What Medicare covers for portable oxygen

Medicare Part B covers portable oxygen concentrators, but only if your doctor prescribes one and you meet specific medical requirements. Medicare will pay for the equipment itself and ongoing supplies, though you will pay a share of the cost through your deductible and coinsurance. The concentrator must be prescribed by a doctor who has documented that you have a chronic lung condition and need supplemental oxygen.

Coverage is available through two routes: you can rent the equipment from a Medicare-approved supplier, or in some cases purchase it outright. Most people start with a rental, which Medicare covers at a set monthly rate. If you rent for an extended period — typically 36 months — you own the equipment at that point, and Medicare stops paying for it.

Key Takeaways

  • Your doctor must prescribe a portable oxygen concentrator and document that you have a chronic lung condition requiring supplemental oxygen.
  • Medicare Part B covers the equipment and supplies after you meet your annual deductible, and you pay 20 percent coinsurance for the rental or purchase.
  • You must use a Medicare-approved durable medical equipment (DME) supplier, and the supplier handles the paperwork with Medicare.
  • Rental payments typically stop after 36 months because you own the equipment at that point, though you remain responsible for maintenance and repairs.
  • If you have Medigap or Medicare Advantage, your out-of-pocket costs may be lower, depending on your specific plan.

How to get Medicare to cover a portable concentrator

Start by talking to your doctor about whether a portable oxygen concentrator is medically necessary for you. Your doctor will need to order an oxygen saturation test (usually done in the office) to measure how much oxygen is in your blood. Medicare requires documentation showing that your oxygen level falls below a certain threshold — typically 88 percent or lower at rest, during activity, or during sleep — before it will cover the equipment.

Once your doctor has the test results and writes a prescription, ask your doctor's office for a list of Medicare-approved DME suppliers in your area. You can also search the Medicare website or call 1-800-MEDICARE to find approved suppliers near you. Contact the supplier directly; they will verify your Medicare coverage, confirm your doctor's prescription, and handle all the paperwork with Medicare on your behalf.

The supplier will deliver the concentrator to your home and show you how to use it. They will also arrange for ongoing maintenance and replacement supplies like tubing and filters. You do not need to submit any paperwork yourself — the supplier does this work.

What you pay out of pocket

Your costs depend on whether you have Original Medicare alone or if you also have Medigap or Medicare Advantage coverage. With Original Medicare, you pay your annual Part B deductible (which changes each year) and then 20 percent of the Medicare-approved amount for the rental or purchase. The remaining 80 percent is covered by Medicare.

For a rental, Medicare pays a set monthly amount to the supplier. Your 20 percent coinsurance is calculated on that amount. If you purchase the concentrator instead, you pay 20 percent of the purchase price after your deductible. Many people find that renting is less expensive upfront, especially if they are unsure whether they will need the equipment long-term.

If you have a Medigap plan, it typically covers your coinsurance, meaning you would pay only your deductible. If you have Medicare Advantage, your out-of-pocket costs depend on your specific plan — some cover durable medical equipment with a copay, others with coinsurance. Check your plan documents or call your plan to find out your exact costs before you order the equipment.

Renting versus buying through Medicare

Medicare allows you to rent or buy a portable oxygen concentrator, and the choice affects your long-term costs. When you rent, Medicare pays the supplier a monthly fee, and you pay your coinsurance on that fee each month. After 36 months of rental payments, you own the equipment outright, and Medicare stops paying for it.

If you purchase the concentrator instead, you pay your coinsurance on the full purchase price upfront (after your deductible). You own it when ready, but Medicare does not cover repairs or replacements after the initial purchase. Many people rent first to see whether they will use the equipment consistently, then own it after three years if they need it long-term.

Talk to your DME supplier about the total cost of each option over time. The supplier can show you the monthly rental cost and the purchase price so you can compare. Your doctor and supplier can also help you decide based on how much you expect to use the concentrator and whether your condition is likely to improve or worsen.

