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, but the coverage rules are strict about what type of device qualifies and how you obtain it.

The device must be prescribed by your doctor as medically necessary for your condition. Your doctor will need to document that you have a chronic lung disease — such as COPD, pulmonary fibrosis, or severe asthma — and that your blood oxygen level falls below a certain threshold. Medicare does not cover portable concentrators for occasional use or for travel convenience alone.

Key Takeaways

  • Medicare Part B covers portable oxygen concentrators when prescribed by your doctor for a chronic lung condition and documented low blood oxygen levels.
  • You must use a Medicare-approved supplier, and the supplier handles the paperwork and billing directly with Medicare.
  • Medicare typically covers 80 percent of the approved amount after you meet your Part B deductible; you pay the remaining 20 percent.
  • Your doctor must complete a detailed prescription that includes your oxygen requirements and the specific type of device you need.
  • Portable concentrators are usually covered as rental equipment rather than purchase, though some situations allow for buying the device instead.

How to get Medicare to cover your portable concentrator

Start by talking to your doctor about whether a portable oxygen concentrator is right for your condition. Your doctor will order a blood oxygen test (called an arterial blood gas test or pulse oximetry) to measure your oxygen saturation level. Medicare requires that your oxygen level be at or below 88 percent on room air, or between 89 and 95 percent if you also have heart problems or swelling in your legs.

Once your doctor confirms you meet these requirements, they will write a prescription that specifies the type of concentrator, how many hours per day you need it, and whether you need it during activity, at rest, or both. This prescription is essential — Medicare will not pay without it.

Next, you must contact a Medicare-approved durable medical equipment (DME) supplier in your area. You cannot buy the concentrator from a retail store or online retailer and expect Medicare to reimburse you. The approved supplier will verify your Medicare coverage, handle all the paperwork, and bill Medicare directly. Ask the supplier for their Medicare approval number before you do business with them.

What you will pay out of pocket

After you meet your Part B deductible for the year, Medicare pays 80 percent of the approved amount for the concentrator rental or purchase. You are responsible for the remaining 20 percent. The deductible amount changes each year; you can find the current year's deductible on Medicare.gov or by calling 1-800-MEDICARE.

The approved amount is set by Medicare, not by the supplier's asking price. If a supplier charges more than the Medicare-approved amount, you do not have to pay the difference — the supplier must write it off. This is called "accepting assignment," and all Medicare-approved suppliers must do this.

If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower. Check your plan documents or call your plan's customer service to learn what your plan covers for durable medical equipment.

Rental versus purchase: which does Medicare cover

Medicare typically covers portable oxygen concentrators as rental equipment. You pay a monthly rental fee, and the supplier maintains and repairs the device. This is usually the most affordable option for Medicare beneficiaries because you do not pay a large upfront cost.

In some cases, Medicare will cover purchase instead of rental. This usually happens when the rental cost over time would exceed the purchase price, or when your doctor documents that you need the device long-term and renting is not practical. Your supplier can tell you whether purchase or rental makes sense for your situation and will work with Medicare to determine which option Medicare will cover.

What happens if your doctor's prescription does not meet Medicare's requirements

If your blood oxygen level is above the Medicare threshold, or if your doctor prescribes a concentrator without documenting medical necessity, Medicare will deny the claim. The supplier will notify you of the denial and explain why.

You have the right to ask your doctor to request a review of the denial or to order additional testing. Some people's oxygen levels drop during activity or sleep even if they are normal at rest, and a test during those times might show you meet the requirement. Your doctor can order an exercise test or overnight oxygen saturation monitoring to capture this.

If you disagree with Medicare's decision, you can file an appeal. The supplier can guide you through this process, or you can contact 1-800-MEDICARE to learn about your appeal rights.

Finding a Medicare-approved supplier near you

Use the Medicare Supplier Directory on Medicare.gov to search for approved DME suppliers in your area. You can search by ZIP code and equipment type. Call at least two or three suppliers to compare their service, delivery times, and equipment options before you choose one.

Ask each supplier the following questions: Are you Medicare-approved? Do you accept assignment? How quickly can you deliver the equipment? What happens if the equipment breaks? Do you offer 24-hour customer support? What brand of concentrators do you carry?

You are not required to use the first supplier you contact. Choosing a supplier with good customer service and reliable equipment support matters, because you will be depending on them for maintenance and repairs.

When to contact your doctor or Medicare

Call your doctor if you think your oxygen needs have changed — for example, if you feel short of breath even with your current concentrator, or if you are using it more hours per day than your prescription allows. Your doctor may need to order new testing and update your prescription.

Contact Medicare directly at 1-800-MEDICARE if a supplier tells you that Medicare will not cover a portable concentrator and you believe you meet the medical requirements. You can also call if you have questions about your coverage or if you want to understand your appeal rights.

Seek when ready medical care if you experience severe shortness of breath, chest pain, or confusion. These are signs of a serious problem that needs emergency attention, not a Medicare coverage question.

Frequently Asked Questions

Can I buy a portable concentrator myself and ask Medicare to reimburse me?

No. Medicare will only pay for equipment purchased or rented through a Medicare-approved supplier. If you buy a concentrator on your own, Medicare will not reimburse you. You must work with an approved supplier from the start so the supplier can bill Medicare directly.

Does Medicare cover portable concentrators for travel?

Medicare covers portable concentrators only if they are medically necessary for your chronic lung condition. If your doctor prescribes one for travel convenience or backup, Medicare will not cover it. The device must be prescribed based on your medical need, not your lifestyle.

What if I have both Medicare and Medicaid?

If you have both programs, Medicaid may cover costs that Medicare does not, such as your 20 percent coinsurance. Contact your state Medicaid office to learn what durable medical equipment coverage is available to you. Bring your Medicare denial or coverage letter so Medicaid can review it.

How long does it take Medicare to approve a portable concentrator?

Once your supplier submits your prescription and medical records to Medicare, approval usually takes 5 to 10 business days. Your supplier will contact you when Medicare approves the claim and will arrange delivery. If Medicare denies the claim, the supplier will notify you and explain the reason.

Can I switch suppliers if I am not happy with my current one?

Yes. You can change to a different Medicare-approved supplier at any time. Contact the new supplier and provide them with your prescription. They will handle the transfer of your equipment and billing. You do not need Medicare's permission to switch suppliers.