Medicare covers Inogen portable oxygen concentrators, but only under specific conditions

Medicare Part B covers Inogen oxygen machines if your doctor prescribes one for medical necessity and you meet the program's requirements for durable medical equipment (DME). The machine itself is covered, but Medicare does not pay for all models equally, and you will owe a percentage of the cost. Coverage depends on whether your oxygen need is chronic (long-term) and documented by a recent blood test, and whether you obtain the device through a Medicare-approved DME supplier.

The most common barrier is that Medicare requires a recent arterial blood gas test or pulse oximetry reading showing your oxygen level is below a certain threshold. If you have not had this test done in the past 30 days, or if your oxygen level does not meet Medicare's standard, the claim will be denied. Many people assume they need oxygen because they feel short of breath, but Medicare requires objective measurement.

Key Takeaways

  • Medicare Part B covers Inogen machines when prescribed by a doctor and obtained through a Medicare-approved DME supplier, but only if your blood oxygen level meets Medicare's threshold.
  • You will owe 20 percent of the approved amount after your Part B deductible is met, or the full cost if you have not yet reached your deductible.
  • Your doctor must order the oxygen and specify the flow rate and hours per day you need it, based on recent test results.
  • Some Inogen models are covered at higher rates than others because they are classified differently under Medicare's payment rules.
  • If you use oxygen only during exercise or sleep, Medicare may cover a machine for those specific times, but the documentation must be clear about when you use it.

What Medicare requires before covering an Inogen machine

Your doctor must order the oxygen concentrator and document the medical reason. Medicare requires one of three types of recent test results: an arterial blood gas test showing oxygen saturation at or below 88 percent, a pulse oximetry reading at or below 88 percent taken while you are awake and at rest, or a reading at or below 88 percent during sleep or exercise if that is when you need oxygen. The test must be no more than 30 days old when your doctor writes the prescription.

If your test results are older than 30 days, you will need a new test before Medicare will cover the device. This is one of the most common reasons claims are denied. Your primary care doctor can order the test, or a pulmonologist or cardiologist can do it. The test result must be in your medical record and attached to the prescription your doctor sends to the DME supplier.

You must also obtain the Inogen through a Medicare-approved DME supplier. Not all medical supply companies are approved, and ordering directly from Inogen or from a non-approved retailer means Medicare will not pay. Ask your doctor's office which suppliers they work with, or search the Medicare DME supplier directory on Medicare.gov.

How much you will pay out of pocket

After Medicare approves the claim, you are responsible for 20 percent of the Medicare-approved amount. This applies after you have met your Part B deductible for the year (currently $240, though this amount changes annually). If you have not yet met your deductible, you pay the full deductible first, then 20 percent of the approved amount.

The Medicare-approved amount varies by model and supplier, but typically ranges from $2,000 to $3,500 for a portable concentrator like the Inogen One G5. Your 20 percent share would be roughly $400 to $700, depending on the specific model and the supplier's contract with Medicare. Some suppliers also charge a rental option instead of purchase; Medicare covers rental at a different rate, and after you have rented for 13 months, the supplier must transfer ownership to you.

If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower. Medigap plans often cover the 20 percent coinsurance, and Medicare Advantage plans have their own cost-sharing rules. Check your plan documents or call your plan to confirm what you will owe.

Which Inogen models Medicare covers

Medicare covers Inogen portable oxygen concentrators as long as they are prescribed for medical necessity and obtained through an approved supplier. The most common models covered are the Inogen One G5, Inogen One G4, and Inogen TAV (travel). Medicare does not publish a list of approved models; instead, it approves the device based on the prescription and the supplier's contract.

Some Inogen models are classified as "stationary" concentrators and others as "portable," and Medicare pays differently for each. A portable concentrator like the Inogen One is paid at the portable rate. If you need both a stationary machine at home and a portable one for travel, your doctor can prescribe both, and Medicare may cover both, but you will owe coinsurance on each.

The supplier will verify coverage before you receive the machine. Do not assume a particular model is covered; ask the supplier to check with Medicare first. If the supplier says a model is not covered, ask your doctor whether a different model would work for you, or whether you should get a second opinion from another supplier.

