Does Medicare Cover a Portable Oxygen Concentrator? 

Oxygen is one of the most fundamental elements in the world, and it is necessary for all forms of life to thrive. In humans, the lungs move oxygen into the blood via the lungs, and the oxygenated blood provides energy to organs. When this process is hindered by blockages in the lungs, not enough oxygen can get into the bloodstream, decreasing the energy given to the rest of the body. This can lead to a host of medical problems, and without oxygen, the body dies.

Causes of oxygen deprivation

There are a number of causes of oxygen deprivation, including chronic obstructive pulmonary disease (COPD), lung cancer and cystic fibrosis. While some lung conditions only cause a temporary reduction in oxygen transfer, others can result in long-term oxygen deprivation. Smoking and working in conditions where certain particles are present can also lead to the development of lung diseases that cause oxygen processing to be hampered in the lungs.

Treatment for lung disease

Depending on the cause, lung diseases are treated using medications and special equipment. Some medications, including steroids, can give a temporary boost to the lungs, allowing them to function properly when faced with acute lung conditions like asthma. In more severe cases involving chronic lung disease, the use of a portable or stationary oxygen concentrator may be necessary.

Does Medicare cover a portable oxygen concentrator?

An oxygen concentrator is a machine that delivers concentrated oxygen via normal airways. The machine delivers concentrated oxygen through plastic tubes that connect to nasal delivery attachments that are inserted into the nasal openings. In some cases, a face mask that covers both the mouth and nose must be used to deliver oxygen to both airways. Most oxygen concentrators available today are portable, but some that are used in clinical and inpatient settings are stationary.

Original Medicare covers portable oxygen concentrators through Part B. Medicare benefits under Part B are used to pay for outpatient services, but they also cover durable medical equipment (DME). In order for DME to be eligible for Medicare benefits, the equipment must come from a Medicare-approved provider. Some Medicare recipients will need to rent DME for a period of time before Medicare coverage will apply toward the purchase of the equipment. In the case of portable oxygen concentrators, Medicare pays for 36 months of rental fees before a purchase is possible.

Qualifying for a portable oxygen concentrator

In order to be considered eligible for Medicare benefits that cover a portable oxygen concentrator, the equipment will first need to be deemed medically necessary. Your doctor will need to document the fact that you suffer from a lung disease or that your arterial blood gas level of oxygen is below normal levels. You may also be required to have tried other methods of treatment before Medicare will consider coverage for a portable oxygen concentrator.

If you qualify, Medicare benefits will cover the concentrator, but they will also cover the additional costs that are required to use the concentrator. These additional costs may include tubing, mouthpieces, nasal delivery pieces, oxygen supplies and machine maintenance and repairs.