How Much Does Medicare Pay For Portable Oxygen Concentrators
Original Medicare does cover Inogen, but the beneficiary is responsible for the Part B deductible and a 20% copay. Medicare Part B generally requires beneficiaries to rent, rather than purchase, an oxygen concentrator. The concentrator and supplies must come from a Medicare-approved supplier. Medicare Advantage plans may offer additional coverage.
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Why Are Portable Oxygen Concentrators Popular
Portable oxygen concentrators are popular because theyre small, light, and convenient to use. Many portable oxygen concentrators weigh as little as 5lbs and are less than 10 inches high. That means you can easily put them in a carrying case and take them with you as you go shopping, visit friends, go out to dinner, or even catch a flight.
Portable oxygen concentrators require batteries that must be changed regularly, but they dont need refilling the way gas or liquid oxygen delivery systems do. That makes them much more convenient than other delivery systems. Most units are very user-friendly too, so its not an extra stressor to have one close at hand.
However, portable oxygen doesnt come cheap, with most units costing somewhere between $2000 $3500.
If youve been prescribed portable oxygen and are worried about the cost, you might be wondering if Medicare will pay for a portable oxygen concentrator. Unfortunately in most cases, the answer is no.
What Will Medicare Pay For
While Medicare does not cover the cost of purchasing these machines, it will cover the cost of renting oxygen equipment and accessories. To be eligible for rental, Medicare requires the following conditions are met:
- Your doctor says you have severe lung disease or youre 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.
Once Medicare determines eligibility, youll need to find an approved oxygen supplier and determine the rental cost. Medicare will pay up to 80% of the cost of your rented oxygen equipment for up to three years. If your medical need for oxygen continues, you may rent the equipment for an additional two years.
Its important to note that after five years, the supplier does not have to renew their rental contract with you. Also, before you rent a portable oxygen concentrator make sure your supplier has experience working with Medicare. It can make a difference.
Working With Your Insurance
In order to maximize your chance of insurance covering your portable oxygen concentrator, the first step is making sure your paperwork is in order. Your doctor should write an order for the POC, and also should include all of your relevant medical information such as test results, the severity of your disease, and how often you require oxygen. If your claim is denied, an appeal should fully document why you need a POC instead of an oxygen tank. Take your time writing out all the ways in which having a POC are necessary to maintain your quality of life, including both professional and personal examples. The more details you provide, the more likely you are to convince your insurance to cover your POC.
Equipment Rental Vs Owning
Medicare covers 80% of the costs of oxygen equipment rental after a person has met the yearly deductible.
If someone wishes to purchase a portable oxygen concentrator, Medicare will help pay for the supplies that the person needs to use alongside the machine. The cost may be either a flat monthly rate or based on use.
The price of a new home oxygen concentrator depends on several factors and ranges from $595 to $2,000 .
Some DME companies allow people to finance a new portable oxygen concentrator with monthly payments. Individuals must decide which is more cost effective: buying the oxygen therapy equipment or paying the 20% copayment to Medicare and renting the equipment.
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Does Medicare Pay For Oxygen
Medicare does not cover the cost of purchasing an oxygen concentrator that said, when you ask, Are portable oxygen concentrators covered by Medicare? the answer is: Sometimes. Medicare may cover oxygen equipment rental costs if you are eligible for Medicare and approved for therapeutic oxygen use. You will need a doctors prescription stating that you need medical oxygen, followed by meeting other certain conditions.
Answering Are portable oxygen concentrators covered by Medicare? clearly can be difficult. Heres what you should know.
How Much Do They Cost
Portable oxygen concentrators have become increasingly popular with a generation always better and efficient than the previous one. They have become smaller, easier to carry, and have even been welcomed by different organizations and transport companies like aircraft. More patients have become increasingly interested in Portable oxygen concentrators, which have encouraged the mass productions of the machines by suppliers. But as with most good things, POCs are not so easy to get. They are pretty expensive.
Getting a standard Portable oxygen concentrator can be telling on a patients budget and can, in most cases, only be purchased by well-to-do individuals. This has made patients with Medicare insurances turn to the Government Healthcare organization for relief.
Generally, Medicare covers seniors health care bills from 65 years and above, younger people with certain disabilities, and people who require a kidney transplant. The coverage offered by Medicare ranges from common medical treatments to more advanced surgeries. They also supply or provide funds for certain health equipment, so it isnt out of place for patients to feel if the organization offers coverage for POCs.
