Medicare will pay for oxygen if your doctor prescribes it for a medical condition and you meet specific requirements

Medicare Part B covers supplemental oxygen — the equipment, the gas, and ongoing supplies — but only when a doctor documents that you need it for a chronic lung condition like COPD, pulmonary fibrosis, or severe asthma. The coverage includes the oxygen concentrator or tank itself, tubing, masks, and refills. You do not buy oxygen outright; instead, you rent the equipment from a Medicare-approved supplier, and Medicare pays the supplier directly.

The process starts with your doctor, not with Medicare. Your doctor must order oxygen therapy and document the medical reason in your chart. Medicare then requires a specific test — an arterial blood gas test or pulse oximetry reading — that shows your oxygen level is below a certain threshold. Without that test result in your file, Medicare will deny the claim, even if your doctor thinks you need it.

Once your doctor has ordered oxygen and the test is documented, you choose a Medicare-approved supplier in your area. The supplier handles the paperwork with Medicare. You pay 20 percent of the approved amount for the equipment rental and supplies; Medicare pays 80 percent. If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower.

Key Takeaways

  • Your doctor must write an order for oxygen and document a medical reason in your medical record before Medicare will consider coverage.
  • Medicare requires a blood gas test or pulse oximetry reading showing your oxygen level is below the threshold — usually 88 percent or lower — taken within the past 30 days.
  • You rent oxygen equipment from a Medicare-approved supplier, not purchase it; the supplier submits the claim to Medicare on your behalf.
  • You pay 20 percent of the Medicare-approved rental cost; Medicare pays 80 percent, after you have met your Part B deductible.
  • Coverage includes the concentrator or tank, tubing, masks, and refills, but only for the amount your doctor prescribes.

The Medical Test Medicare Requires

Medicare will not cover oxygen based on your symptoms or your doctor's clinical judgment alone. The agency requires objective proof: a test showing your blood oxygen level. The two tests Medicare accepts are an arterial blood gas (ABG) test, which measures oxygen directly from an artery, or pulse oximetry, which uses a clip on your finger to estimate oxygen saturation.

The threshold varies slightly by situation. For most people, Medicare covers oxygen if the reading is 88 percent or lower at rest, or 88 percent or lower during exercise or sleep. If you have heart disease, the threshold is sometimes 89 percent. Your doctor orders the test, usually at a hospital lab or clinic, and the result goes into your medical record. The test must be dated within 30 days before your doctor writes the oxygen order, or within 30 days after.

If your test is older than 30 days, Medicare will ask for a new one. If you had the test at a hospital or urgent care, ask for a copy of the results to give to your doctor. Your doctor needs the actual numbers, not just a note that says "low oxygen." Without the specific reading in the medical record, the supplier cannot submit a claim that Medicare will honor.

Finding and Working With a Medicare-Approved Supplier

Not every medical supply company is a Medicare-approved oxygen supplier. You can search for approved suppliers in your area on the Medicare website under "Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS)" or by calling Medicare at 1-800-MEDICARE. You can also ask your doctor's office for a referral; they usually work with one or two suppliers regularly.

Once you have chosen a supplier, give them your doctor's written order and your Medicare information. The supplier will contact your doctor to confirm the order and request a copy of the test results. The supplier then submits the claim to Medicare. You should receive a letter from Medicare within two to three weeks saying whether it approved the claim. If approved, the supplier will deliver the equipment and show you how to use it.

If Medicare denies the claim, the supplier will send you a notice explaining why. Common reasons for denial are that the test is too old, the oxygen level was not low enough, or the doctor's order did not include the medical reason. You can ask your doctor to reorder oxygen with updated test results, or you can file an appeal with Medicare if you believe the denial was wrong.

What Medicare Covers and What You Pay

Medicare Part B covers the equipment rental, the oxygen itself, and related supplies. This includes a concentrator (a machine that pulls oxygen from the air), a portable tank for when you leave home, tubing, masks or nasal cannulas, and replacement supplies. The supplier delivers the equipment and handles maintenance and repairs at no cost to you.

You pay 20 percent of the Medicare-approved amount for the rental; Medicare pays 80 percent. The approved amount is set by Medicare, not by the supplier's list price. If the supplier charges more than the approved amount, you do not pay the difference — that is called balance billing, and it is not allowed. Your out-of-pocket cost depends on whether you have met your Part B deductible for the year. Once you reach the deductible, you pay 20 percent of all covered services for the rest of the year.

