Medicare Part B covers portable oxygen concentrators (POCs) as durable medical equipment (DME) when they are deemed medically necessary.Â
Medicare typically covers 80% of the Medicare-approved amount, after you meet your Part B deductible.
In this guide, you'll learn:
The conditions for Medicare coverage of POCs.
The costs you might still incur.
How Medicare handles rentals versus purchases.
How to ensure you get proper coverage.
Medicare Part B covers POCs under specific conditions:
Your doctor must certify that you have a medical condition requiring supplemental oxygen.
You must have a documented need for oxygen therapy.
You must meet Medicare's criteria for home oxygen use.
POCs are considered DME, which means they must be:
Durable (can withstand repeated use).
Used for a medical reason.
Used in your home.
Part B Deductible: You must meet your annual Part B deductible before Medicare starts paying.
Coinsurance: Medicare typically pays 80% of the Medicare-approved amount. You pay the remaining 20%.
Rental vs. Purchase: Medicare usually covers the rental of oxygen equipment, including POCs. In rare cases, Medicare may approve a purchase.
Supplier Requirements: You must obtain your POC from a Medicare-approved supplier.
Even with Medicare coverage, you may have some out-of-pocket expenses:
Part B Deductible: As mentioned, you must meet this first.
20% Coinsurance: You'll be responsible for this portion of the Medicare-approved amount.
Supplier Charges: If your supplier doesn't accept Medicare assignment, you may have to pay excess charges.
Maintenance and Supplies: You may be responsible for some maintenance costs or replacement supplies.
To ensure you get proper coverage:
Doctor's Documentation: Ensure your doctor thoroughly documents your medical need for a POC.
Medicare-Approved Supplier: Obtain your POC from a supplier that accepts Medicare assignment.
Prior Authorization: Some POCs may require prior authorization from Medicare.
Keep Records: Keep records of all your medical documentation and supplier invoices.
Medicare provides essential coverage for POCs when medically necessary, helping beneficiaries manage respiratory conditions.
Understanding the coverage details and potential costs can help you navigate this aspect of your healthcare.
For more insight into how this concept interacts with others, see our detailed guide on Medicare Part B, which further explores the overall structure of Medicare's outpatient medical insurance and its implications in greater depth.
Generally, Medicare Part B covers the rental of portable oxygen concentrators (POCs), not the outright purchase.
In rare and specific circumstances, Medicare might approve the purchase, but rental is the standard coverage model.
This is because Medicare wants to ensure that the equipment is being used appropriately and that patients receive necessary maintenance and support.
Getting a "free" POC is difficult, as these devices are expensive.
However, here are some avenues to explore:
Medicare Part B: As mentioned, Medicare covers 80% of the rental costs if you meet the medical necessity requirements. This significantly reduces your out-of-pocket expenses.
Medicaid: If you qualify for Medicaid, it may cover some or all of the costs not covered by Medicare.
Charitable Organizations: Some charitable organizations may provide assistance with medical equipment costs.
Manufacturer or Supplier Assistance Programs: Some manufacturers or suppliers may offer financial assistance programs.
It is important to understand that there are very few instances where a POC is provided completely free of charge.
The out-of-pocket cost of oxygen therapy depends on several factors:
Medicare Coverage: If you have Medicare Part B, it will cover 80% of the Medicare-approved amount, leaving you responsible for the remaining 20% and any applicable deductibles.
Private Insurance: If you have private insurance, your coverage will vary depending on your plan.
Rental vs. Purchase: Rental costs will differ from purchase costs.
Type of Oxygen Equipment: Portable oxygen concentrators, oxygen tanks, and liquid oxygen systems have different costs.
Supplier: Prices can vary between suppliers.
Without insurance, the cost of oxygen can be very high.
The rental cost of a POC varies depending on:
Supplier: Different suppliers have different rental rates.
Type of POC: Different models and brands have different costs.
Rental Duration: Longer rental periods may have lower monthly rates.
Location: Rental costs can vary by geographic location.
Generally, rental costs can range from a few hundred dollars per month to considerably more.
It is best to contact local DME suppliers to get quotes for specific POC models.