Oxygen Patient Questions: Will Medicare Pay for Home Oxygen Concentrators?

Have you just found out that you need to use oxygen therapy? Starting the process can be daunting because of all the different options available for patients. Today, the main options for patients on oxygen therapy include tanks and concentrators. Tanks and concentrators both have their advantages and disadvantages. While tanks are much cheaper, many people opt for oxygen concentrators instead because they are much more convenient, require less work and can save money in the long run by cutting out the need for oxygen refills.

Since the initial cost of a concentrator can seem expensive, many patients ask, "Will Medicare cover the cost of home oxygen concentrators?" The remainder of this article will help clarify and answer this question.

The short response to the question is, yes; Medicare will help cover the cost of an oxygen concentrator. However, for patients to qualify for Medicare coverage, there are certain requirements must be met.

Medicare will help cover the cost of most equipment that is considered durable medical equipment, or DME for short. Below is an excerpt from the Department of Health and Human Services Office of Inspector General Medicare Home Oxygen Equipment: Cost and Servicing Manual:

“Section 1834(a)(5) of the Social Security Act authorizes Medicare payment for home oxygen equipment under its durable medical equipment (DME) benefit. DME is defined as medical materials that can withstand repeated use, is used primarily to serve a medical purpose, and is appropriate for use in a beneficiary’s home.”

Since an oxygen concentrator is considered a DME, does that mean Medicare will cover it?

Not exactly:

Coverage on the concentrator will still depend on if the patient's doctor provides the proper documentation in their medical record. Correct documentation includes the physician cataloging that the oxygen concentrator is a medical necessity and writing the patient a prescription stating that he/she requires medical grade oxygen.

If and when Medicare decides to cover the cost of a concentrator, they will enter a contract with a Medicare-approved provider. This agreement states that this provider will supply the patient a concentrator on an extended rental basis. Meanwhile, Medicare will cover the entirety or a portion of the cost of the rental. The contracts between the patient, the Medicare-approved provider, and Medicare will last for 36 months. After the initial three years, renewal may be necessary. To renew the contract, updated documentation, and information from the patient's doctor will be required.

Even when a patient has all of their documents in order and meets all the requirements, the provision of an oxygen solution can take months. Furthermore, many people find that the Medicare-approved provider does not accommodate patients very well. Often ignoring, and avoiding patients who have asked for assistance, or sending them through an extensive bureaucratic system for even the most simple of requests.

If the patient decides that pursuing Medicare coverage is too time-consuming, they can always purchase their oxygen equipment outright. For cash purchases, all that is required is a payment method as well as a prescription from a physician stating that medical grade oxygen is required. Some companies offer financing plans that enable patients to pay for the machine over the course of 3-6 months interest-free to make concentrators more affordable for the patient.

In summary, Medicare will cover a home oxygen concentrator through Medicare's DME benefit. A patient needs the documentation of medical necessity from a doctor, as well as a Medicare approved provider that is able to supply a concentrator on a long term rental basis. The process can be very time-consuming, taking months before the patient sees their oxygen solution.

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