How To Get a Portable Oxygen Concentrator Covered By Medicare

Portable oxygen concentrators (POC) have greatly enhanced the lives of people with chronic respiratory illnesses. Many of these people need additional oxygen to assist their breathing and they used to depend on big and heavy oxygen tanks for this. With a POC, that is no longer the case.

POC give these patients mobility, the freedom to travel and the ability to enjoy most activities such as eating out, traveling, shopping and even flying in a plane. All of this was not the case with traditional oxygen equipment, which is usually large, heavy and cumbersome. Not surprisingly, most people needing supplemental oxygen want these devices. Unfortunately, most POC are expensive and seniors who need this equipment are dependent on Medicare coverage to help them get it.


Portable Oxygen Concentrators

POC are a fantastic technological innovation, as they are basically very small oxygen factories. They take air from the environment, clean it and concentrate the available oxygen and then deliver that concentrated oxygen to the patient through tubes and / or a breathing mask. Not only are they portable, they never have to be refilled with oxygen because they make their own. They run on rechargeable batteries or can be plugged into an electric outlet.

Medicare and Medicare Advantage

Medicare is the nationwide government run healthcare program. Almost everyone 65 years of age or older, plus people with severe disabilities, are eligible for Medicare. In addition to covering doctors, hospitals and medical treatments, Medicare also has coverage for many types of durable medical equipment, such as wheelchairs, walkers, special tools and appliances, etc. This equipment can also include breathing equipment such as oxygen devices. This coverage is limited based on certain rules that will be discussed below.

Originally Medicare consisted of only two types – “A” and “B”. Because of the many limitations in these programs, the government allows people to buy supplemental coverage, known as Medicare Advantage (Part C). These plans are sold and administered by private health insurance companies. Depending on the specific Advantage plan, getting a POC covered could be easier and more available.

Medicare Rules and Procedures

The official rules, as listed by Medicare, relating to coverage of devices such as POC, are as follows:

Medicare Part B (Medical Insurance) covers the rental of oxygen equipment and accessories as durable medical equipment (DME) that your doctor prescribes for use in your home.

Medicare will help pay for oxygen equipment, contents and supplies for the delivery of oxygen when all of these conditions are met:

– Your doctor says you have a severe lung disease or you’re not getting enough oxygen.

– Your health might improve with oxygen therapy.

– Your arterial blood gas level falls within a certain range.

– Other alternative measures have failed.

If you meet the conditions above, Medicare oxygen equipment coverage includes:

– Systems that provide oxygen

– Containers that store oxygen

– Tubing and related oxygen accessories for the delivery of oxygen and oxygen contents

Medicare Coverage

The above rules should allow coverage of POC, but there are limitations and restrictions.

– Medicare will NOT cover the PURCHASE of a POC, only for a rental.

– Because Medicare has a stingy allowance for these rentals, the patient will often have to pay some of the rental costs out of pocket.

– This type of covered equipment rental can only be done through a Medicare authorized supplier, which limits the availability.

– Most of these suppliers will only rent out used, reconditioned machines.