Medicare covers portable oxygen concentrators, but only if a doctor prescribes one and you meet specific medical requirements

Medicare Part B will pay for a portable oxygen concentrator if your doctor determines you need one for a medical condition — most commonly chronic obstructive pulmonary disease (COPD), severe asthma, or heart disease that causes low blood oxygen. The device must be prescribed by a doctor, and you must have a recent oxygen level test (called an arterial blood gas test or pulse oximetry reading) showing your oxygen saturation is below a certain threshold. Medicare does not pay for a concentrator straightforward because you want one or because you feel short of breath; the medical evidence has to be documented 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, and you pay 20%. If you buy one outright, Medicare covers 80% of the purchase price (again, after your deductible). The rental route is often cheaper upfront, but if you need the concentrator for more than a few months, buying becomes the better financial choice because rental payments eventually exceed the purchase price.

Key Takeaways

  • Your doctor must prescribe a portable oxygen concentrator and document that your blood oxygen level is low enough to meet Medicare's medical criteria.
  • Medicare Part B covers 80% of the approved cost (rental or purchase) after you pay your annual deductible; you pay the remaining 20%.
  • Renting is cheaper at first, but buying becomes more economical if you need the concentrator for longer than about 36 months.
  • You must use a Medicare-approved supplier to get coverage; buying from a non-approved seller means Medicare will not pay.
  • If Medicare denies your claim, you can request a reconsideration within 180 days of the denial letter.

How to get Medicare to pay: the step-by-step process

Start by seeing your doctor and describing your symptoms — shortness of breath during activity, difficulty exercising, or low energy. Your doctor will order an oxygen level test. This is the critical step: without documented low oxygen saturation, Medicare will deny the claim. The test results must show your oxygen level is 88% or lower at rest, or 88% or lower during activity or sleep, depending on your condition.

Once your doctor confirms you need supplemental oxygen, ask them to write a prescription for a portable oxygen concentrator. The prescription should specify the flow rate (measured in liters per minute) and whether you need it at rest, during activity, or both. Your doctor will also need to fill out a Certificate of Medical Necessity (CMN), a form that documents why you need the device. This form is what Medicare uses to determine whether to pay.

Next, contact a Medicare-approved durable medical equipment (DME) supplier in your area. You can find approved suppliers by calling Medicare at 1-800-MEDICARE or searching the Medicare Supplier Directory online. Give the supplier your prescription and CMN. The supplier will submit the paperwork to Medicare on your behalf and handle the approval process. This usually takes one to two weeks.

Once Medicare approves the claim, you will receive the concentrator from the supplier. You pay your Part B deductible (if you have not met it yet) plus 20% of the approved cost. The supplier bills Medicare for the remaining 80%.

Renting versus buying: which costs less over time

Medicare allows you to rent a portable oxygen concentrator, and the rental cost is typically lower each month than the cost of buying one outright. A monthly rental might run $50 to $100 (after insurance), while purchasing a concentrator can cost $1,500 to $3,000 depending on the model and features. If you need oxygen for only a few weeks or months — for example, while recovering from surgery — renting makes sense financially.

However, if you need the concentrator for a longer period, buying becomes cheaper. After about 36 months of rental payments, you will have paid as much as or more than the purchase price. If your doctor says you will need supplemental oxygen long-term or permanently, ask about purchasing instead of renting. Medicare will cover 80% of the purchase price just as it does for rentals.

Some suppliers offer a rent-to-own option, where a portion of your monthly rental payment goes toward the purchase price. This can be a middle ground if you are uncertain how long you will need the device. Ask your supplier whether this option is available and whether Medicare will cover it the same way.

What Medicare considers "medically necessary"

Medicare has strict rules about when a portable oxygen concentrator is considered medically necessary. Your oxygen saturation must be measured by a clinical test, not guessed or estimated. The test must show one of these conditions: oxygen saturation of 88% or lower at rest while breathing room air, or oxygen saturation of 88% or lower during sleep or exercise, or a drop of 5% or more during activity.

Your doctor must also document that you have a condition known to cause low blood oxygen — COPD, interstitial lung disease, cystic fibrosis, pulmonary hypertension, severe heart disease, or severe anemia are common examples. If you have shortness of breath but your oxygen level is normal, Medicare will not pay for a concentrator, even if you feel like you need one.