The prescription and ordering process

Your doctor writes a prescription that includes your name, the specific Inogen model (or just "portable oxygen concentrator" if the model is not specified), the flow rate in liters per minute, and the number of hours per day you need oxygen. The prescription must also state whether you need oxygen at rest, during activity, during sleep, or at all times. This detail matters because it affects whether Medicare covers the device and at what rate.

You then contact a Medicare-approved DME supplier with the prescription. The supplier verifies your Medicare coverage, confirms the prescription meets Medicare's requirements, and orders the machine. The supplier will ask for your Medicare number and may ask you to sign a form confirming you understand your cost-sharing responsibility. The machine typically arrives within one to two weeks.

If the supplier tells you Medicare will not cover the device, ask why. Common reasons are that your recent test results do not meet the threshold, your prescription is incomplete, or your doctor did not specify the medical reason. Your doctor can address any of these issues by providing updated test results or a revised prescription.

What to do if Medicare denies the claim

If Medicare denies your claim after you have already received the machine, the supplier will send you a notice explaining the reason. The most common reasons are that your oxygen test results were too old, your oxygen level did not meet the threshold, or the supplier was not Medicare-approved. Read the notice carefully to understand which requirement was not met.

You have the right to request that Medicare reconsider the denial. This is called an appeal. You must request the appeal within 120 days of the denial notice. To appeal, contact the supplier and ask them to submit additional information, such as a more recent test result or clarification from your doctor about your medical need. The supplier can resubmit the claim with this new information.

If the appeal is also denied, you can request a hearing before a Medicare hearing officer. This process takes longer but may result in coverage if you can show that Medicare made an error. Your doctor can help by providing a statement explaining why you need the oxygen and why the test results support that need.

Medicare Advantage and Medigap coverage for Inogen

If you have a Medicare Advantage plan instead of Original Medicare, your coverage for Inogen machines may be different. Medicare Advantage plans must cover at least what Original Medicare covers, but they can set their own rules about which suppliers you must use, how much you pay, and whether you need prior approval. Contact your Medicare Advantage plan before ordering to confirm coverage and find out which suppliers are in-network.

If you have a Medigap plan in addition to Original Medicare, the Medigap plan may cover your 20 percent coinsurance, depending on which Medigap plan you have. Plans C, D, G, and M cover the Part B coinsurance, so your out-of-pocket cost would be zero after you meet your Part B deductible. Plans A, B, and F do not cover DME coinsurance. Check your Medigap plan documents or call your plan to confirm.

Frequently Asked Questions

Can I buy an Inogen on my own and then submit it to Medicare for reimbursement?

No. Medicare will not reimburse you for a machine you purchased on your own. You must obtain the machine through a Medicare-approved DME supplier from the start. If you buy one independently, you will have to pay the full cost yourself.

Does Medicare cover the batteries and accessories for an Inogen?

Medicare covers replacement batteries and accessories as part of the DME benefit, but only if they are ordered through the same Medicare-approved supplier and are medically necessary. Batteries typically need replacement every one to two years. Ask your supplier what is covered under your initial purchase and what costs extra.

What if my doctor says I need oxygen but my test results are borderline?

If your oxygen level is close to but does not quite meet Medicare's threshold, ask your doctor whether a repeat test might show a lower level, or whether testing during activity or sleep might meet the requirement. Some people's oxygen levels vary throughout the day. Your doctor can also request a manual review by Medicare if they believe the test was inaccurate.

How long does it take Medicare to approve an Inogen?

Once the supplier submits the prescription and test results to Medicare, approval typically takes one to two weeks. Some suppliers can expedite the process if your need is urgent. Ask the supplier for a timeline when you place the order.

Will Medicare cover a second Inogen if I already have one?

Medicare may cover a second portable concentrator if your doctor prescribes it for a specific medical reason, such as one for home and one for travel. However, Medicare will not cover a replacement for the same machine within a certain time frame unless there is a documented change in your medical condition. Ask your supplier about Medicare's replacement rules.