Medicare Part B covers portable oxygen concentrators, but only if your doctor prescribes one and you meet specific medical requirements
Medicare Part B will pay for a portable oxygen concentrator if a doctor has documented that you need supplemental oxygen due to a lung or heart condition. The device must be prescribed by your doctor, and you must have a recent blood oxygen test (called an arterial blood gas test or pulse oximetry) showing your oxygen level is low enough to warrant treatment. Medicare does not cover portable concentrators for everyone who wants one — the medical need has to be demonstrated first.
How much Medicare pays depends on whether you rent or buy the device. If you rent, Medicare typically covers 80% of the approved rental cost after you meet your Part B deductible. If you buy one, Medicare covers 80% of the approved purchase price. You pay the remaining 20%, plus your deductible. The exact amount varies because Medicare's approved price differs by region and by the specific model your doctor prescribes.
Key Takeaways
- Your doctor must prescribe a portable oxygen concentrator and document that your blood oxygen level is too low, not just that you have a lung condition.
- Medicare Part B covers 80% of the cost after your deductible, whether you rent or buy, but the approved amount varies by region and device model.
- You will need a prescription from your doctor and a recent oxygen level test result to submit to a Medicare-approved durable medical equipment supplier.
- Renting is often cheaper upfront, but buying may cost less over time if you need oxygen for more than a few months.
- If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower because those plans cover some or all of your 20% coinsurance.
How to get Medicare to cover a portable concentrator
Start by talking to your doctor about whether a portable oxygen concentrator is right for you. Your doctor will order an oxygen level test if you have not had one recently. The test results must show that your oxygen saturation is 88% or lower at rest, or 88% or lower during exercise or sleep, depending on your condition. Your doctor will then write a prescription that includes the specific type and flow rate of oxygen you need.
Once you have the prescription, contact a Medicare-approved durable medical equipment (DME) supplier in your area. You can find these suppliers by calling Medicare at 1-800-MEDICARE or by searching the Medicare website. The supplier will submit your prescription and test results to Medicare for review. Medicare will decide whether to cover the device based on your medical records. This review usually takes one to two weeks.
If Medicare approves your claim, the supplier will deliver the concentrator to your home and show you how to use it. You will receive a bill for your 20% coinsurance and any part of your deductible you have not yet met. If you have a Medigap plan (supplemental insurance), it may cover your coinsurance. If you have a Medicare Advantage plan, check your plan documents to see what your out-of-pocket cost will be.
Renting versus buying: what Medicare pays for each
Medicare allows you to either rent or buy a portable oxygen concentrator. The choice affects how much you pay and when.
| Renting | Buying |
|---|---|
| Medicare pays 80% of the monthly rental cost after your deductible. You pay 20%. | Medicare pays 80% of the approved purchase price after your deductible. You pay 20%. |
| Lower upfront cost. You pay month to month. | Higher upfront cost, but no ongoing payments. |
| The supplier maintains and repairs the equipment at no extra cost to you. | You are responsible for repairs and maintenance after the warranty ends. |
| Rental payments continue as long as you use the device. After 36 months of rental, Medicare may require you to buy instead. | You own the device outright after you pay your share. No time limit. |
Most people rent at first because the upfront cost is lower. However, if your doctor says you will need oxygen for more than a few months, buying often becomes cheaper in the long run. After 36 months of rental payments, Medicare's rules typically shift, and you may be required to purchase the device instead of continuing to rent. Ask your DME supplier to calculate the total cost of renting for your expected time frame versus buying outright.
What Medicare does not cover for portable concentrators
Medicare covers the concentrator itself and basic accessories like tubing and a carrying case, but it does not cover everything related to oxygen therapy. Medicare does not pay for backup batteries, extra batteries beyond what comes with the device, battery chargers, or replacement parts that wear out after your warranty ends. You will need to buy these items yourself or check whether your Medigap or Medicare Advantage plan covers them.
Medicare also does not cover portable concentrators prescribed for reasons other than documented low blood oxygen. For example, if your doctor thinks oxygen might help your energy level but your oxygen test results are normal, Medicare will deny the claim. The same applies if you want a concentrator for travel or convenience without a medical reason documented in your test results.
