Are Oxygen Concentrators Covered by Insurance? (Complete Guide 2025)
Apr 06

Are Oxygen Concentrators Covered by Insurance? (Complete Guide 2025)

Apr 06

As healthcare evolves, the critical question for many in 2025 is: "Are oxygen concentrators covered by insurance?" In most situations, the answer is yes—provided certain medical and documentation criteria are met. This comprehensive guide outlines how to navigate insurance policies, expectations, and effectively secure coverage for oxygen concentrators.

Understanding Oxygen Concentrators

What is an Oxygen Concentrator?

An oxygen concentrator is a medical device that extracts oxygen from ambient air, delivering high-concentration oxygen therapy crucial for treating respiratory conditions.

Who Needs an Oxygen Concentrator in 2025?

Individuals diagnosed with:

  • COPD

  • Pulmonary fibrosis

  • Heart disease

  • Severe asthma

  • Long-term COVID-19 and RSV complications

Types of Oxygen Concentrators

  • Home-based Units: Stationary, powerful units ideal for home use.

  • Portable Oxygen Concentrators (POCs): Compact, battery-powered, suitable for active lifestyles and traveling.

Medical Necessity & Documentation Requirements in 2025

Doctor’s Role in Approval

Healthcare providers must:

  • Conduct appropriate oxygen level testing (blood gas or pulse oximetry)

  • Diagnose respiratory conditions

  • Issue an oxygen therapy prescription

Required Documentation

Insurers typically require:

  • Certificate of Medical Necessity (CMN)

  • Recent ABG or pulse oximetry results

  • Proof oxygen therapy is essential to treatment

Insurance Coverage in 2025

Medicare Part B

Medicare covers oxygen concentrators as Durable Medical Equipment (DME), primarily via rentals. Coverage typically includes:

  • 80% of approved rental costs (after deductible)

  • Coverage for up to 36 months, plus maintenance thereafter

Eligibility typically requires oxygen saturation below 88% or demonstrated improvement with supplemental oxygen.

Medicaid

Medicaid coverage varies by state but generally includes oxygen concentrators for medically qualified individuals. Verify specifics with your local Medicaid office.

Private Insurance

Insurers like Cigna, Humana, Kaiser Permanente, and Aetna have broadened their coverage, offering:

  • Rental and purchase options

  • Extensive lists of approved concentrators

  • Improved portability and advanced models

Always confirm provider networks and pre-authorization requirements.

Approval Process in 2025

Steps to Obtain Coverage

  1. Visit your pulmonologist or primary care provider.

  2. Complete a certified oxygen evaluation (in-person or via telehealth).

  3. Submit test results and CMN to your insurer.

  4. Select an approved DME supplier.

  5. Regularly follow-up to maintain coverage compliance.

Claim Filing Tips

  • Utilize digital portals for efficient document submission.

  • Maintain detailed records of all communications and claims.

  • Address documentation requests promptly to avoid delays.

Handling Insurance Denials

Common Reasons for Denials

  • Missing pre-authorization

  • Oxygen levels above coverage criteria

  • Non-approved DME providers or device models

Backup Solutions

  • Resubmit corrected documentation

  • Explore state health assistance programs

  • Contact support organizations (Oxygen for Life, American Lung Association)

  • Manufacturer financing plans

Rental vs. Purchase (2025)

Option Average Cost Insurance Preference
Rental $150–$300/month Preferred (Medicare, many private plans)
Purchase $2,000–$4,500 Possible (some private insurers, Medicaid)

Out-of-Pocket Costs in 2025

  • Medicare: Typically 20% coinsurance after deductible.

  • Private Plans: 5–30% depending on policy details.

  • No Insurance: Full cost unless discounts apply.

Financial Assistance Programs (2025)

National Assistance Programs

  • Veterans Affairs (VA)

  • State senior health initiatives

  • Disability-focused grants

Non-Profit Organizations

  • COPD Foundation

  • Breathe California

  • HealthWell Foundation

Traveling with an Oxygen Concentrator

International Travel

Confirm with travel health insurers regarding emergency oxygen coverage.

Airline Tips

  • Notify airlines 48–72 hours before flights

  • Ensure concentrator is FAA-approved

  • Carry backup batteries

Key Questions to Ask Insurance Providers

  • Is this model covered?

  • Can I use online DME suppliers?

  • What are rental vs. purchase terms?

  • Are portable models covered?

  • Will I need annual renewals?

Choosing the Right Oxygen Concentrator

Consider:

  • Battery life (8–12 hrs preferred)

  • FAA approval for travel

  • Flow settings adaptability

  • Low noise levels (under 45 dB)

FAQs (2025)

  1. Are portable oxygen concentrators fully covered by Medicare? Typically rented, not purchased outright.

  2. Can coverage be obtained without an in-person visit? Yes, telehealth is often accepted.

  3. Is annual renewal of CMN necessary? Usually yes.

  4. What if my doctor isn't in-network? Check costs; consider switching providers if needed.

  5. Does Medicaid cover pediatric oxygen concentrators? Yes, with medical necessity.

  6. Are advanced POCs covered? Coverage varies by insurer and medical justification.

Conclusion: Securing Your Coverage in 2025

With evolving policies and improved technology, obtaining insurance coverage for oxygen concentrators has become more accessible. Plan proactively, ask critical questions, and ensure timely documentation. By following these guidelines, you can secure the necessary equipment without financial strain and significantly improve your quality of life.