Will Medicare Pay For A Portable Oxygen Concentrator?
Posted by Portable Oxygen Solutions on 18th Feb 2014
Customers often come to us here at Portable Oxygen Solutions and ask us the question; Will Medicare pay for a portable oxygen concentrator? Ah yes, a very good question indeed and an important one too for anyone looking to purchase a portable oxygen concentrator. Because we get this question so much, today we decided to write an article explaining to you why it is highly unlikely or difficult, at best, to get a portable oxygen concentrator through Medicare or any other insurance funding channel. If you have found our company and reading this article, then you are probably already discovering how difficult it is to find a Medicare equipment company that carries portable oxygen concentrators, much less, the model best for you and your lifestyle. You may be frustrated from being told “NO”. We can help! But first, lets look at why it is next to impossible to get a portable concentrator through Medicare.
Will Medicare help pay for a portable oxygen concentrator? Unfortunately, the answer isn’t a simple yes or no. Medicare has always paid a certain amount for oxygen. Over recent years, that amount has continued to be reduced. The latest reduction in how much Medicare would pay for portable oxygen concentrators was almost 50%. Due to this recent Medicare reduction in payment is why we hear so many oxygen users say their respiratory equipment supplier told them Medicare does not cover portable oxygen concentrators (POC). The truth is these respiratory suppliers can’t afford to provide you a portable oxygen concentrator costing thousands of dollars when they can get by setting you up with oxygen tanks costing a few hundred dollars. If you qualify, Medicare and other insurances do have the new reduced rental fee for Portable Oxygen Concentrators, which means they can pay a certain amount to the equipment companies for this technology. However, the respiratory equipment suppliers are not convinced Medicare pays enough for them to see a return on their investment and they are not required by Medicare to give you a portable oxygen concentrator. They are only required to supply equipment that maintains your oxygen needs.
Understanding How Medicare Pays
Whether you have a home oxygen concentrator, liquid oxygen, tanks, or a portable oxygen concentrator, all of this equipment is considered a rental item in the eyes of Medicare and the equipment company. An equipment company provides the oxygen equipment to you, then they bill Medicare a monthly fixed rental fee. Oxygen equipment is limited to a 36-month rental period. Due to the reimbursement guidelines, respiratory suppliers who bill Medicare tend to be cautious and very selective with what types of oxygen equipment they provide to you. Once you qualify for supplemental oxygen, Medicare will begin paying the respiratory supplier the monthly rental fee for 36 months (3 years), and then just a small “service fee” for the following 24 months. Medicare respiratory suppliers that provide oxygen to you are required to maintain the equipment for a total of 60 months (5 years).
Given these circumstances, the medical equipment companies will first consider how long you have been on oxygen to determine how many months are left within your 36 month rental period. They are not likely to supply a portable oxygen concentrator to you if you are not at the beginning of your 36 month rental period, especially if you are wanting to move from another equipment provider. As an example, if you have been on oxygen for 12 months and you want to move to another respiratory supplier in hopes of getting a portable oxygen concentrator, the new supplier would only receive 24 months of rental payments before moving into the “maintenance fee only” months. So there is very little financial incentive to accept you as a new oxygen patient and provide you with a Portable Oxygen Concentrator. Why?…Because the cost of the Portable Oxygen Concentrator exceeds the amount Medicare will reimburse the equipment company. With this said, best case scenario is that the equipment company will only consider newly diagnosed oxygen patients at the beginning of their 3 year rental period or those patients who have been on oxygen for 5 years and Medicare has ruled the patient can start over with a new 36-month payment period and a new 5-year obligation period. Note: Medicare considers the useful life of oxygen equipment to be 5 years, therefore, at the end of the 5 year useful life period, the equipment company can start the rental process over again. This also requires the equipment company to replace the old respiratory equipment with new equipment. At this point is where you will have your best chance in obtaining a portable oxygen concentrator from your Medicare respiratory supplier. As you can see, there is so many variables that have a negative impact on getting a portable oxygen concentrator. This is why many of the equipment companies are choosing to NOT carry portable concentrators. They simply do not see a return on their investment and it is too difficult for them to de
To frustrate you even more, Medicare just made things a lot tougher by implementing their National Competitive Bidding (NCB) process for medical equipment supply companies in most areas of the country. Companies with the lowest bid were those awarded Medicare contracts. This means the Medicare rental fee that is reimbursed to equipment suppliers has been reduced even more! You also have less oxygen suppliers to choose from because bidders who were not among the lowest priced are excluded from the market and not allowed to serve new oxygen patients. So there continues to be less and less financial motivation for oxygen equipment supply companies to set you up with a portable oxygen concentrator.
Portable Oxygen Solutions has chosen not to bill Medicare or Private Insurance so we do not have these restrictions.
Now, more and more oxygen patients are taking charge of their own lives and taking control of their own healthcare! How?…By purchasing their own equipment. The benefits of portable oxygen concentrators are far greater than the cost of the machines. There is a world of possibilities with portable oxygen concentrators that are as active as you are.
Don’t let your oxygen prescription change your life! A portable oxygen concentrator will allow you to continue to work, travel, play sports, participate in hobbies, socialize and maintain your independent lifestyle while finding it easier to comply with your oxygen therapy.
The Right Oxygen Equipment Can Be As Important As The Oxygen, Itself!! Stay Active. Live Well.
Please give us a call. We will take the necessary time to understand your medical needs and your lifestyle needs and advise accordingly.
Call us toll free at 1-800-958-0192.