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If Your Insurance Cover A Portable Oxygen Concentrator
By
Jonathan Reed
Updated January 24, 2025

If Your Insurance Cover A Portable Oxygen Concentrator?

Insurance can help you get a portable oxygen concentrator at an affordable rate. Learn about your insurance company's requirements and guidelines for applying for POC here.
Product Specialist: Emma Clark
Clinical Applications Specialist: Dr. James Bennett

Portable oxygen concentrators (POCs) are gaining popularity among patients managing respiratory conditions. Thanks to their convenience and technological innovation. These devices are more efficient, smaller, and lightweight than traditional oxygen tanks. 

The introduction of POCs brings a significant leap in medical technology. They allow the user to have mobility while undergoing oxygen therapy, improving their quality of life.

However, the cost of these oxygen machines may be a financial challenge to the deserving. The demand for POCs is rising, and this raises a critical question. Does insurance cover a portable oxygen concentrator? 

The balance between healthcare necessity and meeting the costs is an emotional topic. Patients, caregivers, governments, and the private sector depend on insurance.

health-insurance

Does Medicare Cover a Portable Oxygen Concentrator?

Yes, Medicare covers portable oxygen concentrators. Their medical insurance, Medicare Part B, covers medical supplies for outpatients.

POCs are under the durable medical equipment (DME) category.

What Do You Need to Qualify?

To qualify for Medicare POC coverage, you must meet specific eligibility conditions. They are:

  • Confirmation of a diagnosis that warrants at-home oxygen therapy from a qualified registered doctor.
  • A demonstrated medical necessity of oxygen therapy.
  • Qualifying oxygen saturation level.
  • Supplier must be Medicare-enrolled.

Will Medicare Cover All the Costs?

Medicare covers DMEs mainly for rentals. The supplier rents the equipment for 36 months. The supplier, however, is bound to extend the period for another 24 months. You will pay 20% of the rental cost, while Medicare pays 80%.

Does Medicare Cover the Purchase of a Portable Oxygen Concentrator?

The main cover available under Medicare for POCs is for rentals. A rental is different from a purchase. During the rental period, you have freedom of use but not the actual owner, so long as you stick to the agreement. After the contract expires, the supplier will take back the equipment.

Does Medicaid Pay for Portable Oxygen Concentrators?

Yes, although Medicaid cover for POCs differs from state to state. In many states, the Medicaid program covers up to 100% of the cost of portable oxygen concentrators. You need to contact your state Medicaid agency for any coverage amounts and requirements inquiries.

What Do You Need to Qualify?

To qualify for Medicaid, you must meet specific eligibility criteria.

  • A diagnosis from a registered Medicaid registered doctor.
  • A prescription showing the necessity of oxygen therapy.
  • A supplier registered with Medicaid.

Will Medicaid Cover All the Cost?

Yes, Medicaid can cover all the cost of a portable oxygen concentrator. However, a POC must fit your state’s DME definition and oxygen therapy as a medical necessity.

Your state’s Medicaid agency can help with the assessment of your qualifications.

Does Private Insurance Cover a Portable Oxygen Concentrator?

Private insurance health policies regarding POC coverage may differ from Medicare and Medicaid. Each insurance company has its policies and guidelines. The contract between you and private insurance can affect the extent and type of coverage you receive for POCs.

Key Factors Influencing Private Insurance Cover for a Portable Oxygen Concentrator

Several factors influence private insurance coverage for a POC. These include:

  • Terms and conditions of the insurance plan.
  • A healthcare professional must determine medical necessity.
  • An individual health condition.

You must review your private health insurance policy document to confirm POC coverage. Consulting with your insurance provider can also help you understand the coverage specifics.

Process of Obtaining a Private Insurance Cover for a Portable Oxygen Concentrator

The process of getting a cover for a POC from private has some relation with Medicare. Both require medical diagnosis and a prescription from a qualified registered healthcare provider. It is a requirement to show the medical necessity for oxygen therapy.

However, you need to fill out a claim form and attach the documents for private insurance. The insurer assesses the claim form against the policy guidelines. The coverage depends on your eligibility. 

Private insurance coverage for portable oxygen concentrators may be complete or partial. Private insurance may also have restrictions on brands of POCs they cover. Another challenge you might face is high deductibles and premium rates.

Conclusion

Yes, insurance covers a portable oxygen concentrator. However, the coverage depends on the specific insurance policy guidelines and your eligibility. You can also explore an affordable portable oxygen concentrator from ReadyO2.

Medicare usually covers the rental costs of POC as part of its Durable Medical Equipment (DME). They generally do not cover the full cost of purchasing the equipment. Medicaid coverage for POCs varies from state to state. But in many states where a POC fits as medically necessary DME, it covers up to 100% of the cost.

For private insurance, coverage for a POC varies. The beneficiary policy and medical necessity determine the eligibility. In case of a denial, you can gather more proof and appeal your claim.

Sources

I am Dr. Jonathan Reed, a proud member of the readyO₂ team. With a background in respiratory therapy, I’m dedicated to helping those in need by answering questions and providing clarity. I strive to educate and inspire our audience by making complex topics accessible and engaging. My goal is to educate and inspire our audience, ensuring they have the information necessary to make informed decisions about their health. It’s a privilege to support individuals on their journey to better breathing and well-being.

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