Does Insurance Cover Portable Oxygen Concentrators? Find Out Here
You can feel lucky to have a medical card when undergoing oxygen therapy, but does insurance cover portable oxygen concentrators? Since companies may also vary with their guidelines and requirements, it can be a long way to research whether or not they can help you.
Fortunately, this article will provide ideas about these health insurance companies, their coverage, and other related information. Read ahead to get started!
Does Insurance Cover Portable Oxygen Concentrators?
If you ask, "does insurance pay for portable oxygen concentrators," the answer will be partly yes or no, depending if you have met the specific guidelines each insurance company requires. Generally, they ask for prescriptions, Certificates of Medical Necessity, physician orders, and other medical files.
Once you have submitted these things, they will check whether your health condition is eligible for portable oxygen concentrator usage. Otherwise, they will deny your request and thus fail to give you insurance coverage benefits.
On the other hand, if you become entitled to the benefits, most companies will only pay for your rental charges on precise durations. A few can provide the entire cost, while some can pay part of the expenses.
To learn more about each insurance agent's specific features, requirements, and coverage, continue reading this article!
Does Blue Cross Blue Shield Cover Portable Oxygen Concentrators?
Yes, if only you meet the specific requirements for becoming eligible for the medical insurance of portable oxygen concentrators. Blue Cross Blue Shield has various branches globally. While we can say that each state may offer different coverage benefits, here are its general and detailed scope, financial assistance, and guidelines.
Generally, the claims for portable oxygen concentrators under Blue Cross Blue Shield insurance coverage will undergo a thorough review. That will help the company to determine if the person requesting it has a medical need for oxygen.
With that in mind, the insurance agent may require patients to get a prescription from a licensed respiratory therapist or doctor. On the other hand, they may also ask you to have a signed physician order or Certificate of Medical Necessity containing the following information:
- Date of the physician order, prescription, or certificate
- Patient name, address, and Blue Cross Blue Shield membership number
- Physician name, address, and telephone number
- Supplier name, location, and telephone number
- Patient diagnosis
- Equipment or supplies prescribed
- Duration of oxygen need
- Statement of medical necessity for oxygen equipment
Before you can avail of an oxygen concentrator covered by insurance under Blue Cross Blue Shield, they will also check the guidelines and information below to ensure your health is not at stake.
- There must be a partial oxygen pressure of 60 or less or an oxygen saturation of 89% or less in room air.
- Sleep apnea with hypoxia
- Chronic interstitial pneumonia
- Chronic obstructive lung disease, such as chronic bronchitis, emphysema, and bronchiectasis, excluding uncomplicated asthma
- Pulmonary hypertension
- Chronic congestive heart failure
- Secondary polycythemia
- Cystic fibrosis
- Primary or metastatic carcinoma of the lung
- Chronic interstitial pulmonary infiltrate-type pulmonary diseases such as eosinophilic granuloma, pneumoconiosis, pulmonary fibrosis from extensive tuberculosis, and idiopathic fibrosis
Unfortunately, Blue Cross Blue Shield will deny everyone who will claim an oxygen concentrator insurance if their diagnosis does not belong to those listed above due to lack of medical necessity.
Once you have met the specific requirements and guidelines, you can use the following insurance coverage for your equipment.
- Adjustment, repair, or replacement of accessories and parts needed for the oxygen concentrator to function efficiently and normally
- Monthly payments for the rental charges if the oxygen concentrator can be under a rental with a cost less than when you purchase it
- Purchased unit if the costs of buying the machine are less expensive than renting it
Payments and Duration
The insurance for durable medical equipment DME can only be under purchase or rental. If the unit is under the latter, the total rental payments may not go beyond the allowable purchase price of the portable oxygen concentrator. However, since POCs belong to the life-sustaining DMEs, you can rent them continuously as long as your oxygen necessity exists.
Does Medicare Cover Portable Oxygen Concentrators?
Yes, but only in specific situations and eligibility. Every durable medical equipment falls under the Medicare Part B benefits, and thus, the first thing you must do is to be eligible for the said benefits.
You can read on to know everything in detail!
Insurance Requirements and Guidelines
First, you must meet the following criteria to be a beneficiary of Medicare Part B. Before applying for the insurance benefits, ensure to prepare these things beforehand.
- Your respiratory therapist or doctor's diagnosis and certification that you are suffering from lung problems, causing your body not to get adequate oxygen
- The arterial blood gas levels are decreasing to a specific range.
