What You Need to Know About Oxygen and Medicare
So, you've been diagnosed with a respiratory disease and your doctor says that you need supplemental oxygen in order to breathe better and stay healthy. After considering different options, you and your doctor now decide that a portable oxygen concentrator is the best piece of equipment to fit your needs. Now what?
Oxygen equipment can get pricey, so the first question you probably have is, “are portable oxygen concentrators covered by Medicare?” This is one of the most common questions we get asked, and, unfortunately, it's not an easy one to answer.
The simple answer is that, yes, it is possible to get Medicare and some insurance providers to cover part of the cost of a portable oxygen concentrator. But it's extremely unlikely to happen, and you have to know the whole story to understand why.
Why Insurance Doesn't Like to Cover Portable Oxygen Concentrators
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There are some very rare situations in which Medicare or insurance will cover the purchase or rental of a portable oxygen concentrator. However, even if they do, they don't cover the entire cost of the machine, you have to meet strict criteria to qualify, and each situation is evaluated on a case-by-case basis.
Medical insurance companies have a long reputation of finding any excuse to deny patients coverage for medical equipment and treatments. Unfortunately, Medicare is no exception. They have strict rules that make getting coverage difficult and burdensome, and they often find reasons to deny approval for a treatment even when a doctor says that it's the best option.
That's why, if you want the best possible chance of getting insurance or Medicare to pay for your equipment, you need to understand your provider's criteria. It's important to follow their guidelines meticulously, making sure you dot every “i” and cross every “t” to avoid getting rejected on a technicality.
Medicare oxygen benefits can technically be used to rent a portable oxygen concentrator, but the problem is finding a Medicare supplier that offers them. Medicare reimbursement simply doesn't pay suppliers enough every month for them to be able to afford to offer portable oxygen concentrators. Because of this, most people have narrow options for supplemental oxygen and have to choose between either liquid or gas tanks.
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Other insurance companies, on the other hand, work differently. You will need to talk to your insurance provider to understand what kinds of oxygen supplies they cover and what requirements you need to meet in order to qualify.
Additionally, Medicare and private insurance companies usually require you to prove that you need portable oxygen, specifically, before they will consider covering the cost of a portable oxygen concentrator. This can be a difficult standard to prove, and varies between different insurance providers.
It's important to understand that, even if you find a provider that offers them, you're not likely to get the brand or type of portable oxygen concentrator that you want. Suppliers that offer portable oxygen concentrator rentals usually only carry a small selection, and there's no guarantee that you'll get a high-quality model.
What is Medicare's Criteria for Covering Oxygen Equipment?
Most insurance and Medicare providers will help you pay for some kind of portable oxygen equipment if you meet a specific set of criteria. Usually, this includes a doctor's recommendation and a thorough medical report that proves that you need supplemental oxygen to stay healthy.
Here is an example of Medicare's criteria for covering supplemental oxygen and related equipment:
You have a serious lung disease (such as COPD, cystic fibrosis, bronchiectasis, etc.), or you have symptoms of low blood oxygen levels (such as pulmonary hypertension, erythrocythemia, congestive heart failure, etc.)
Your health is likely to improve with supplemental oxygen therapy
You have medical tests from your doctor to prove that you have low blood oxygen levels (and these tests were taken while your condition was stable, e.g. not during an exacerbation)
You have tried other medications and treatments, but are still unable to get enough oxygen
- You need oxygen therapy 24/7 (Medicare will not cover supplemental oxygen therapy if you only need to use it at night)
All of these criteria have to be verified by your doctor in writing before you can receive Medicare benefits for supplemental oxygen. Your doctor will also have to write and submit a detailed report of your oxygen needs, called a Certificate of Medical Necessity.
If you forget to include any required tests or paperwork, your provider will likely deny or delay your coverage. Therefore, it pays to be meticulous.
Look out for these common mistakes patients make when submitting their Medicare requests:
- Forgetting to include a detailed certificate of medical necessity written by your doctor
- Outdated test results, doctor's examinations, or certificate of medical necessity
- Missing appropriate medical tests proving low blood oxygen levels (hypoxia), such as an arterial blood gas test or oximetry test
- Missing mobility certification (to prove portable oxygen needs)
- Forgetting to include your oxygen prescription
What makes Medicare coverage even more complicated is the fact that Medicare oxygen benefits work on a 5-year cycle. This cycle begins the first time you get coverage for any supplemental oxygen supplies and starts over every five years.
The only time that Medicare will pay enough to purchase or rent new oxygen supplies is during the first three years, when they offer a higher monthly allowance. During the fourth and fifth years, however, the monthly allowance is much lower and only covers the cost of maintenance and care for the equipment you already have.
In order to even have chance at getting a portable oxygen concentrator from a Medicare supplier, you have to get the timing right. If you are already receiving oxygen tanks or other supplies through Medicare, you'll need to wait for the beginning of the next five-year cycle before any Medicare supplier will consider your request for a portable concentrator.
That's why it's important to sign up at the very beginning of the five-year cycle, that way your portable oxygen concentrator supplier can utilize the full amount of your Medicare benefits. Even then, if you do everything right, finding a supplier that offers portable concentrators near you and getting the supplies you want can be next to impossible.
The Trouble With Medicare Reimbursement: Monthly Rentals and Budget Cuts
The unfortunate truth is that, no, most Medicare and insurance providers will not help you pay for a portable oxygen concentrator. Even if your provider agrees to pay for your supplemental oxygen supplies, they will usually only offer enough to cover “cheaper” options like portable liquid or gas oxygen tanks.