When Medicare will not cover a portable concentrator

Medicare will not cover a portable oxygen concentrator if your oxygen saturation level does not meet the threshold, even if you feel short of breath. The test results must show that your blood oxygen is 88 percent or lower under the conditions Medicare recognizes (at rest, during activity, or during sleep). If your oxygen level is higher, Medicare considers supplemental oxygen medically unnecessary.

Medicare also will not cover equipment from a supplier that is not Medicare-approved. If you order a concentrator from a non-approved supplier or purchase one on your own, Medicare will not reimburse you. Always confirm that your supplier is on the Medicare-approved list before you place an order.

If your doctor prescribed a concentrator but Medicare denies coverage, you have the right to appeal. Your doctor's office or the DME supplier can help you file an appeal and provide additional medical documentation. The appeal process typically takes several weeks.

What happens after 36 months of rental

After you have rented a portable oxygen concentrator for 36 consecutive months, you own it. Medicare stops paying the monthly rental fee, and the equipment is yours to keep. You are responsible for any repairs, maintenance, or replacement parts from that point forward.

If the concentrator breaks down after you own it, you will need to pay for repairs out of pocket, or you can purchase a new one. Some people choose to buy a new concentrator at that point if the rental model is no longer available or if they want a newer model. Medicare does not cover a second piece of equipment unless your medical condition changes and your doctor prescribes an additional concentrator for a different purpose.

If you no longer need the concentrator after you own it, you can keep it as a backup or donate it. You are not required to return it to the supplier.

Medicare Advantage and Medigap coverage for oxygen equipment

If you have a Medicare Advantage plan, your coverage for portable oxygen concentrators is determined by your specific plan, not by Original Medicare rules. Some Medicare Advantage plans cover durable medical equipment with a copay (for example, $50 per month), while others use coinsurance like Original Medicare. A few plans may not cover portable concentrators at all, or may have restrictions on which suppliers you can use.

Check your Medicare Advantage plan documents or call the plan's customer service number to find out your exact coverage and costs before you order equipment. You may need to get prior authorization from your plan before your doctor can prescribe the concentrator.

If you have Original Medicare plus a Medigap plan, your Medigap plan typically covers the 20 percent coinsurance that Original Medicare does not pay. This means you would pay only your annual Part B deductible, and Medigap would cover the rest. Different Medigap plans cover durable medical equipment differently, so review your plan documents or call your Medigap insurer to confirm.

Frequently Asked Questions

Do I need a prescription from my doctor to get a portable oxygen concentrator covered by Medicare?

Yes. Your doctor must prescribe the concentrator and document that you have a chronic lung condition requiring supplemental oxygen. Your doctor will also order an oxygen saturation test to show that your blood oxygen level meets Medicare's threshold. Without a prescription and test results, Medicare will not cover the equipment.

Can I use any oxygen concentrator supplier, or does it have to be Medicare-approved?

It must be a Medicare-approved durable medical equipment supplier. If you order from a non-approved supplier, Medicare will not pay for it, and you will be responsible for the full cost. You can search for approved suppliers on the Medicare website or call 1-800-MEDICARE for a list in your area.

What is the difference between a portable and a stationary oxygen concentrator under Medicare?

A portable concentrator is designed to be moved around and used outside the home, while a stationary concentrator stays in one place. Medicare covers both types if your doctor prescribes them, but the monthly rental or purchase cost may differ. Your doctor will prescribe whichever type fits your medical needs and lifestyle.

If I own the concentrator after 36 months, can Medicare help pay for repairs?

No. Once you own the equipment, Medicare does not cover repairs or maintenance. You will need to pay for repairs out of pocket or purchase a new concentrator if the current one cannot be fixed. Some people buy an extended warranty or maintenance plan from the supplier before the 36-month rental period ends.

Will my Medicare Advantage plan cover a portable oxygen concentrator the same way Original Medicare does?

No. Medicare Advantage plans set their own coverage rules for durable medical equipment. Some plans cover concentrators with a copay, others with coinsurance, and a few may not cover them at all. Contact your Medicare Advantage plan directly to find out your coverage and any costs you will owe.