- Your health's well-being will improve with oxygen therapy using portable oxygen concentrators.
- You and your doctor have tried other medical treatments, but none became effective.
Aside from that, you will also need to get a DME Information Form or Certificate of Medical Necessity signed and issued by your doctor. A Medicare-approved DME supplier is also necessary to proceed with the application process.
Once your application gets accepted, the Medicare coverage will include the following things:
- Oxygen-related accessories, such as tubing or mouthpiece
- Containers for oxygen storage
- Oxygen contents, including oxygen concentrate and liquid oxygen
- Maintenance of the oxygen concentrator, such as servicing and required repairs
Moreover, if you must use a humidifier with your portable oxygen concentrator, you can apply for that because Medicare may also assist you with the costs.
Payments and Duration
In terms of payments, the Part B deductible will require you to pay 20% of the Medicare-approved amount while Medicare pays for the remaining 80%. You will rent the portable oxygen concentrator from a trusted supplier for 36 months.
After the said duration exceeds, the supplier must still provide oxygen units and their related accessories and supplies for another 24 months. Moreover, they must maintain their condition or furnish them as long as you need these oxygen machines until you complete the five years. Remember that they cannot ask you for additional payments for these.
In addition, if you use oxygen tanks where gaseous or liquid oxygen contents are essential, Medicare will continue to pay monthly for the delivery of the contents even after the 36-month rental span. Hence, that will also mean you must pay an amount of 20% of the Medicare-approved costs for these things.
However, if your medical needs for an oxygen concentrator continue after five years, you can no longer ask the supplier to provide you with the oxygen equipment, accessories, and contents. Instead, you can get a replacement unit from the same supplier or other companies.
Once you receive new oxygen and oxygen equipment, another 36-month payment period will start with the 5-year supplier obligation. To know more about Medicare covering health issues, you can also look for Medicare Supplement Insurance.
Does Medicaid Cover Portable Oxygen Concentrators?
Yes, but only if you become entitled to the portable oxygen concentrator covered by insurance. If you compare Medicaid with Medicare, you will see similarities between the two; that's why it is not complicated to understand Medicaid's coverage. To further explain this, you may read the essential information below.
Insurance Requirements and Guidelines
Initially, Medicaid will require a valid prescription from your respiratory therapist or doctor. Aside from that, they can also find these things from you:
- For clients who are under Medicare's group I criteria or chronic oxygen patients
- A valid prescription for the first twelve months or the authorized prescriber's specified length of need, whichever has a shorter duration, and a renewed valid prescription every twelve months
- Documented verification of at least twelve months, where the lab values or oxygen saturations affirm the necessities for continuous oxygen use for the patient. If the coverage is ongoing, the provider may measure the oxygen saturation. However, the Medicaid agency will not accept lifetime certificates of medical need.
- For clients who are under Medicare's Group II criteria or borderline oxygen patients
- A valid prescription for the first three months or the authorized prescriber's specified length of need, whichever has a shorter duration, and a renewed valid prescription three months after the initial certification and annually after that
- There must be a documented verification of the lab values or oxygen saturations, affirming the necessities for continuous oxygen use. If the coverage is ongoing, the provider may measure the oxygen saturation. The Medicaid agency will not accept lifetime certificates of medical need.
Even without prior authorization, the Medicaid agency covers the rental of stationary and portable oxygen systems, as follows:
- For patients twenty years old and younger, only when prescribed by a respiratory therapist or doctor.
- For patients twenty-one years and older, only when prescribed by a respiratory therapist or doctor and the patient meets either Medicare Group I or II clinical criteria.
On the other hand, those twenty-one years old and older who do not meet the Medicare clinical criteria must have prior authorization.
Aside from that, the Medicaid agency also does not cover oxygen therapy and related supplies, equipment, and services to those twenty-one years old and older, but not limited to:
- Angina pectoris in the absence of hypoxemia
- Severe peripheral vascular disease causing clinically evident desaturation in one or more extremities but without systemic hypoxemia
- Dyspnea without evidence of hypoxemia or cor pulmonale
The Medicaid agency does not cover humidifiers separately from the rented oxygen concentrator unit. All necessary accessories belong to the monthly rental charges and payment. Moreover, they do not pay for spare oxygen tanks and related supplies for travel or backup apart from the rented equipment.
Payments and Duration
The Medicare agency will cover the cost of one rental payment for portable oxygen concentrators, including oxygen contents, every thirty days. These units can be either liquid or gas.
