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Does Medicare Pay for Portable Oxygen Concentrators?

Medicare and Oxygen Therapy: Do You Qualify?

So, when does Medicare pay for oxygen? When it comes to Medicare and oxygen therapy, the Medicare oxygen requirements are not completely clear cut. You can be denied coverage, and left wondering, “why won’t Medicare pay for oxygen concentrators?” As such, it is essential that your doctor confirms that you meet the requirements below and documents your eligibility thoroughly.

Medicare will help pay for your supplemental oxygen equipment if you meet the following requirements and receive a prescription for medical oxygen from your doctor. The requirements include:

·         Documentation from your doctor that you have a severe lung disease or that you are not currently getting enough oxygen 

·         Evidence that your health will be improved by oxygen therapy

·         An arterial blood gas level that falls within a certain (low) range

·         Evidence that alternative measures have failed

Getting Oxygen Equipment Covered After Qualifying for Medicare

Once you determine your eligibility, you will need to find a Medicare-approved supplier of oxygen and apply with them to determine what your total costs will be. If you are wondering, “why won’t Medicare pay for oxygen concentrators in full?” the answer is that Medicare rarely covers 100% of your medical bills. As the leading health insurer for people 65 and older, providing this coverage is expensive, and the funding comes from taxpayers.

However, Medicare usually covers part of your medical expenses if you qualify.

If the conditions above are met, Medicare will cover up to 80% of the cost for the rental of oxygen equipment from an approved oxygen supplier for 36 months. This includes the oxygen delivery system, any required oxygen storage containers, tubing and other related oxygen accessories required to deliver the oxygen to the patient. Oxygen machine maintenance, servicing and repair costs can also be included for a portable oxygen concentrator covered by Medicare. You will still pay 20% of the Medicare approved cost for your oxygen supplies, and your Part B deductible will still apply if you have one. 

After 36 months, you are eligible to continue to rent your oxygen therapy supplies from your same provider for another 24 months, up to a total of 5 years, as long as you can demonstrate medical need for oxygen. You will need to continue to show that your health is dependent upon the portable oxygen concentrator Medicare coverage you have been receiving. After that time, you can renew your oxygen equipment rental agreement, though your provider is not required to continue providing service to you after the initial 5 years. This can make things difficult as you must go through a contracted Medicare provider for your rental agreement. So how can you make your portable oxygen tank Medicare experience as easy as possible? Call a supplier that has plenty of experience going through the Medicare process. 

Frequently Asked Questions: Medicare and Portable Oxygen Concentrators

Why won’t Medicare pay for oxygen concentrators? Medicare does not cover the full cost of purchasing an oxygen concentrator primarily because they have determined that it is more cost-effective for them to cover monthly rentals instead. As such, the answer to “why won’t Medicare pay for oxygen concentrators” is that they will cover part of the cost of the rental, but not purchasing because they have deemed it too costly.

If you decide you want to own your equipment, you should plan to purchase your portable oxygen concentrator on your own.

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