These portable tanks are usually cheaper than portable oxygen concentrators in the short run, because the monthly fee to rent the tanks and equipment is relatively small. Most insurance and Medicare providers pay just enough to cover this monthly cost.
Unfortunately, what Medicare offers is usually just not enough on its own for suppliers to afford to give patients portable oxygen concentrators. Medicare pays for all oxygen supplies through a set monthly allowance, which, most of the time, is much too little for such a high-tech device. Because of this, most Medicare oxygen suppliers don't offer portable oxygen concentrators at all.
Even if both you and your doctor think that you need a portable concentrator, Medicare is only required to provide you with a supplemental oxygen supply that's adequate, not the oxygen supply that's right for you. Since that requirement can be satisfied with liquid and gas oxygen tanks, that's often the only Medicare-covered option available.
This is unfortunate, especially because renting oxygen tanks can end up costing more in the long run. The price of renting tanks month after month can quickly add up and be even more expensive than the one-time cost of purchasing a portable oxygen concentrator.
Unfortunately, Medicare and insurance providers tend to think more about short-term costs than long-term ones, and would rather collect the monthly payments for years than pay off a portable oxygen concentrator all at once. Even if you managed to find a provider that offers portable concentrators, the likelihood of getting the brand and model you want is slim to none.
Medicare reimbursement has gotten even worse since it started using the competitive bidding process as a cost-saving strategy. Competitive bidding means that Medicare licenses are only given out to medical equipment suppliers that offer lowest prices.
This results in Medicare offering even less money to pay for oxygen supplies, making it even more impossible for Medicare suppliers to afford to offer portable oxygen concentrators to patients.
But don't be disheartened! Even if your insurance or Medicare won't help you pay for a portable oxygen concentrator, there are other affordable options. Here at Life PT Medical, you can get discounted equipment and financing so you can afford a portable oxygen concentrator without dealing with insurance or Medicare at all.
Solution #1: We Can Offer You the Cheapest Portable Oxygen Concentrators
It's tragic that most medical insurance providers won't meet their patients' needs and help them get the medical equipment that's right for them and their lifestyle. That's why we've made it our mission to offer portable oxygen concentrators at the lowest possible price, so you can afford to get the oxygen delivery system that's best for you.
The way we do it is by buying large quantities of wholesale portable oxygen concentrators in bulk so we can get the best prices on the equipment and keep our own costs low. That way, we can pass the discount on to you and offer portable oxygen concentrators at extremely low prices that you won't find anywhere else.
Our portable concentrators are so inexpensive that the manufacturers we buy from won't allow us to advertise our best prices on our website. You'll need to download our portable oxygen concentrator price list to see our lowest prices.
At LPT Medical we offer much more than just the lowest-priced portable concentrators around. We also offer monthly financing to make our equipment even more affordable and have a selection of like-new, used portable oxygen concentrators at an even further discounted price.
Solution #2: We Offer the Best Quality Second-Hand Portable Oxygen Concentrators
Even if you can't afford the cost of brand new equipment, you can get an even greater discount on one of our second-hand portable oxygen concentrators. We offer a good selection of lightly-used and refurbished portable concentrators that are thoroughly tested and reconditioned, so they're basically like new!
Our inventory of like-new portable oxygen concentrators is always changing, so make sure to check back with us often to see what we have in stock. And know that all of our machines are thoroughly inspected tuned up before going up for sale, so you always know you're getting the best quality.
Solution #3: We Offer Low Monthly Payments to Help You Finance Your Portable Oxygen Concentrator
We understand that many people don't have the money to pay for such an expensive piece of medical equipment out of pocket right away. That's why we offer monthly financing options to help you manage the cost and get the portable oxygen concentrator you want.
With our monthly financing program, you can afford the equipment you need now and pay back the cost over time in small monthly installments. That way, you can start benefiting from the comfort of a new portable oxygen concentrator right away.
The best part about our low monthly payments is that they allow you to get the exact brand and model of portable oxygen concentrator that you need without having to drain your savings or go through the insurance run-around. And once you've made your last payment, the oxygen concentrator completely belongs to you!
Solution #4: We Can Assist You in Getting Your POC Covered by Medicare
It's been a long time coming, but we are finally able to offer our patients assistance when it comes to covering the expenses of a portable oxygen concentrator through Medicare. We are one of the only online oxygen concentrator companies to be able to offer this service and we are delighted because it means we are able to get these units into the hands of more people who need them.
Typically, when you buy a portable oxygen concentrator, you're given a reimbursement code. You can then use this code to file a claim with Medicare or your private insurance company. The problem with this is that you are given virtually no assistance or instruction on how to actually file and win a claim with your insurance company.
With our new program, however, our respiratory specialists will work one on one with you and Medicare to help you get the reimbursement that you deserve! At the end of the day, this means you have one less thing to worry about. Medicare jargon can be confusing, but when you work with our team, you won't need to waste any time learning about it only to be disappointed that Medicare doesn't give you the answer you expected or wanted. Simply hand the work off to us and we'll gladly take care of it!
Consider Your Options for a New Portable Oxygen Concentrator Today!
There are many ways you can benefit from using a portable oxygen concentrator instead of a multitude of heavy, cumbersome tanks. Using a portable oxygen concentrator can improve your mobility, allow you to travel, and can make a huge difference in your comfort and quality of life.
That's why it's important to us to help more people like you get the best portable oxygen concentrators at a reasonable, affordable cost. Because of our low prices and financing options, more people than ever before are able to afford and experience the benefits of using a portable oxygen concentrator.
Contact us today or call 1-800-946-1201 to get more information on our products and financing options. We can help you find the best option and experience the life-changing freedom of using a portable oxygen concentrator.