If the coverage is for contents only, the company will pay a maximum of one payment for portable oxygen contents every thirty days if the client owns the unit or when it meets the capped monthly rental period.
In terms of maintenance, the agency will cover one maintenance fee of a portable oxygen concentrator every six months together with the oxygen trans-filling equipment. However, it will only apply once it meets the capped rental period or the client owns the unit. The maintenance fee will be 50% of the monthly rental charges.
Lastly, for oxygen supplies replacement, Medicaid will pay for them after the thirty-six-month capped rental span or if the client owns the unit. These supplies and their payment coverage are as follows:
- Tubing, limited to one replacement every thirty days
- Nasal cannula, limited to two replacements every thirty days
- Variable concentration mask, limited to two replacements every thirty days
Does United Healthcare Cover Portable Oxygen Concentrators?
Yes, but only limited. United Healthcare has insurance benefits for its members and beneficiaries, but the applicants must follow such guidelines to be eligible. Moreover, the company only offers a deductible cost instead of paying the entire expenses.
Here are the following guidelines and payment coverage.
Insurance Requirements and Guidelines
United Healthcare only grants benefits limited to a single purchase of a DME, such as a portable oxygen concentrator. Such repairs or replacements of the unit will also apply in the same manner as the purchase.
In this insurance, you must purchase, rent, or obtain the DME from an authorized seller or directly from the prescribed network physician to receive network benefits. Aside from that, the following are the requirements you must fulfill to be eligible for health insurance.
- Your respiratory therapist or doctor ordered you will use a portable oxygen concentrator primarily in a home setting as an outpatient.
- You will use the unit for medical purposes.
- You will not use the equipment if you do not have any disease or disability.
Payments and Duration
Your costs will be different depending if you are under the network benefits or out-of-network ones. For instance, if you fall under the former, you will have to pay 20% coinsurance after meeting the medical deductible. On the other hand, if you are the latter, you will have to cover the 50% coinsurance after meeting the medical deductible.
If the durable medical equipment costs more than $1,000, you will need prior authorization to proceed with the process. However, remember that this information is from United Healthcare's California branch.
Does Humana Cover Portable Oxygen Concentrators?
Yes. Humana is also similar to what Medicare offers. They are only different in some ways, which you can read in the following paragraphs below.
Insurance Requirements and Guidelines
First, your respiratory therapist or physician can refer you to different services. However, Humana requires initial approval before your doctor can lead you to a specific service.
In this process, the company will consider whether or not the service is medically necessary, covered, and meets the general and accepted medical practice. Moreover, durable medical equipment, such as a portable oxygen concentrator, will also need prior authorization if the costs exceed $750.
Humana's insurance coverage includes purchasing or renting durable medical equipment, including adjustments and repairs. Nevertheless, it is their authority to choose between buying or renting one. Some examples of the items they cover are;
- Oxygen tanks
- Oxygen concentrators (stationary or portable)
- Insulin pumps
- Dialysis equipment
- Hospital beds
Payments and Duration
The Medicare Advantage Plan establishes how Humana manages and reimburses its charges for DMEs, such as supplies, contents, and other related services. In this case, you can refer to Medicare's payments and duration above to learn more.
Does Insurance Pay for Portable Oxygen Concentrators?
Fortunately, the answer to the question "does insurance cover oxygen concentrators" is yes, but not all patients are eligible for medical supplies covered by health insurance.
Every insurance company requires specific guidelines and standards to only grant those who deserve medical assistance. Moreover, they also check whether or not the person requesting the portable oxygen concentrator needs the machine because otherwise, they can experience health risks and oxygen toxicity.
Does Tricare Cover Portable Oxygen Concentrators?
Yes. Like the previous insurance companies, Tricare also accepts beneficiaries for health insurance for portable oxygen concentrators. However, you must follow specific requirements to become one.
The following are the requirements and insurance coverage.
Insurance Requirements and Guidelines
Everyone who benefits from Tricare must receive approval from Health Net Federal Services, LLC (HNFS) for all items or units. If they fail to have one, Point of Service charges will apply significantly when the purchase price of the item exceeds $2,000.
A Tricare-authorized provider can file a request for services, which states that the equipment is from the physician's order, primary health caretaker, or respiratory therapist. All orders or prescriptions will then become valid for one year, requiring the beneficiary to renew them annually.