How your other insurance affects what you pay
If you have a Medigap (supplemental) plan, it will typically cover your 20% coinsurance for durable medical equipment, which means you pay only your deductible. Different Medigap plans cover different amounts, so check your plan documents or call your Medigap insurer to confirm.
If you have a Medicare Advantage plan instead of Original Medicare, your coverage and costs work differently. Medicare Advantage plans must cover portable oxygen concentrators at the same level as Original Medicare, but they can charge different copays or coinsurance amounts. Some Medicare Advantage plans cover durable medical equipment with a flat copay (for example, $50), while others use coinsurance. Call your Medicare Advantage plan before you see your doctor to find out what your out-of-pocket cost will be.
If you have neither Medigap nor Medicare Advantage coverage, you will pay 20% of the approved cost yourself, plus your Part B deductible if you have not met it yet. The total out-of-pocket cost depends on the price Medicare approves in your region and the specific model your doctor prescribes.
What to ask your doctor before you start the process
Before your doctor writes a prescription, ask these questions to make sure Medicare will cover the cost:
- Do my recent oxygen test results show that I need supplemental oxygen? (Ask to see the actual numbers.)
- Will you prescribe a portable concentrator, or do you think I should start with a stationary one at home?
- How long do you expect I will need oxygen therapy?
- What specific model and flow rate are you prescribing, and why?
- Will you write the prescription in a way that Medicare will recognize, or do I need to go to a specific supplier?
If your doctor says your oxygen level is borderline or normal, ask whether a test done during exercise or sleep might show a different result. Some people have normal oxygen levels at rest but low levels when they move around or sleep. If that is the case, your doctor may order a different type of test that Medicare will recognize.
When Medicare denies coverage and what to do
Medicare may deny your claim if your oxygen test results do not meet the threshold, if your doctor's prescription does not include enough detail, or if the DME supplier submitted incomplete paperwork. If you receive a denial letter, you have the right to ask Medicare to review the decision.
The denial letter will explain why Medicare said no and will tell you how to request a review. You have 120 days from the date on the letter to file an appeal. You can appeal on your own, or you can ask your doctor or the DME supplier to help. If your doctor believes the denial is wrong, ask them to write a letter to Medicare explaining why you need the device. Include this letter with your appeal.
If you have a Medicare Advantage plan, the appeal process is slightly different. Your plan will handle the appeal instead of Medicare directly. Call your plan's customer service number on the back of your card to start the appeal process.
Frequently Asked Questions
Do I need a prescription from my regular doctor, or can any doctor prescribe a portable concentrator?
Your regular doctor can prescribe one, but it must be a doctor who has examined you and has access to your medical records. A doctor at an urgent care clinic or a doctor you have never seen before may not have enough information about your condition. If you do not have a regular doctor, ask your primary care doctor or a pulmonologist (lung specialist) to evaluate you for oxygen therapy.
What if I already own a portable concentrator and want Medicare to pay for it?
Medicare will not reimburse you for a device you already bought without a prescription. However, if you have a current prescription from your doctor and you meet the medical requirements, you can contact a Medicare-approved DME supplier and ask them to submit a claim for a new device. Medicare will treat it as a new purchase, not a reimbursement for an old one.
Can I choose any portable concentrator model, or does Medicare limit which ones I can get?
Your doctor chooses the model based on your medical needs, not based on what you prefer. Medicare will cover any model that your doctor prescribes, as long as it is on Medicare's approved list. The DME supplier can tell you which models are approved. If you want a specific brand or model, ask your doctor whether it is medically appropriate for you.
Will my portable concentrator be covered if I travel outside the United States?
Medicare does not cover medical equipment used outside the United States. If you travel internationally, you will need to arrange oxygen therapy through a provider in the country you are visiting, or you will need to pay out of pocket for your device. Some travel insurance plans cover portable medical equipment abroad, so check your policy before you travel.
How often does Medicare pay to replace my portable concentrator?
Medicare typically covers a replacement concentrator every five years if your old one is no longer working and cannot be repaired. If you bought your device, you own it and can use it as long as it works. If you are renting, the supplier is responsible for replacing it if it breaks down. Ask your supplier or your DME company about their replacement policy.