This article helps you determine whether Medicare offers POCs coverage and the requirements that make a patient eligible for getting one.
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Are You Eligible For Medicare
Before you ask, Are portable oxygen concentrators covered by Medicare? make sure you qualify for Medicare. If you are 65 or older, you have a documented disability or you have end stage renal disease, you are eligible for Medicare. From there, see your doctor to ensure you meet all the criteria for getting your portable oxygen concentrator covered by Medicare.
Medicare Deductible And Coinsurance
Since portable oxygen concentrator and other oxygen equipment falls under the category Durable Medical Equipment and is covered on Medicare Part B. It says that you need to pay 20% of the Medicaid-approved amount , and then the Part B deductibles will apply.
Therefore, if you have been approved for the coverage of oxygen equipment through Medicare, the cost for oxygen equipment rental from the accredited supplier will be covered by Medicare for 36 months. Once 36 months have passed, you will be covered for another 24 months of oxygen equipment and other supplies until you will be covered for a total of 5 years, or as long as you medically need oxygen therapy.
Aside from the oxygen equipment, here are some oxygen accessories and services that are also included in the coverage for monthly rental payments:
- Oxygen machine servicing
- Oxygen machine repair and maintenance
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How Does A Portable Oxygen Concentrator Work
A portable oxygen concentrator, sometimes called a POC, is similar to a home oxygen concentrator but more mobile, says Corrielus. These devices are small enough to carry, which makes them ideal for travel, and some are approved for use on airlines.
According to Corrielus, heres how an oxygen concentrator works:
- The device draws in air from your surrounding environment.
- Air is compressed inside the device.
- Nitrogen is filtered out of the air.
- Pure oxygen is inhaled through a nasal tube or mask.
Does Medicare Cover Oxygen For Copd Treatment
If you have chronic obstructive pulmonary disease and your doctor determines that oxygen therapy is medically necessary for you, Medicare will help cover your oxygen equipment.
Other health conditions that could require you to need medically necessary oxygen therapy can include:
- Cystic fibrosis
- Severe asthma
As mentioned above, Medicare Part B will cover the rental of your oxygen concentrator and other equipment only if it is prescribed by your doctor for use in your home.
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What Happens After 36 Months
If you still need oxygen after renting the equipment for 36 months, your medical supplier must continue maintaining the equipment and furnishing supplies for up to 5 years . The DME supplier must also continue supplying the monthly delivery of oxygen tanks or cylinders, for which you will continue paying the 20 percent coinsurance.
After 5 years, your current provider no longer has to supply oxygen equipment â even if you still have a medical need for oxygen. You can, of course, continue with this provider if you both agree. You may also choose a different durable medical equipment supplier and begin a new 36-month rental period.
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Level Of Care Eligibility
Medicaid eligibility differs on a state-by-state basis, depending on the level of care that is medically necessary and needed. In order to qualify for Medicaid, individuals must be able to prove that they require a level of care that meets certain criteria or requires a level of personal care assistance.
The definition of level of care varies from state to state, but in general, it refers to assistance to those who lack cognitive function, the inability to engage in activities of daily living, and mental and behavioral health issues. These factors are just some tools that are used to assess the level of care at nursing homes for older adults, according to the American Council on Aging. Keep in mind that the level of care varies depending on the state youre in, so the criteria that might make one eligible in one state, may not apply to the other.
When Does Medicare Part B Cover Oxygen Therapy
According to Medicare.gov, Part B covers doctor-prescribed equipment or accessory rentals for oxygen therapy as durable medical equipment.
Medicare also covers the delivery of oxygen and supplies for people who already own equipment if:
- The doctor must diagnose a lung disease that causes inadequate blood oxygen.
- Blood oxygen levels must fall below a specified range.
- Oxygen therapy can help the condition improve.
- Alternative treatments have failed.
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I Need A Portable Oxygen Concentrator Is It Covered By Medicare
You know you need a portable oxygen concentrator, but will Medicare cover it? Unfortunately, this is a complicated question to answer. Upon being diagnosed with needing this oxygen machine or other medical equipment, this probably isnt the only question you have.
For example, will you receive your equipment at little to no cost? Should you consider purchasing a used portable oxygen concentrator? Who is the best person to contact about your coverage? Its rare to receive direct answers to these queries, but were here to help guide you through coverage solutions.