Aside from that, any equipment that costs $150 or greater and rental items of any price will need a certificate of medical necessity. This certificate must include the following information:
- Type of durable medical equipment
- The reason why the equipment is necessary
- Length of the necessity
- Prescription date
- Provider's name and signature
Tricare's insurance coverage includes the following durable medical equipment:
- Those that improve, maintain and restore one's health
- Those that assist the patient's physiological and medical needs
- Those that provide medically appropriate quality and performance levels suitable for the medical condition
- Those that are not violating regulations and policies
In addition, they also cover these things below:
- Customization and attachments to DMEs medically necessary for your condition
- Repairs and maintenance
- Replacement due to accidental damage, change in physical health, and other unfortunate reasons
- Duplicate items for a backup life-support system
Does VA Pay for Portable Oxygen Concentrators?
Yes, only if the patient needs the portable oxygen concentrator. Veteran Affairs offers two programs to eligible veterans and their surviving spouses to help them with health treatments, including home oxygen therapy. You can continue reading to learn more about their guidelines and coverage.
Insurance Requirements and Guidelines
According to the Eligibility for Health Care Programs, the only Veterans that can be eligible for home oxygen therapy are the following:
- Those diagnosed by a health professional with one medical condition (either cor pulmonale, pulmonary hypertension, chronic hypoxemia, or secondary polycythemia)
- Those who are medically in need of oxygen therapy
- Those who become stable on optimal non-oxygen therapy
Aside from that, VA can only approve an application for portable oxygen concentrators if there is evidence that the oxygen therapy is necessary or the potential benefit is more than the potential harm. If you are applying for the first time, the evidence must be from a physician's diagnosis, respiratory therapist's report, or prescription.
You will need to wait for an initial four months for the approval because the company will review a three-month follow-up of the arterial blood gas levels to check if you consistently meet the approval criteria. Once you pass this part, your home oxygen therapy can last for an additional twelve months, which is the maximum frequency period. Otherwise, the company will decide whether they will continue or cancel your benefits.
Aside from the portable oxygen concentrators, Veterans and their surviving spouses can apply to two programs that provide an average of 10 to 20 hours of in-home non-medical aide care per week.
The first program offers care services to Veterans of all ages who require non-medical assistance to assist them with daily activities, such as transportation, meal preparation, grooming, or bathing. That will help them to stay independent at home.
On the other hand, the second program is a VA Pension Benefit, which they call Aid and Attendance. This benefit aims to give care services to elderly Veterans and their spouses who require non-medical assistance like the one stated above. The only difference is that the second program can happen specifically in their home or chosen place of residence.
How To Save Money When Buying Portable Concentrators
While applying for medical assistance from insurance companies helps you reduce the costs of purchasing or renting a portable oxygen concentrator, there can be multiple other ways that may allow you to save tens to hundreds of dollars. These strategies are as follows:
Look for the Best Brand
The foremost thing you can consider is choosing the best brand on the market. You must check its quality and durability to ensure that the portable oxygen concentrator can last in the long run. You can do this by checking the product reviews you can find in the rating section in online stores.
Aside from that, you must also look at the specifications, such as the flow settings, weight, size, and similar characteristics. If you purchase an oxygen unit that does not suit your prescribed oxygen flow, you can experience health risks due to an incorrect setting. Hence, you may need to pay for medications and buy a new machine.
Find Reputable Retailers and Providers
You can conveniently find a product you want through the internet. You will only need to click a few times on your phone, and a portable oxygen concentrator can come right in front of your door.
However, the downside is that you can be unaware if the sellers are scammers or if the oxygen units are original. Dishonest companies may appear, so you must be careful who to transact with when purchasing a portable oxygen concentrator.
One of the most common things disreputable retailers do is that they do not require prescriptions from buyers. Since these oxygen machines need certifications or medical papers, purchasing a unit from someone who does not ask for one will most likely give you a low-grade oxygen concentrator.
Moreover, you must check if the unit is a medical oxygen machine or recreational. These things are different, so if you wrongly purchase the latter, you cannot receive adequate delivery of oxygen specified on your prescription.
If you find a company that does not provide what you need, you may become obliged to spend more to buy new ones. Furthermore, they may also harm your health because you cannot use the machine when you need it the most.
Fortunately, you do not have to look elsewhere because Sprylyfe guarantees high-quality portable oxygen concentrators. You can check our list or contact our product specialists to assist you!
