Will Your Insurance Cover a Portable Oxygen Concentrator?

Will Your Insurance Cover a Portable Oxygen Concentrator?

Insurance coverage can make a portable oxygen concentrator more affordable, but approval depends on meeting specific medical and documentation requirements. Understanding how Medicare, Medicaid, and private insurers evaluate oxygen equipment coverage will help you prepare and avoid surprises.

Portable oxygen concentrators are becoming a preferred choice for individuals managing chronic respiratory conditions such as COPD, pulmonary fibrosis, and severe asthma. They offer mobility, comfort, and improved independence compared to traditional oxygen cylinders. Modern POCs are lighter, quieter, and more efficient, making them suitable for daily use at home or during travel.

However, the cost of a portable oxygen concentrator can be a financial barrier for many patients. This leads to a common question among those beginning oxygen therapy: Will insurance pay for a portable oxygen concentrator? Understanding insurance rules helps ensure you maximize benefits and avoid avoidable out-of-pocket expenses.

Does Medicare Cover a Portable Oxygen Concentrator?
Yes, Medicare provides coverage for portable oxygen concentrators under Medicare Part B when medical necessity is established.

POCs qualify as Durable Medical Equipment. Medicare typically pays for rental instead of allowing direct purchase.

Medicare Qualification Requirements
To qualify, you must meet Medicare's oxygen medical necessity guidelines, which include:

  • A confirmed diagnosis requiring supplemental oxygen from a Medicare-enrolled physician

  • A documented need for oxygen therapy supported by clinical evaluation

  • Lab-verified low blood oxygen levels from an arterial blood gas test or pulse oximetry

  • Use of a Medicare-approved DME supplier

How Medicare Pays
Medicare covers approximately 80 percent of the approved rental cost once the annual deductible is met. Patients are responsible for the remaining 20 percent unless they have supplemental coverage. The standard rental period is 36 months, with the supplier responsible for equipment maintenance and oxygen delivery for an additional 24 months.

Does Medicare Buy Portable Oxygen Concentrators Outright?
In most cases, no. Medicare primarily rents equipment and does not typically purchase portable oxygen concentrators for patients. After the rental term, the device is returned unless special exceptions apply.

Does Medicaid Cover Portable Oxygen Concentrators?
Yes, Medicaid may cover POCs. Coverage varies by state, but many state Medicaid programs will pay for portable oxygen equipment if the device meets the Durable Medical Equipment criteria and medical necessity is proven.

Medicaid Qualification Requirements

  • A diagnosis from a Medicaid-approved physician

  • A prescription indicating oxygen need and flow settings

  • Proof of medical oxygen necessity

  • Supplier participation in Medicaid

Some states provide full coverage, while others require prior authorization or place limits on device type or brand.

Does Private Insurance Cover Portable Oxygen Concentrators?
Private insurance policies may cover a portable oxygen concentrator, but benefits vary significantly by plan. Coverage depends on the terms of your contract and medical eligibility. Some plans follow Medicare guidelines, while others have broader or more restrictive criteria.

Factors That Influence Private Insurance Approval

  • Policy coverage terms and medical necessity language

  • Clinical documentation and oxygen testing results

  • In-network DME supplier rules

  • Limitations on approved POC brands or models

Private plans may cover rental, partial purchase, or require higher deductibles and coinsurance compared to Medicare.

How to Get Private Insurance Coverage for a POC

  • Obtain a physician evaluation and prescription

  • Provide qualifying oxygen test results

  • Submit a completed insurance claim form

  • Provide any additional documentation requested

If denied, patients can appeal with additional medical evidence and physician support.

Conclusion
Insurance can help offset the cost of a portable oxygen concentrator, but coverage depends on meeting strict eligibility requirements and working with approved suppliers. Medicare typically provides rental coverage, Medicaid options vary by state, and private insurer rules differ by policy.

If you do not qualify or prefer to purchase a POC outright, consider affordable models, refurbished units, and manufacturer financing programs. Insurance navigation takes patience, but understanding the rules increases your chances of approval and lowers your long-term costs.

 

Sources

https://www.cms.gov/Medicare/Equipment-DMEPOSCertContractors/DMEPOS-COMPONENT/POSHomeOxygen
https://www.medicaid.gov/medicaid/benefits/epsdt.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574700/
https://www.fda.gov/medical-devices/home-health-and-consumer-devices/oxygen-concentrators

Back to blog