Portable Oxygen Concentrators: How Medicare Can Cover Your Breathing Support Device
For individuals with chronic respiratory conditions, a portable oxygen concentrator can be life-changing—offering mobility, comfort, and continuous access to oxygen. But the cost can be a concern. Fortunately, Medicare may cover part or all of the expenses for these essential devices, depending on medical eligibility and documentation. Understanding how Medicare coverage works, who qualifies, and what steps to take can make it easier to get the breathing support you need without unnecessary stress or financial burden. This article explains how to navigate the process clearly and confidently.
What Is a Portable Oxygen Concentrator?
A portable oxygen concentrator is a medical device that delivers oxygen therapy to individuals with low blood oxygen levels. Unlike traditional oxygen tanks, POCs are lightweight, battery-powered, and ideal for mobile use—at home or on the go.
These devices work by filtering ambient air, concentrating the oxygen, and delivering it to the user through a nasal cannula or mask. They’re commonly used by individuals with chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, or other long-term respiratory conditions.
Does Medicare Cover Portable Oxygen Concentrators?
Yes—but with some conditions. Medicare Part B (Medical Insurance) may cover oxygen equipment and accessories—including POCs—if specific criteria are met.
However, Medicare usually covers oxygen as a rental item, not as a direct purchase. When prescribed by a Medicare-approved doctor and obtained through a participating supplier, the equipment is typically rented for up to 36 months.
It’s important to know that Medicare does not always cover portable models specifically. They often cover the least expensive option that meets your medical needs, which may be a stationary oxygen concentrator rather than a portable one.
Medicare Coverage Requirements for Oxygen Equipment
To qualify for oxygen therapy through Medicare, you must:
- Be enrolled in Medicare Part B
- Have a documented medical need for oxygen (confirmed via testing)
- Receive a prescription from a Medicare-approved healthcare provider
- Demonstrate low blood oxygen levels, typically:
- An arterial blood gas level (ABG) at or below 55 mm Hg
- Or an oxygen saturation level of 88% or less at rest, during sleep, or after exercise
Your doctor must provide medical records to support the necessity for supplemental oxygen. If your condition justifies mobility-based oxygen use, your physician should clearly state that a portable unit is medically necessary.
What Medicare Pays vs. What You Pay
Medicare will typically cover 80% of the Medicare-approved cost of oxygen equipment, including any necessary accessories, tubing, or oxygen tanks.
You are responsible for the remaining 20% coinsurance, unless you have supplemental insurance like Medigap or Medicaid, which may cover part or all of your out-of-pocket expenses.
Remember: even though oxygen devices are rented, you must continue to pay monthly premiums for Medicare Part B and meet your annual deductible.
Important Facts and Tips About Medicare and POCs
- POC brands like Inogen, Philips Respironics, and CAIRE are well known, but not all are available through Medicare suppliers.
- Not all suppliers provide portable units under Medicare. Ask upfront whether the company offers Medicare-covered POCs.
- The 36-month rental period can be followed by a 24-month maintenance period, during which your supplier must continue service without charging you additional equipment rental fees.
- Always check if the supplier is Medicare-approved and accepts assignment (this means they agree to Medicare’s approved payment rate).
- If you travel frequently, a POC is more suitable—but you may need to pay out-of-pocket if Medicare declines coverage for portability.
Comparison Table: Medicare vs. Out-of-Pocket Purchase
| Option | Medicare-Covered Rental | Direct Purchase (Out-of-Pocket) |
|---|---|---|
| Coverage | Up to 80% (if eligible) | No coverage |
| Device Type | Least expensive medically necessary | User selects specific model |
| Cost Estimate (Typical POC) | £0–£50/month after coinsurance | £1,500–£3,000 upfront |
| Portability | Not always covered | Fully portable (buyer’s choice) |
| Supplier Restrictions | Must be Medicare-approved | Any retailer |
Prices, rates, or cost estimates mentioned in this article are based on the latest available information but may change over time. Independent research is advised before making financial decisions.
Alternatives if Medicare Doesn’t Fully Cover Your Needs
If Medicare does not approve coverage for a portable model, you might explore:
- Medicare Advantage (Part C) plans that include expanded DME benefits
- Medicaid (if eligible based on income)
- Veterans Affairs (VA) benefits for qualifying veterans
- Nonprofits or grants for chronic respiratory patients
- Financing options or buy-back programs through medical equipment retailers
Conclusion
Medicare can offer critical financial help for those needing oxygen support—but getting coverage for a portable oxygen concentrator requires proper documentation and careful coordination with your healthcare provider and supplier. Understanding the eligibility criteria and rental structure can save you from unexpected costs while ensuring access to the right respiratory support device.
The shared information of this article is up-to-date as of the publishing date. For more up-to-date information, please conduct your own research.