Consider Used and Refurbished Units
Another tip to save money when buying portable oxygen concentrators is to look for used or refurbished units. These POCs will allow you to have your oxygen necessities by only paying a discounted cost or half the original price.
To specify these terms, used oxygen machines pertain to those already owned by another oxygen patient in the past. However, they do not mean that these units are old, worn out, and can no longer be functional for a long time. Instead, they can be slightly used or not used at all, allowing you to have them in near mint condition.
On the other hand, refurbished units have already undergone repairs and replacements. For example, their sieve beds, the special filters used to remove unwanted gas from the air, once became worn out and replaced.
Still, although these types of oxygen concentrators are secondhand, buying them from a trusted company will ensure that you can still use them efficiently in the long run.
For instance, if you buy one from Sprylyfe, we guarantee that our used and refurbished oxygen concentrators are high-quality and functional. You can purchase them with confidence at a lower price to have oxygen therapy for as low as $999!
Get One During Sales
You can look for physical or online stores that offer sales every payday, special holidays, or shop anniversaries. They can give you discounts or package deals that will allow you to spend less on portable oxygen concentrators and their necessary accessories.
If you are searching for one, Sprylyfe can also grant you up to 25% off on selected brands and products! Aside from that, we also partnered with Thrive eLearning to give the $497 Thrive ePulmonary Advanced Workshop to customers for free. You only need to purchase a brand new portable oxygen concentrator to access and enjoy these things below:
- One-on-one counseling with medical experts
- Step-by-step breathing exercises for easy breathing
- Step-by-step disease management regimen
- Best-selling guides and e-books
- Support group opportunities with patients, experts, and caretakers
- Online counseling for COPD and respiratory illness knowledge
Opt for Package Deals
Speaking of package deals, you can also purchase a portable oxygen concentrator with its necessary accessories and components, all at once. If you buy batteries, carrying cases, and charging cables separately, that will be more costly because the provider will not offer discounted prices.
In addition, buying these things altogether will have lesser shipping fees, for they will be in a single box. You can also use your portable oxygen unit with maximum ease immediately because you do not have to wait for its accessories to come on a different delivery day.
Manage Financing Options
When buying oxygen tanks, the last tip to spare yourself some money is to consider your financing options. Some insurance companies like Sprylyfe may allow you to do payment plans, while some may offer installments.
Aside from that, warranties and trustworthy assurance will save you from the expensive costs of re-purchasing units due to defective items. For instance, Sprylyfe, Inc. ensures all customers that the products and services rendered to them will satisfy their standards and necessities.
To make that possible, we offer a 30-day return and exchange policy, which allows customers to send a report to our customer service within 30 days upon receipt. If the damage is due to the shipping process, let us notify the shipping company within two days. Once you fail to contact us and the 48-hour duration exceeds, we can no longer become responsible for the conflict.
Moreover, all exchanges need a return authorization. You can contact us at 1-800-314-8225 if you have inquiries about how to create one. The good thing is that we will not require you to pay for additional shipping costs unless you want a faster shipping process.
After 30 days, we sincerely apologize for the inconvenience because you can no longer request this financing option.
FAQs About Insurance Coverage on Portable Oxygen Concentrators
How much does Medicare pay for portable oxygen concentrators?
Generally, Medicare will pay 80% of the standard costs while you will handle the remaining 20%. For instance, if you rent a portable oxygen concentrator that costs $200 per week on average, you will only pay $40, and Medicare will take care of the remaining $160 on the rental charges weekly.
How to get Medicare to pay for oxygen?
Before you can get Medicare to pay for your oxygen concentrator, you must meet such conditions, including:
- Your respiratory therapist or licensed doctor diagnosed you have a severe lung condition, impairing your oxygen levels.
- Your health will improve with the use of oxygen equipment.
- Your arterial blood gas levels decrease to a specific range.
- You have tried other medical cures, but there were no improvements.
Get Your Portable Oxygen Concentrator Covered By Insurance Today!
Oxygen therapies with portable oxygen concentrators can be a pain in the pockets. They will usually require you to spend much for the units, accessories, and oxygen contents.
Fortunately, since many insurance companies have answered "yes" to the question "are portable oxygen concentrators covered by insurance," you can receive your prescribed machine and oxygen levels for your respiratory illness.If you are looking for an equipment provider suitable for your medical insurance, you can check us out at Sprylyfe today! We can also offer other payment options to help you lower the costs. While your health is our top priority, we ensure that everything does not weigh too much on your budget.