Oxygen therapy helps people with breathing problems such as COPD, emphysema, sleep apnea, and more. An oxygen concentrator is a piece of durable medical equipment that filters nitrogen out of the air and delivers 90% to 95% oxygen to the lungs to help people breathe better. Medicare Part B offers some coverage for oxygen concentrators under its durable medical equipment (DME) provision. Let’s explore the details of when Medicare covers oxygen concentrators.
Eligibility requirements for Medicare to cover oxygen concentrators
To qualify for Medicare coverage of an oxygen concentrator, your doctor must prescribe it. Your doctor may prescribe a nocturnal oxygen concentrator that you use only at night, which is a stationary unit that stays where you sleep. If your doctor prescribes 24/7 oxygen, Medicare will cover both a stationary and a portable oxygen unit.
The vendor you choose must also accept Medicare as payment. Medicare covers some of the costs of renting but not purchasing an oxygen concentrator and the necessary supplies. Let’s take a closer look at renting as opposed to buying your equipment.
Renting vs. buying an oxygen concentrator
You can choose to either purchase or rent an oxygen concentrator, but it may be more cost-effective to rent an oxygen concentrator as Medicare doesn’t provide any coverage if you choose to purchase the machine, accessories, or oxygen. They also will not cover maintenance in this scenario. On the other hand, they do cover a portion of the machine, accessories, oxygen, and maintenance if you rent.
Medicare covers the following:
- Device rental.
- Oxygen contents.
- Tubing or mouthpiece.
- Necessary supplies (e.g., trans-tracheal oxygen catheter).
- Machine maintenance, servicing, and repairs.
You can rent an oxygen concentrator machine monthly for up to 36 months. After the initial 36 months, the law states that your supplier must continue to provide your supplies and maintain your equipment in good working order and cannot charge you for these services as long as the oxygen is medically necessary as prescribed annually for an additional 24 months. After these five years, your supplier can end your contract, but if you still need a machine, you can continue services with your current provider or switch to a new one.
If you plan to travel by air and need to use an oxygenator while flying, you must use an oxygen concentrator that is approved for in-flight use. If your current machine is not approved for in-flight use, you can rent an approved oxygen concentrator online or get a referral for a supplier from an airline, but your current supplier is not obligated to provide it to you, and Medicare does not cover the rental of the additional device. Suppliers will provide the documentation you need to bring an oxygen concentrator on a plane.
Costs
According to the National Council on Aging, portable oxygen concentrators typically cost between $2,000 and $4,000, but Medicare may help cover some of the cost if you rent it. You must first satisfy your Medicare deductible before Medicare will cover an oxygen concentrator and accessories. After that, Medicare will pay 80% of the costs, and you will be responsible for the remaining 20%.
In addition to the equipment fee, you may have to pay a coinsurance fee every six months for the supplier to come service the equipment in your home. The supplier can bill Medicare for this service only if they actually come to your home to perform the service and inspection.
You may have other options to help cover the costs of using an oxygen concentrator. For example, if you are eligible for both Medicaid and Medicare, Medicaid may cover some of the expenses in addition to Medicare. Medicaid coverage rules vary from state to state. Also, if you have Medigap coverage, it may help with costs not covered by Medicare for oxygen therapy.
It’s also important to note that Medicare Advantage plans may cover different coverage than original Medicare, as each plan is unique. If you have a Medicare Advantage plan, check with your insurance provider to learn the details of their oxygen therapy coverage.
Final thoughts on Medicare covering oxygen concentrators
Medicare provides coverage for oxygen concentrator rental if prescribed by a doctor. Your plan will only cover it according to your doctor’s specifications. Understanding the requirements is essential to ensuring you have access to the oxygen therapy necessary to help you breathe better and stay healthy.
