Medicare covers portable oxygen concentrators, but only if your doctor prescribes one and you meet specific medical requirements.

Medicare Part B covers durable medical equipment (DME), which includes portable oxygen concentrators. However, coverage is not automatic. Your doctor must document that you have a chronic lung condition — such as COPD, pulmonary fibrosis, or severe asthma — and that your blood oxygen level falls below a certain threshold. Medicare will not pay for a portable concentrator if you use it only occasionally or for convenience.

The process starts with your doctor ordering the equipment. Your doctor submits the prescription and medical documentation to a Medicare-approved DME supplier. The supplier handles the paperwork with Medicare. If Medicare approves, you typically pay 20% of the approved amount after you meet your Part B deductible. Medicare pays the remaining 80%.

Key Takeaways

  • Your doctor must prescribe a portable oxygen concentrator and document that your blood oxygen level is low enough to meet Medicare's medical criteria.
  • You must order the equipment from a Medicare-approved DME supplier, not directly from a manufacturer or non-approved retailer.
  • Medicare pays 80% of the approved amount after your Part B deductible is met; you pay the remaining 20%.
  • Portable concentrators are covered as a rental or purchase depending on the cost and your situation, and your doctor and supplier will determine which option Medicare will cover.
  • If Medicare denies coverage, you have the right to appeal the decision with your doctor's help.

What Medicare's Medical Requirements Are

Medicare requires that your blood oxygen saturation (measured by pulse oximetry) be 88% or lower while at rest, or 88% or lower during exercise or sleep, depending on your condition. Your doctor orders a test called an arterial blood gas (ABG) test or a pulse oximetry test to measure this. The test results must be documented in your medical record and submitted with the prescription.

You must also have a diagnosis that causes chronic low oxygen levels. Common conditions include COPD, interstitial lung disease, cystic fibrosis, bronchiectasis, and severe heart disease. If your condition is less common, your doctor may need to provide additional documentation explaining why you need supplemental oxygen.

Medicare also requires that you have already tried other treatments for your condition. For example, if you have COPD, your doctor should document that you are using inhalers or other medications as prescribed before Medicare will cover oxygen equipment.

How to Order Through a Medicare-Approved Supplier

You cannot order a portable oxygen concentrator directly from a manufacturer and have Medicare pay for it. You must use a Medicare-approved DME supplier. Your doctor can recommend a supplier, or you can search for one on Medicare's website at dmepos.cms.gov. Enter your zip code to find suppliers in your area.

Contact the supplier and tell them you have a prescription for a portable oxygen concentrator. The supplier will ask for your Medicare number, your doctor's name and contact information, and details about your condition. The supplier then submits the prescription and medical documentation to Medicare for review. This step is called prior authorization, and it can take one to two weeks.

Once Medicare approves, the supplier will contact you to arrange delivery and setup. The supplier will show you how to use and maintain the equipment. Ask the supplier about their customer service hours and how to reach them if you have problems with the concentrator.

Rental Versus Purchase: What Medicare Covers

Medicare may cover a portable oxygen concentrator as a rental or as a purchase, depending on the cost of the equipment and how long you are expected to need it. Generally, if the rental cost over time would exceed the purchase price, Medicare approves a purchase instead. Your doctor and the DME supplier work together to determine which option makes sense for your situation.

If Medicare approves a rental, you pay 20% of the monthly rental cost after your deductible. The supplier owns the equipment and is responsible for maintenance and repairs. If Medicare approves a purchase, you pay 20% of the purchase price after your deductible, and you own the equipment. You are responsible for maintenance, though the supplier may offer a maintenance plan for an additional cost.

Some portable concentrators cost between $1,500 and $3,000 to purchase. Monthly rentals typically range from $100 to $300, depending on the model and supplier. Your out-of-pocket cost depends on your specific plan and whether you have already met your Part B deductible for the year.

What Is Not Covered

Medicare does not cover a portable oxygen concentrator if your blood oxygen level is normal at rest and during normal activity. Medicare also does not cover concentrators used only for travel or convenience, or for conditions that do not cause chronic low oxygen levels.

Medicare does not cover accessories such as carrying cases, extra batteries, or replacement tubing beyond what comes with the equipment. Some suppliers include these items in their rental or purchase price, so ask before you order. You may be able to purchase accessories out of pocket from the supplier or from other retailers.

If you order from a non-approved supplier or without a prescription, Medicare will not pay. You will be responsible for the full cost.

What Happens If Medicare Denies Your Request

If Medicare denies coverage, the DME supplier will send you a letter explaining the reason. Common reasons for denial include insufficient medical documentation, blood oxygen levels that do not meet Medicare's threshold, or a diagnosis that Medicare does not consider a covered condition.

You have the right to appeal. Ask your doctor to review the denial letter and provide additional medical evidence if needed. Your doctor can write a letter to Medicare explaining why you need the equipment and why the original documentation may have been incomplete. The supplier can also help you file an appeal.

The appeal process has several levels. A first-level appeal (called a redetermination) is reviewed by the same contractor who made the original decision. If that is denied, you can request a second-level appeal (reconsideration) reviewed by a different contractor. If you disagree with that decision, you can request a hearing before an administrative law judge. Your doctor's support throughout this process is important.

Supplemental Insurance and Other Coverage Options

If you have a Medigap or Medicare Advantage plan in addition to Original Medicare, your supplemental plan may cover some or all of your 20% coinsurance. Check your plan documents or call your plan's customer service to learn what your plan covers for DME.

If Medicare denies coverage and you still need a portable oxygen concentrator, you can purchase one out of pocket. Some manufacturers offer payment plans or discounts for uninsured or out-of-pocket customers. You can also ask your doctor whether a stationary oxygen concentrator (which is less expensive) might meet your needs at home, even if you need a portable one for travel.

Frequently Asked Questions

Do I need a new prescription every time I rent or buy a new concentrator?

No. Once your doctor prescribes a portable oxygen concentrator and Medicare approves it, you can rent or purchase from any Medicare-approved supplier without a new prescription, as long as your medical condition has not changed significantly. If your condition changes or your oxygen needs increase, your doctor may order new testing and update your prescription.

Can I use my portable concentrator while traveling by airplane?

Medicare covers the concentrator itself, but the airline's rules about using medical equipment on board are separate from Medicare coverage. Contact your airline before you travel to learn their policy on portable oxygen concentrators. Many airlines allow them, but some require advance notice or have specific requirements about battery type and size.

What if I need a concentrator urgently and do not have time for Medicare approval?

You can rent or purchase a portable concentrator out of pocket while the Medicare approval process is underway. Once Medicare approves, you can submit receipts to Medicare for reimbursement of the 80% they would have covered. Keep all receipts and documentation. Ask the supplier whether they can help you file for reimbursement.

Will Medicare cover a second portable concentrator if I need a backup?

Medicare typically covers one portable oxygen concentrator. A second concentrator is usually not covered unless your doctor documents a medical reason — for example, if you need one at home and one at a workplace, and your condition requires continuous oxygen. Your doctor would need to submit a separate request with medical justification for Medicare to consider covering a second unit.

What if my portable concentrator breaks and needs repair?

If you are renting, the supplier is responsible for repairs and replacements at no cost to you. Contact the supplier when ready if the concentrator stops working. If you purchased the concentrator, you are responsible for repair costs unless you purchased a maintenance plan from the supplier. Some manufacturers offer warranties that cover repairs for a set period after purchase.