You know you need a portable oxygen concentrator, but will Medicare cover it? Unfortunately, this is a complicated question to answer. Upon being diagnosed with needing this oxygen machine or other medical equipment, this probably isn’t the only question you have.
For example, will you receive your equipment at little to no cost? Should you consider purchasing a used portable oxygen concentrator? Who is the best person to contact about your coverage? It’s rare to receive direct answers to these queries, but we’re here to help guide you through coverage solutions.
Will Medicare Cover My Portable Oxygen Concentrator?
The answer to this question is sorta. Medicare has always paid a set amount towards medical oxygen equipment, however, in 2013 their reimbursement rate was reduced by 50%. Usually, durable medical equipment (DME) providers cover the cost of equipment up front and bill Medicare for it later, but this made it too expensive for most supplies to cover POCs.
Because it became increasingly difficult for respiratory suppliers to cover the expenses involved with providing portable oxygen concentrators to patients, many now opt to provider other, less expensive oxygen supplies instead. For example, an oxygen tank is way less costly than a POC. So, depending on your provider, you could have your POC fully or only partially covered.
If you own your own equipment, Medicare will help pay for oxygen contents and supplies for the delivery of oxygen upon meeting Medicare conditions including doctor recommendation, failing arterial blood gas level range and other alternative measures have failed. Medicare helps pay for systems for furnishing oxygen, containers that store oxygen, tubing and related supplies for the delivery of oxygen and oxygen contents, and in some cases Medicare may also pay for a humidifier.
How Much Does It Cost To Rent A Portable Oxygen Concentrator?
You can actually rent a portable oxygen concentrator instead of having it purchased through Medicare. A DME will rent oxygen supplies to you and then bill Medicare a monthly fee for reimbursement of the rental.
Prices vary based on equipment cost and monthly reimbursement rates. Some DMEs will finance the equipment to you with a low monthly cost. This involves you paying a fixed amount out of pocket based on the price of the portable oxygen concentrator you would like to rent and your Medicare reimbursement rate.
Medicare rules have made this process a little complicated. Oxygen supplies are limited to a 36 month (3 years) and according to Medicare guidelines, the equipment must be maintained for 5 years.
This can cause suppliers to be picky about the equipment they provide depending on how long you’ve been on oxygen therapy. Companies will usually only be willing to supply a small portable oxygen if you’re towards the beginning of your rental period so the monthly reimbursements from Medicare will cover their costs. This is still the case for some providers even if you’re willing to pay a monthly rental fee.
Also, if you rent go through with a rental option you will probably be sent a used portable oxygen concentrator with a shorter lifespan. Also, you won’t be building equity in your machine, because you won’t get to keep it. That’s why some DMEs will allow you to finance a brand new POC through them with monthly payments.