If you have a Medigap policy, it may cover some or all of your 20 percent coinsurance. If you have a Medicare Advantage plan, your copay or coinsurance may be different; check your plan documents or call the plan to find out what oxygen rental costs you.

Portable Oxygen and Travel

If your doctor prescribes portable oxygen, Medicare covers a portable concentrator or portable tanks. A portable concentrator is a battery-powered machine about the size of a small backpack that lets you move around your home and leave the house without carrying heavy tanks. Portable tanks are lighter than stationary tanks but run out of oxygen faster and need refilling.

Your supplier can show you how to refill portable tanks at home or where to refill them when you travel. Some suppliers offer exchange programs where you drop off an empty tank and pick up a full one. If you travel by air, you must notify the airline in advance; oxygen equipment has specific rules for airplane cabins, and you cannot bring your own oxygen on board.

Medicare covers the cost of portable equipment the same way it covers stationary equipment — you rent it from an approved supplier and pay 20 percent coinsurance. If you need oxygen only during exercise or sleep, your doctor can prescribe it for those specific times, and Medicare will cover it for those uses only.

What Happens If Medicare Denies Your Claim

If Medicare denies coverage, the supplier will send you a notice called an "Explanation of Benefits" (EOB) that explains the reason. The most common reasons are: the test result is too old or does not meet the threshold, the doctor's order is incomplete, or the supplier is not Medicare-approved.

You have the right to appeal. You can ask your doctor to submit updated test results and reorder oxygen, or you can file a formal appeal with Medicare. To appeal, follow the instructions on the denial notice. You have 120 days from the date of the notice to file. If you need help with an appeal, you can contact your State Health Insurance information Program (SHIP), which offers free counseling on Medicare issues.

If your oxygen needs change — for example, you need higher flow rates or different equipment — your doctor can write a new order. Medicare will review the new order the same way it reviewed the first one. You do not need a new blood gas test if your medical condition has not changed, but if more than a year has passed since the last test, Medicare may ask for an updated one.

Switching Suppliers or Equipment Types

You can change oxygen suppliers at any time. If you are unhappy with your current supplier's service or equipment quality, contact a different Medicare-approved supplier and give them your doctor's order. The new supplier will submit a claim to Medicare, and if approved, they will take over your oxygen delivery. You do not need your doctor's permission to switch suppliers, only a valid order.

If you want to switch from a concentrator to portable tanks, or from tanks to a concentrator, your doctor can write a new order specifying the equipment type. Medicare will cover the new equipment under the same rental arrangement. Some people use both — a stationary concentrator at home and portable tanks or a portable concentrator when they go out — and Medicare can cover both if your doctor prescribes both.

Frequently Asked Questions

Does Medicare cover oxygen if I only need it at night or during exercise?

Yes. Your doctor can prescribe oxygen for specific times of day, and Medicare will cover it for those uses. The test result must show your oxygen level is low during that specific activity — for example, a sleep study showing low oxygen during sleep, or an exercise test showing low oxygen during exertion.

What if my doctor says I need oxygen but my test result is not low enough?

Medicare will not cover oxygen if the test does not meet the threshold, even if your doctor believes you need it. You can ask your doctor to order a different type of test — for example, a sleep study if you only desaturate at night — or to retest you at a later date if your condition has worsened. A second opinion from a pulmonologist may also help.

Do I have to use a specific supplier, or can I choose?

You can choose any Medicare-approved supplier in your area. Ask your doctor for a referral, or search the Medicare DMEPOS supplier list online. Different suppliers may offer different equipment or service levels, so it is worth calling a few to compare before you decide.

Will my oxygen equipment be replaced if it breaks?

Yes. Your supplier is responsible for maintaining and repairing the equipment at no cost to you. If it cannot be repaired, the supplier will replace it. You should not pay for repairs or replacement parts — if a supplier asks you to, contact Medicare or your supplier's customer service to report it.

What if I no longer need oxygen — do I have to keep paying?

No. Tell your supplier you want to stop oxygen therapy, and they will stop billing Medicare. Your doctor can also write an order to discontinue oxygen, which signals to the supplier that coverage has ended. You will not be charged after you stop using the equipment.