Does Medicaid Cover Portable Oxygen Concentrators [Get The Facts]

If you have COPD or Chronic Obstructive Pulmonary Disease, you may require aid with performing regular living tasks and additional oxygen supply.

Classic and bulky Oxygen Tanks have been replaced by smaller concentrators throughout the years, but because they are still considered a “luxury” item, many individuals ask if Medicaid would fund it.

If you’re worried about the same thing, keep reading because we’ve got all the surprising facts you need to know.

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What does Medicaid cover? 

Medicaid is a government program in the United States that was established to assist families and people in need of medical attention who are frequently below the poverty line or have low earnings.

Because Medicaid is funded in part by the federal government and in part by states, each state has its own set of rules and restrictions for recipients. This is one of the reasons why determining who is covered and for what treatments can be challenging.

In general, Medicaid covers the following:

  • Regular doctor’s visits;
  • Specialist if needed;
  • Therapies
  • Laboratory
  • X-ray
  • Nursing home
  • Dental services

Is this, however, inclusive of some of the equipment that patients use during their illness and recovery? Continue reading to learn more.

What Is Considered Durable Medical Equipment?

Durable Medical Equipment, or DME, is a term used by several medical insurance companies, including Medicaid. This word refers to the tools and accessories that patients require in order to fight sickness, keep comfortable, and safe while recovering and that can be used multiple times.

It can include a variety of things like:

  • Wheelchairs;
  • Hospital beds;
  • Canes and crutches;
  • Walkers;
  • Kidney machines;
  • Ventilators;
  • Bili blankets and lights;
  • Lifts;
  • Bathroom equipment;

The oxygen tank and concentrator are usually on this list since they are medically important for some patients. But does this imply that every patient is entitled to a free oxygen concentrator? Stay tuned for more information in the fine print.

Does Medicaid Cover Oxygen Concentrators?

Yes, in certain states and under certain conditions, Medicaid will cover the cost of renting and maintaining an oxygen concentrator.

Because the rules and regulations in each state change, you may become confused about your rights and what may be provided for you. This is sensible, and the best approach to ensure that you have coverage is to contact your local Medicaid organization and ask all of the pertinent questions.

In general, oxygen concentrators are classified as DME, or Durable Medical Equipment, because they are required for patients who have some form of lung deficiency.

However, there are a few factors to bear in mind:

  • To begin with, this type of equipment is often highly expensive, and you must get a specific prescription from your doctor in order to be qualified for one.
  • If you require an oxygen support device, you may have to settle with less costly models, such as oxygen tanks, because they are more likely to be covered by the program.

So, depending on your sickness, doctor’s evaluation, and state of residence, you may be qualified for a portable oxygen concentrator. However, in most circumstances, this piece of equipment will be rented, and many Medicaid beneficiaries will have access to the least costly version.

What types of oxygen assistance devices does Medicaid cover?

While there are several types of oxygen support devices on the market, Medicaid prefers some of them even if they are not the most comfortable for the user. In general, you may expect to receive the standard oxygen tank while being completely covered by Medicaid (if your state allows this coverage).

If you want to be more mobile and comfortable, Oxygen Concentrators are a good option because they are compact enough to fit in your backpack. However, they are more expensive and considered a “luxury” item in medicine, therefore Medicaid may refuse to cover entire costs.

This means you should call your health insurance provider or a Medicaid representative to learn more about your alternatives.

What else is covered by Medicaid?

Aside from the equipment or the oxygen concentrator, you will be covered for a few other things, such as:

  • Servicing;
  • Oxygen contents;
  • Tubing or the mouthpiece;
  • Oxygen machine maintenance and repair.

All of this assumes that your Medicaid will fund the rental of an oxygen concentrator or equivalent device. In very rare situations, people with dual Medicaid and Medicare coverage may be entitled to purchase the equipment.

Again, this is subject to local rules and restrictions, so you must verify online and contact the reps for additional information.

Children, pregnant women, and the elderly are always regarded as the most vulnerable members of society, and they are usually covered for all expenditures.

How to find an Oxygen Concentrator covered by Medicaid?

Finding a vendor willing to take Medicaid and purchasing or renting an oxygen concentrator are best left to your Medicaid help agents. 

You will be required to provide the following documentation:

  • A chest exam to establish that you have significant lung illness and difficulty breathing;
  • A doctor’s order proving that you require certain devices to preserve your health, containing your diagnosis, name, and other information;
  • Analyses demonstrating that your arterial blood gas levels are below normal;
  • Confirmation that other options are not suitable for you;

Once you have all of the necessary papers, you may work with your Medicaid reps to obtain the necessary equipment.

What is the price of a portable Oxygen Concentrator?

Oxygen concentrators range in price from $1.400 to $3,500, depending on the kind and manufacturer. As you can see, this is not the most economical choice on the market, which is why Medicaid will pay the leasing fee.

If your state does not allow Medicaid to pay the entire cost, you may still be eligible for a price reduction, so make sure to ask all manufacturers and your health insurance carrier for further information.

Do I need a prescription for a portable oxygen concentrator?

Yes, your doctor must make a specific recommendation and issue a prescription stating that you require an oxygen concentrator. This is especially true if you need to be mobile, on the go, or have another issue that necessitates a transportable oxygen source, as opposed to large oxygen tanks.

The prescription will also mention the type of treatment you need, like:

  • How many liters per minute (LPM);
  • Is it a continuous or
  • Pulse dose device and other details

Final Thoughts

Medicaid is a fantastic opportunity for adults and families in need who have a lung deficiency or other medical issues. It is intended to assist you with the price of the treatments as well as other expenses.

Keep in mind that you must contact your Medicaid provider or your health insurance carrier for more information. This will guarantee that the oxygen concentrator is rented most comfortably and cost-effectively possible.

David Duford
Author: David Duford