The question of whether Medicare will cover the cost of a portable oxygen concentrator is one we receive frequently. You may have been told by your homecare provider that Medicare does not cover portable oxygen concentrators or that they simply do not carry them. You’ll rarely be given a full explanation, in part because it’s complicated. The answer is Yes and No.
The Yes and No of Medicare Coverage
No, Medicare will not purchase a portable oxygen concentrator. They provide only a monthly rental benefit for oxygen equipment.
No, Medicare will not cover a portable oxygen concentrator in addition to the oxygen tanks you most likely already receive. They don’t pay more money for more equipment.
Yes, your Medicare oxygen benefit covers the cost of portable oxygen. However, the portable oxygen benefit can be satisfied with small liquid tanks, larger gaseous tanks, or a portable oxygen concentrator. Regardless of the equipment provided, Medicare pays the same amount of money each month to the homecare provider. It is up to your homecare provider to decide what you will receive.
Yes, your homecare provider can choose to provide you with a portable oxygen concentrator under your Medicare benefit.
No, most homecare providers do not choose to provide a portable concentrator. Since they receive the same amount of reimbursement from Medicare for a portable concentrator as they would for an oxygen tank, and yet the portable concentrator is much more costly to them, most homecare providers simply cannot afford it.
Can I change homecare providers to get a portable oxygen concentrator?
Again, the answer is a bit complicated. Your Medicare oxygen benefit runs on a 5-year cycle. During the first 3 years, your homecare provider can bill Medicare the full benefit amount for your home and portable equipment. They receive about $125 per month for all oxygen equipment. During the final 2 years, they can only bill Medicare for the maintenance on the equipment, so they receive even less.
Any company that may provide a portable oxygen concentrator would need to take advantage of the full 5-year cycle in order to recoup enough cost to cover their expenses. Thus, they would need to be able to bill Medicare within the first couple months of your initial need for oxygen, or at the beginning of your next 5-year cycle. Timing is everything.
Also, keep in mind that oxygen equipment falls under Medicare’s competitive bidding which is geographic in nature. Most likely there are several homecare companies that have won the bid for your area and only those companies can bill Medicare on your behalf.
So what’s the bottom line?
Yes, Medicare covers the cost of a portable oxygen concentrator. But in reality, your odds of finding a local Medicare company that will provide you with a portable concentrator are slim to none.
That’s why at OxiMedical we provide you with the best brands in portable oxygen at prices you can afford.