The portable concentrator itself must be approved by Medicare. Most major brands (Inogen, Philips Respironics, SeQual, Caire) sell models that Medicare covers, but not every model from every brand qualifies. Your supplier will know which models are approved and will make sure you get one that Medicare will pay for.

What happens if Medicare denies your claim

If Medicare denies your claim, you will receive a letter called a Notice of Non-Coverage or Explanation of Benefits (EOB) that explains why. Common reasons for denial include: oxygen level test results that do not meet the threshold, a missing or incomplete Certificate of Medical Necessity, or use of a non-approved supplier.

You have the right to request a reconsideration within 180 days of the denial letter. Contact your supplier or your doctor's office and ask them to help you file the appeal. If the denial was because your oxygen level was borderline, ask your doctor whether a repeat test might show a lower level, especially if you have been more active or if your condition has worsened. If the denial was because of paperwork, the supplier can resubmit with the missing information.

If you disagree with the reconsideration decision, you can request a hearing before a Medicare Administrative Law Judge. This process takes longer but is free. Your supplier or a patient advocate can help you prepare.

Portable concentrators versus stationary models: what Medicare covers

Medicare covers both portable and stationary (home) oxygen concentrators, but the rules are slightly different. A stationary concentrator stays plugged in at home and is usually cheaper than a portable one. A portable concentrator runs on batteries or can be plugged in, so you can take it with you. Medicare will pay for a portable concentrator only if your doctor documents that you need to leave home regularly and that a stationary model alone is not enough.

If your doctor prescribes both — a stationary concentrator for home and a portable one for outings — Medicare will cover both. However, if you only need oxygen at home, Medicare will typically cover only a stationary model, not a portable one, because a portable concentrator is more expensive and not medically necessary for someone who stays home.

Supplemental insurance and out-of-pocket costs

If you have a Medigap (supplemental insurance) plan, it may cover some or all of your 20% coinsurance for the oxygen concentrator. Check your plan documents or call your supplemental insurance company to find out. Some Medigap plans cover durable medical equipment coinsurance; others do not.

If you have a Medicare Advantage plan (Part C) instead of Original Medicare, your coverage for oxygen concentrators may be different. Some Advantage plans cover portable concentrators the same way Original Medicare does; others have different rules or require you to use specific suppliers. Call your Advantage plan to ask about coverage before you see your doctor or contact a supplier.

If cost is a concern, ask your supplier whether they offer payment plans or whether there are lower-cost portable concentrator models that Medicare covers. Some suppliers also know about patient information programs run by the concentrator manufacturers, which can help reduce your out-of-pocket cost.

Frequently Asked Questions

Do I need a new oxygen test every year to keep my portable concentrator covered?

Medicare does not require a new test every year if your condition is stable and your doctor confirms you still need the device. However, if your concentrator needs to be replaced or if Medicare requests updated documentation, your doctor may need to order a new test. Ask your doctor and supplier what documentation Medicare requires for your specific situation.

Can I buy a portable concentrator online and have Medicare pay for it?

No. Medicare will only pay if you purchase or rent from a Medicare-approved DME supplier. If you buy from an online retailer or non-approved seller, Medicare will not reimburse you. Always confirm that your supplier is Medicare-approved before you place an order.

What if my doctor says I need a portable concentrator but my oxygen test is normal?

Medicare will not pay based on your doctor's opinion alone. The oxygen test results are what Medicare uses to make the decision. If your test is normal but you have symptoms, ask your doctor whether a test during exercise or sleep might show lower oxygen levels, since some people only desaturate during activity.

Will Medicare pay for a backup portable concentrator?

Medicare typically covers one portable concentrator. If you need a backup for reliability or travel, you would likely have to pay for it yourself. However, if your primary concentrator breaks and is being repaired, Medicare may cover a temporary rental while you wait. Ask your supplier about this option.

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

Once your supplier submits the prescription and Certificate of Medical Necessity, Medicare usually makes a decision within one to two weeks. If Medicare needs more information from your doctor, the process may take longer. Ask your supplier for a timeline specific to your claim.