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By Christopher M. Worsham and Peter A. Kahn Oct. 19, 2021

S ome Americans working from home during the pandemic noticed sizable increases in their monthly electric bills from increased energy use. But for patients like ours with advanced lung disease — and those living with other chronic conditions — who depend on medical equipment, large electric bills represent a monthly cost to simply stay alive.

Many people who require long-term extra oxygen at home use what is called an oxygen concentrator. These devices extract and concentrate oxygen from the air and deliver it through tubing connected to the nose. Concentrators can use more electricity than a refrigerator, and the cost for the extra electricity can add up quickly.

In a study published Tuesday in JAMA Network Open, we and our colleague Gretchen Berland estimated that using a concentrator can cost hundreds of dollars a year for extra electricity: Operating a typical device for a year costs $322 in an average state, ranging from $252 in Louisiana to $853 in Hawaii. For individuals living on fixed incomes, these additional costs can represent substantial financial hardships.

Oxygen concentrators are just one example life-supporting medical devices. People with other severe chronic conditions may require machinery like a ventilator to help them breathe, a pump to assist a failing heart or take over its work, or a dialysis machine to filter the blood.

Insurers may cover the cost of these devices, but they don’t cover the electricity needed to operate them. On top of the costs of running the device, patients may also incur significant expenses when hiring an electrician to safely wire the home for their use.

Some people who need extra electricity to manage chronic illnesses have limited options to defray these costs. Utilities may provide discounted electricity rates, but this is not universal, and applying for these benefits can be difficult, especially for people who are disabled or elderly. States like California have medical baseline rate statutes to keep bills lower for them, and many states offer varied protections against service cutoffs for non-payment — provided patients or their doctors have filled out the right paperwork, at the right time, for the right condition.

While these protections are important, they are neither universal nor sufficient to fully shield people from excessive electricity bills, one of the many uncovered costs to people living with chronic illnesses. More steps should be taken to ensure that people don’t spend what little money they may have on electricity just to stay alive. At a minimum, health insurers and/or utilities should relieve patients of this additional financial burden.

Insurers could cover the costs of running equipment, just as they provide other supplies necessary to operate medical equipment in the home, like replacement parts, fluids, tubes, or batteries. Users could either be reimbursed or provided a stipend, or insurers could pay the utility companies directly.

Another option is for utilities to subsidize energy costs for various medical devices in the home. Wireless data transmission from medical devices (either over Wi-Fi or mobile networks) is now commonplace for home medical devices such as pacemakers or CPAP machines that transmit data to doctors and patients alike. Using similar technology, there are ample opportunities for utilities to assist and protect patients with life-supporting electrical devices. With patient consent, a utility could be automatically notified of a medical device in the home. Data on device use could be used to calculate the cost of operating it, and those costs could be removed from the electric bill. Energy companies would know exactly which types of devices were located in what homes, helping both utilities and patients understand electricity-related health risks, plan for maintenance and upgrades of the electrical grid, and triage and respond to unplanned power outages.

People using life-supporting devices at home are likely saving the larger health care system thousands of dollars by avoiding institutionalized care — potentially while living on modest, fixed incomes. While it’s easy to dismiss electricity costs to operate life-supporting equipment, they can be substantial. It’s time to take steps to better protect vulnerable patients — and their finances.

Christopher M. Worsham is a pulmonologist and critical care physician at Massachusetts General Hospital and a researcher at Harvard Medical School in Boston. Peter A. Kahn is a pulmonologist, critical care physician, and researcher at Yale School of Medicine in New Haven, Conn.

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