Getting The Right Information From Your Doctor
Once you confirm that you qualify for Medicare, see your doctor to get sufficient documentation for Medicare oxygen requirements. Your doctor will need to complete a certificate of medical necessity and compile a detailed written order that includes all of the following:1,2
- Your full legal name
- The date of the prescription and order
- A thorough description of all required oxygen equipment, including the recommended oxygen delivery system and all necessary accessories
- Your prescribed flow rate, as well as whether you will require pulse dosing or continuous flow
- The amount of time you will need supplemental oxygen and frequency of need
- Your doctors signature
Once you have this paperwork, you can submit it to Medicare, where you will either be approved or denied.
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What Does Oxygen Equipment Rental Include
Medicare oxygen equipment is rented for 36 months. In addition, medical equipment suppliers must furnish the oxygen equipment and related supplies for an additional 24 months if necessary.
Your monthly rental includes the following oxygen accessories and services:
- Tubing or mouthpiece
- Oxygen contents, including liquid oxygen and oxygen concentrate
- Maintenance of the oxygen machine
Medical suppliers must provide both the equipment and related supplies for up to 5 years, assuming you continue to have a medical need for oxygen.
What Does Medicare Cover For Portable Oxygen Concentrators
- Medicare covers portable oxygen concentrators when they are prescribed for use at home.
- Medicare does not cover portable oxygen concentrators when used outside of the home.
- This includes situations where a patient uses them during travel, exercise, or other activities.
Medicare does cover medical equipment and oxygen devices but the key is they do not cover the cost to purchase this equipment outright.
They cover a rental agreement where oxygen equipment can be rented to you monthly for a 36 month agreement.
The problem for many suppliers is that in 2013 Medicare cut their reimbursement rates for oxygen equipment in half.
So, a company would have to purchase the equipment upfront and get paid piece by piece over the next 3 year at a rate that might not be profitable for them.
Hence why we see many companies accept prescriptions for these saying they will cover them but then only giving the patient oxygen tanks instead.
They can bill the whole amount up front for supplies that are ordered each month like oxygen tanks and the tubes needed to use it.
We often get told it is company policy to only allow a patient to get a portable oxygen concentrator when traveling long distance. One company told us they only allow a patient to have a portable oxygen concentrator for 3 days and they have to show proof that they are traveling out of town such that they would need it. It depends on the situation.
For this reason we have seen some companies get creative in getting these.
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Does Medicare Cover Oxygen Therapy
Yes, oxygen therapy, as well as oxygen therapy tank accessories, are covered under Part B. Oxygen equipment and all accessories are Durable Medical Equipment. Part B covers the rental and use of DME for beneficiaries to use within their homes.
Medicare covers storage containers for oxygen, tubing, other oxygen accessories, and units that provide oxygen. Also, if the oxygen machine works with a humidifier, this may have coverage.
For Medicare to cover oxygen equipment and supplies, beneficiaries must have the following:
- Have a prescription from your doctor
- Have documentation from your doctor showing you have a lung disorder preventing you from receiving enough oxygen and that other measures have not been successful in improving your condition
- Proof of gas levels in your blood from your doctor
Its more cost-effective to rent your oxygen equipment from a participating DME supplier. Your rental payments will be paid up to 3 years. After that, the supplier will still own the equipment. However, they must still supply oxygen to you for an additional 24 months. If you still need oxygen therapy after 5 years, you can renew your contact with the supplier or find a new one.
If you use an oxygen concentrator, your Part B benefits will cover the cost of servicing your equipment every 6 months once the 36-month rental window has ended.
Best For High Altitude And Traveling: Oxlife Independence Portable Oxygen Concentrator
Courtesy of O2 Concepts
The Oxlife Independence is excellent for traveling due to its operational altitude of 13,123 feet. Unlike other models that top out at 8,000 or 10,000, this portable oxygen concentrator can keep up even up higher and it comes with wheels and a cart handle for easier transportation.
The pulse dose setting ranges from one to six LPM. It also has a continuous setting of one to three LPM for precision oxygen. The battery keeps both pulse dose mode chugging for up to four hours and up to 1.5 hours operating in the continuous mode.
Weight: 16.7 lbs | Delivery/Flow Type: Continuous and pulse flow | Battery Life: 1.5 hours
Patients need to talk to their doctors about if they can handle a portable concentrator to see if their breathing technique and liter flow are adequate from that concentrator to meet their needs. The last thing you want to do is go out and buy a concentrator that doesnt meet the needs of the patient. Dr. Albert Rizzo, M.D., the Chief Medical Officer with the American Lung Association
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