A portable oxygen concentrator (POC) is a battery-operated medical device designed to provide highly concentrated oxygen therapy on the go. POCs draw in ambient air, filter out nitrogen, and deliver concentrated oxygen to the user through a nasal cannula. Because POCs are small, lightweight, and often FAA-approved for air travel, they significantly enhance the quality of life for individuals with chronic respiratory conditions like COPD. New portable concentrators are expensive, typically costing between $1,500 and $4,000, while even refurbished units can range from $800 to $2,000. Securing this necessary equipment without personal expense is a significant financial hurdle for many patients, requiring navigation of complex insurance rules, strict medical documentation, and charitable resources.
Maximizing Insurance and Government Coverage
The primary avenue for obtaining a Portable Oxygen Concentrator is through your existing health insurance, which classifies the device as Durable Medical Equipment (DME). Medicare Part B covers DME and structures coverage almost always as a rental, not an outright purchase. Under Medicare, the equipment is typically rented from an approved supplier for a 36-month period.
During this 36-month rental period, Medicare Part B generally covers 80% of the approved cost after the annual deductible is met. The patient is responsible for the remaining 20% coinsurance, which may be covered by a supplemental insurance plan, such as Medigap or a Medicare Advantage plan, potentially resulting in zero out-of-pocket costs. After the 36-month period, the supplier must continue to provide the equipment, maintenance, and accessories for the remainder of the equipment’s five-year useful life at no further charge to the patient.
A significant distinction exists between covering oxygen therapy in general and covering a portable unit specifically. Medicare generally covers the oxygen therapy itself, but obtaining a POC requires proving medical necessity for mobility outside the home, in addition to the need for a stationary unit. Coverage for a portable unit is not automatic just because it is more convenient; it requires specific documentation that the patient requires oxygen during ambulation or exertion.
Private insurance and Medicaid coverage for POCs vary widely, but they generally follow Medicare’s strict guidelines for medical necessity. Many private plans include DME riders, but require prior authorization from the insurer before the equipment can be delivered. State-run Medicaid programs have their own rules, with some covering up to 100% of the cost if the equipment is deemed medically necessary and falls within the state’s DME definition. If coverage for a portable unit is denied, patients have the right to appeal the decision by submitting detailed medical evidence to challenge the initial ruling.
Securing Assistance Through Non-Profit Organizations
When insurance coverage is insufficient or a denial appeal fails, non-profit organizations offer an alternative pathway to secure a portable oxygen concentrator. Disease-specific foundations often run charitable programs to help patients obtain necessary respiratory equipment. National organizations like the COPD Foundation and the American Lung Association provide resources, direct financial assistance, or referrals for equipment lending programs.
These assistance programs may offer certified refurbished units, professionally checked and restored to safe operating condition. Other charitable entities, such as the HealthWell Foundation, offer grants that can help underinsured individuals cover out-of-pocket expenses, copayments, or even the full cost of medical equipment like POCs. Patients can also check with their local Area Agency on Aging or community health clinics, which may maintain equipment lending closets or have connections with medical suppliers who offer discounted devices.
State-level assistive technology programs are another resource, providing devices to people with disabilities, which can sometimes include oxygen concentrators. While not common for direct equipment donation, some POC manufacturers or equipment suppliers offer patient assistance programs to reduce the financial burden, particularly for those with limited income. Exploring these organizational options requires proactive outreach and often involves a separate application process to demonstrate financial need and medical necessity.
Essential Documentation and Qualification Requirements
The process always begins with a foundational medical requirement: a physician’s prescription, regardless of the funding source (Medicare, private insurance, or charitable organization). This prescription must be based on a face-to-face visit with the prescribing physician within a specified timeframe, typically 30 days prior to the initial certification. The physician must document that alternative treatments, such as medications or inhalers, have been tried or considered and were deemed clinically ineffective.
The most specific documentation required is proof of hypoxemia. This proof is established through a qualifying blood gas study, such as an Arterial Blood Gas (ABG) test, or pulse oximetry readings (SpO2 levels). To qualify for continuous oxygen, a patient must demonstrate an oxygen saturation level consistently at or below 88% while at rest, during sleep, or during exercise.
For a portable unit specifically, the medical record must also indicate that the patient is mobile within the home and requires oxygen support during ambulation. The physician must complete a Certificate of Medical Necessity (CMN), a form that formally attests to the diagnosis, the need for oxygen, the prescribed flow rate in liters per minute, and the frequency of use. Since a patient’s condition can change, this documentation must be current, and Medicare requires periodic re-testing and recertification by the physician to maintain coverage.