Portable Oxygen Concentrators Covered by Medicare

Medicare provides coverage for portable oxygen concentrators under certain conditions, recognizing them as durable medical equipment (DME). Coverage is typically provided under Medicare Part B or Part C, provided the equipment is prescribed for use in the home and not for use outside of the home. If you are enrolled in Medicare and have a medical need for oxygen, you’ll generally rent the oxygen equipment from a supplier for an initial 36-month period, after which the supplier is obligated to provide you with the equipment for up to an additional 24 months, summing to a total of 5 years of coverage.

However, it’s important to note that Medicare’s coverage for portable oxygen concentrators is conditional on the agreement of the DME supplier to provide a portable option, which may not always be the case. This is partly because portable concentrators are often more expensive than stationary ones, while Medicare’s reimbursement rate to the supplier remains the same for either option.

To qualify for Medicare coverage, you must meet specific medical requirements, such as having an oxygen saturation level below 88% while at rest, or below 90% when active. If these criteria are met, Medicare will cover the rental of a portable oxygen concentrator. After meeting your Part B deductible, you will pay 20% of the Medicare-approved amount for the equipment. Coverage may vary depending on your specific medical condition, mobility level, and the particular Medicare plan you are enrolled in.

Additionally, if you have a Medigap plan, it’s possible to have even lower out-of-pocket costs for your oxygen concentrator, potentially reducing your cost to $0 depending on the specifics of your plan.

Types of Portable Oxygen Concentrators Covered

Continuous Flow vs. Pulse Dose POCs

Continuous Flow POCs:

• Definition: These devices deliver a constant stream of oxygen, regardless of the patient’s breathing pattern.
• Medicare Coverage: Medicare may cover continuous flow POCs if the patient’s medical condition requires this specific type of oxygen delivery. The patient must meet Medicare’s criteria for oxygen therapy.

Pulse Dose POCs:

• Definition: Pulse dose POCs provide oxygen in bursts at the beginning of each breath, which can be more efficient and extend the battery life of the device.
• Medicare Coverage: Pulse dose POCs are often covered by Medicare as they are suitable for patients who require oxygen therapy during exertion or throughout the day. The coverage is contingent on the patient’s oxygen needs as determined by a healthcare provider.

Features of Medicare-covered POCs

• • Battery Life: Medicare-covered POCs must have sufficient battery life to meet the patient’s mobility needs.
  • Alarms/Alerts: Devices should have systems to alert users of low oxygen, low battery, or technical malfunctions.
  • Portability: POCs should be easily transportable, often including a carrying case or cart.
  • FAA Approval: Many POCs covered by Medicare are FAA-approved for airline travel, reflecting their portability and reliability.

Medicare Requirements:

• • • • Functional Necessity: The POC must be deemed medically necessary by a Medicare-enrolled physician.
      • Compliance with Standards: POCs must comply with specific standards for oxygen delivery and safety as outlined by Medicare.

Brands and Models Commonly Covered by Medicare

• • • • Inogen: Known for lightweight and efficient models.
      • Respironics: Offers a range of POCs that are popular for their reliability.
      • Invacare: Well-regarded for durable and user-friendly oxygen solutions.

Common Models:

• • • • Inogen One Series: Various models like the Inogen One G3 or G4 are compact and have different flow settings to accommodate varying oxygen needs.
      • Respironics SimplyGo: A choice for those who need continuous flow and pulse dose options.
      • Invacare Platinum Mobile Oxygen Concentrator: Offers robust performance with a focus on portability and durability.

Medicare’s Coverage Specifics

• • • • Medicare typically covers the rental of a POC, and the specific model covered will depend on the contract between Medicare and the DME suppliers.
      • The actual brands and models covered can change as new products enter the market and contracts are updated.
      • It’s essential for patients to consult with their healthcare provider and a Medicare-approved DME supplier to determine the specific brands and models available to them through their Medicare coverage.

Tips and Considerations for Beneficiaries of Portable Oxygen Concentrators Covered by Medicare

When selecting a portable oxygen concentrator covered by Medicare, consider weight, battery life, and flow type. Look for a device that fits your lifestyle, ensuring it’s light enough for everyday carry and has a battery life that supports your daily routine.

Medicare typically covers oxygen equipment rental rather than purchase. Understand your plan: some may allow purchase after continuous rental. Weigh the long-term costs and convenience to decide whether to rent each month or work towards ownership.

For those with wanderlust, ensure your portable oxygen concentrator is FAA-approved for air travel. Check airline policies in advance and always have extra batteries for the duration of the flight and possible delays to keep your journey smooth.

Regular maintenance is key to your concentrator’s longevity. Replace filters and cannulas as recommended, and familiarize yourself with common issues and fixes. If problems persist, contact your supplier immediately—don’t risk a lapse in your oxygen therapy.