugs and more.
One of extra benefits that may be included in some Medicare Advantage plans is air conditioners for people who have asthma. If you have asthma and have a Medicare Advantage plan, you could potentially have both an oxygen concentrator and an air conditioner covered by your plan.
Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!
About the author
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.
Where you’ve seen coverage of Christian’s research and reports:
MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts enrollment in any plan depends upon contract renewal.
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Q: What Happens To My Inogen Concentrator If Exposed To Covid
A: COVID-19 is a living virus. It needs living cells to replicate. Since there are no living cells within Inogen concentrators the virus will not thrive or grow. If exposed the virus may remain active for hours to several days. If you believe your concentrator to be contaminated please follow the cleaning and disinfection procedures contained within the Instructions for Use that came with your product. Refer to What if my unit gets contaminated question below for information on cleaning.
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Are There Specific Medicare Oxygen Requirements For An Inogen One Medicare Rental
Medicares requirements are the same, regardless of your oxygen delivery system. Every Medicare patient must meet the same home O2 requirements before receiving approval to rent oxygen equipment. Medicare does cover an Inogen One Medicare rental if you meet the criteria. Contact Inogen for more information.
How Much Does Medicare Pay For Oxygen
Medicare does not pay all of the costs of oxygen therapy. For example:
- An individual with original Medicare must pay an annual Part B deductible, which is $203 in 2021. They will also have to pay 20% of the Medicare-approved amount for HBOT or home oxygen therapy.
- There is a 36-month limit for Medicare payments for oxygen equipment rental. After that time, a person will pay 20% of the Medicare-approved amount if they use equipment that requires the delivery of gaseous or liquid oxygen contents.
- A person must also pay 20% of the Medicare-approved amount for a rented or purchased humidifier, as long as they use it with a respiratory assist device or a continuous positive airway pressure device.
For those with a Medicare Advantage plan, the costs of coverage may vary. People should contact their plan provider to find the coverage guidelines for oxygen therapy.
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Level Of Care Eligibility
Medicaid eligibility differs on a state-by-state basis, depending on the level of care that is medically necessary and needed. In order to qualify for Medicaid, individuals must be able to prove that they require a level of care that meets certain criteria or requires a level of personal care assistance.
The definition of level of care varies from state to state, but in general, it refers to assistance to those who lack cognitive function, the inability to engage in activities of daily living, and mental and behavioral health issues. These factors are just some tools that are used to assess the level of care at nursing homes for older adults, according to the American Council on Aging. Keep in mind that the level of care varies depending on the state youre in, so the criteria that might make one eligible in one state, may not apply to the other.
How Are Portable Oxygen Concentrators Covered By Medicare
Portable oxygen concentrators are covered by Medicare only if the DME supplier agrees to offer you a portable option.
Because portable concentrators are more expensive than stationary ones and because Medicares reimbursement rate to the supplier is the same either way many suppliers will only offer stationary oxygen concentrators to Medicare beneficiaries.
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What Does Medicare’s Oxygen Equipment Coverage Include
If you qualify for oxygen equipment, Medicare coverage includes a system to provide the oxygen, containers for oxygen storage, and oxygen-related accessories like tubing. If you need to use a humidifier with your oxygen machine, Medicare may also help pay for that.
Please note that, if you own your own equipment AND meet the qualifications listed above, Medicare Part B covers the oxygen contents and related supplies.
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 wont 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:
- 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 range
- Evidence that alternative measures have failed
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What Equipment And Accessories Are Covered By Medicare
If you meet all the requirements, Medicare Part B will pay for specific equipment needed to provide oxygen therapy in your home.
Oxygen equipment and supplies Medicare will pay for:
- Medical-grade oxygen
- Systems that provide oxygen
- Containers that store oxygen
- Tubing or mouthpieces
Medicare will also cover equipment and supplies for continuous positive airway pressure therapy. CPAP machines, tubing and face masks are used to treat sleep apnea and similar conditions.
The Cost Of Oxygen Concentrators
Lets first look at the cost of oxygen tanks. Without any insurance, you can expect to pay between $1500 and $3500 to purchase a portable oxygen tank. Prices will also vary based on air capacity, battery life, and accessories, among other things.
You also have the option of renting a concentrator. Though prices vary by supplier, you can expect to pay as much as $35 per day without insurance. This may seem high, but rental fees usually include parts and repairs for as long as you have the device. Your supplier may or may not include these services if you choose to buy your tank.
Does Medicare Cover Oxygen For Copd Treatment
If you have chronic obstructive pulmonary disease and your doctor determines that oxygen therapy is medically necessary for you, Medicare will help cover your oxygen equipment.
Other health conditions that could require you to need medically necessary oxygen therapy can include:
- Cystic fibrosis
- Severe asthma
As mentioned above, Medicare Part B will cover the rental of your oxygen concentrator and other equipment only if it is prescribed by your doctor for use in your home.