Learn About Lincare and Medicare Coverage Options

Understanding Lincare and Its Role in Respiratory Care

Lincare is one of the largest home respiratory equipment and oxygen suppliers in the United States. The company provides medical equipment and supplies to patients who need respiratory support at home, including oxygen concentrators, continuous positive airway pressure (CPAP) machines, nebulizers, and related accessories. Founded in 1978, Lincare operates in all 50 states and serves millions of patients annually through a network of local branches and delivery centers.

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When a doctor prescribes respiratory equipment for home use, patients often receive their supplies through a durable medical equipment (DME) supplier like Lincare. The company handles equipment delivery, setup, maintenance, and ongoing support. Lincare works with various insurance plans, including Medicare, to help process payment for these services and products. Understanding how Lincare operates within the healthcare system can help you know what to expect when you receive respiratory equipment at home.

Lincare's services include oxygen delivery and refills, equipment rental and purchase options, equipment training and setup, maintenance and repair services, and 24/7 customer support for equipment issues. The company also manages insurance billing and works directly with Medicare to coordinate coverage. Many patients interact with Lincare not by choosing the company directly, but because their doctor's office has a relationship with Lincare or because Medicare directs them to a preferred supplier in their area.

Lincare generates revenue through equipment rentals, product sales, and insurance reimbursement. For Medicare beneficiaries, Lincare may bill Medicare directly for covered items, which means patients may have lower out-of-pocket costs depending on their coverage situation. However, the company also serves patients with private insurance, Medicaid, Veterans Affairs coverage, and cash-pay patients. This multi-payer model means Lincare's billing and coverage processes can vary significantly based on your specific insurance situation.

Practical Takeaway: Lincare is a major supplier of home respiratory equipment that works with Medicare and other insurance plans. When your doctor prescribes home oxygen or respiratory equipment, you may receive it through Lincare. Knowing this company's role helps you understand the equipment delivery and billing process.

How Medicare Covers Respiratory Equipment and Supplies

Medicare Part B covers durable medical equipment (DME), which includes many respiratory devices and supplies. DME is defined as equipment that can withstand repeated use, is medically necessary, and is primarily used to serve a medical purpose. For respiratory care, this typically includes oxygen concentrators, portable oxygen tanks, CPAP machines, BiPAP machines, nebulizers, and related supplies like tubing and filters.

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Medicare's coverage of DME involves specific rules about payment amounts, rental versus purchase decisions, and supplier requirements. For oxygen equipment, Medicare typically covers the equipment itself, delivery, setup, maintenance, and supplies. The specific coverage amount depends on whether the item is rented or purchased. For rental items, Medicare pays a monthly rental fee. For purchased items, Medicare pays a single purchase amount. Some items have a "capped rental" period, meaning Medicare will pay rental fees for a certain number of months, after which the patient owns the equipment.

To receive Medicare coverage for respiratory equipment, several conditions must be met. A doctor must order the equipment and document medical necessity. The patient must be enrolled in Medicare Part B. The supplier must be a Medicare-enrolled DME supplier. The equipment must be on Medicare's list of covered items. The supplier must submit the claim to Medicare with proper documentation. This process can take several weeks, and during that time, patients may need to pay out of pocket or wait for equipment delivery.

Medicare Part B beneficiaries typically pay 20 percent of the approved amount for DME after meeting the annual Part B deductible (which was $240 in 2024). This means if Medicare approves $100 per month for oxygen rental, a patient would pay $20 per month. However, if a patient has supplemental insurance (Medigap), that policy may cover some or all of this 20 percent cost-sharing. Patients with both Medicare and Medicaid may have different out-of-pocket costs depending on their state's Medicaid program.

Practical Takeaway: Medicare Part B covers many respiratory devices and supplies, but you'll typically pay 20 percent of the approved amount after your annual deductible. A doctor's order, Medicare enrollment, and a Medicare-approved supplier are all required for coverage to work.

Medicare Advantage Plans and DME Coverage Differences

Medicare Advantage plans (Medicare Part C) offer an alternative way to receive Medicare benefits. These plans are offered by private insurance companies approved by Medicare and must cover all services that Original Medicare covers, including DME. However, the specific rules about how DME is covered can differ significantly from Original Medicare. Understanding these differences is important if you have a Medicare Advantage plan and need respiratory equipment from a company like Lincare.

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One major difference is that Medicare Advantage plans may have preferred supplier networks. This means the plan may have contracts with specific DME suppliers in your area, and you may receive better coverage or lower costs if you use those preferred suppliers. If you use an out-of-network supplier, you might pay more out of pocket or face coverage denials. When you need respiratory equipment, it's important to contact your Medicare Advantage plan to find out which suppliers are in-network. In some cases, Lincare may be an in-network supplier, while in other areas or plans, different companies may be preferred.

Medicare Advantage plans also set their own cost-sharing amounts for DME. Some plans charge a flat copay per item (for example, $50 for an oxygen concentrator). Others charge a percentage of the cost, similar to Original Medicare. Some plans cover all DME with no cost-sharing, while others have higher out-of-pocket costs than Original Medicare. Additionally, Medicare Advantage plans may have prior authorization requirements, meaning your doctor must get approval from the plan before the supplier can deliver equipment. This can add delays to the process.

Another consideration is that Medicare Advantage plans may have different rules about rental versus purchase. Some plans automatically move beneficiaries to purchase after a certain rental period, while others allow indefinite rental. Some plans charge different copays for rentals versus purchases. These variations mean that two patients in different Medicare Advantage plans might pay completely different amounts for the same oxygen concentrator from the same supplier like Lincare.

Practical Takeaway: If you have a Medicare Advantage plan, check with your plan about which respiratory equipment suppliers are in-network and what your cost-sharing will be. These details vary by plan and can significantly affect your costs.

Supplemental Insurance (Medigap) and Its Effect on DME Costs

Medigap (supplemental insurance) policies are sold by private insurance companies to help pay costs that Original Medicare doesn't cover, such as deductibles, copayments, and coinsurance. For patients receiving respiratory equipment through Original Medicare and a company like Lincare, Medigap can substantially reduce out-of-pocket costs. However, it's important to understand which Medigap policies cover DME costs and how much they actually pay.

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All standardized Medigap plans (labeled A through N) cover the 20 percent coinsurance that Medicare patients owe for DME after meeting the Part B deductible. This means if you have a Medigap policy, the insurance company typically pays that 20 percent portion. Some Medigap plans go further and also cover the Part B deductible itself, which means you would have almost no out-of-pocket cost for DME. Medigap plans F and G are particularly comprehensive for cost-sharing coverage, though Plan F is no longer available to people who became Medicare-eligible after December 31, 2019.

The amount Medigap covers depends on the specific plan you purchased. For example, a Medigap Plan N covers the 20 percent coinsurance for DME but requires you to pay the Part B deductible and may have copays for certain services. A Medigap Plan G covers the 20 percent coinsurance and the Part B deductible, leaving you with minimal costs for DME. When you work with a supplier like Lincare, you should provide both your Medicare information and your Medigap information so the supplier can bill both insurances correctly and understand your final out-of-pocket amount.

One important note: Medigap coverage is individual and depends on the policy you purchased. You should review your specific policy documents or contact your Medigap insurance company to confirm what