Does Medicare Cover Nebulizers?
Key Takeaways
- Your doctor or medical provider may prescribe a nebulizer device when medically necessary for respiratory conditions such as asthma and COPD.
- Both Original Medicare and Medicare Advantage plans cover nebulizer devices.
- Medicare Part B covers nebulizers as durable medical equipment (DME). In specific situations, Part A or Part D (if you are enrolled) may cover costs associated with a nebulizer.
- Like all covered DME, Medicare will pay for most of the cost, but you will still pay a portion.
Nebulizers are an essential piece of medical equipment for people with chronic respiratory conditions, such as asthma, COPD, and cystic fibrosis. Nebulizers may also treat acute conditions like respiratory infections that cause wheezing and bronchitis.
If your doctor says you need a nebulizer, it can be covered by Original Medicare, the public health insurance program for U.S. adults who are at least 65 or have certain disabilities. Medicare Part B, which is medical insurance, covers a nebulizer as durable medical equipment (DME). Medicare Part A, which is hospital insurance, can cover the costs if you receive inpatient nebulizer therapy.
If you’ve enrolled in a Medicare Advantage plan from a private insurance carrier, it substitutes for Parts A and B. Your plan must at least match the coverage you would get from Original Medicare and may offer additional benefits.
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How Do I Get a Nebulizer?
A nebulizer is durable medical equipment (DME) that a person with asthma, COPD, or another respiratory condition can use to administer medication quickly and quickly to the lungs. A nebulizer turns liquid medicine into a very fine mist that you can inhale through a face mask or mouthpiece. Taking medication this way allows it to go straight into the the respiratory system.
When your doctor prescribes a nebulizer, you can order one from a Medicare-approved supplier. Find a participating supplier by checking the listings for your ZIP code on Medicare.gov.
After you have met the annual Medicare Part B deductible, you are responsible for 20% of the Medicare-approved cost for most covered equipment and services. This means that Medicare will pay for 80% of the cost of your nebulizer, and you will pay the remaining 20%.
What Nebulizer Will Medicare Pay For?
There are three main types of nebulizers: jet, ultrasonic, and mesh. Each works a little differently but performs the same primary function — to turn liquid medication into a mist that you can inhale.
Medicare Part B will cover the purchase or rental of whatever type of nebulizer your doctor prescribes for you as long as it’s:
- Medically necessary
- For home use
- Ordered from a participating supplier
Medicare will also cover the cost of accessories and tools needed for a nebulizer. Depending on the type of nebulizer you have, these can include:
- Face masks
- Mouthpiece
- Air compressor
- Tubing
- Filters
- Sterilization and cleaning equipment
Will Medicare Cover My Nebulizer Medication?
You can use a nebulizer to administer a variety of medications. Part B may cover certain drugs that commonly used in nebulizers, including bronchodilators like Albuterol. These drugs open your bronchial tubes and airway to help you breathe more easily.
Other medications you may take through a nebulizer include:
- Antibiotics
- Anticholinergics
- Beta-agonists
- Corticosteroids
- Saline
- Steroids
To get coverage for any medications you take at home and aren’t covered by Part B, you’ll need a Part D prescription drug plan. Part D plans are offered by private insurance carriers, and coverage details vary by plan. Check your policy to see what you’ll pay for a regular supply of any medications you’ve been prescribed.
Medicare Advantage Prescription Drug plans include Part D coverage.
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How Often Will Insurance Cover a Nebulizer?
Medicare will cover the cost of renting or buying a nebulizer every five years. Before you can get started with a new nebulizer, you must apply for your device within six months of your doctor visit when the nebulizer becomes medically necessary.
For Medicare to consider a medical device “durable,” it must have an expected lifespan of three years or more.
When the time comes, you may have the choice to rent or buy your device. Either way, the device must come from a Medicare-approved supplier. If you decide to rent your nebulizer, you will automatically own it after 13 months.
So what if bumps and breaks happen before you’re eligible for a new device?
If your nebulizer uses a filter, Medicare will cover a replacement as often as needed when a doctor prescribes it. Medicare will cover 80% of the costs for repairs and replacements, including tubing, masks, and compressors, as often as necessary after you meet the Part B deductible for the year.
If you own your nebulizer, Medicare will allow you to replace it after five years of use. A DME rental agreement lasts as long as the nebulizer is necessary, up to 13 months.
How Much Do Nebulizers Cost?
The exact cost of your nebulizer will depend on what type you order and whether you rent or buy your equipment. Most suppliers provide DME through rental agreements.
For equipment that’s covered by Part B, you will pay 20% of the approved price while Medicare pays 80%.
With rental equipment, Medicare makes monthly payments for the items for a certain period. You pay 20% of the amount approved by Medicare after you have met your annual Medicare Part B deductible.
How Much Does a Nebulizer Cost Without Insurance?
The cost of nebulizers without Medicare or other insurance depends on what type you need. Prices can range from around $30 to several hundred dollars.
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Sources
- Nebulizers & nebulizer medications. Medicare.gov.
- Medicare coverage of durable medical equipment and other devices. Medicare.gov.
- The three types of nebulizers. COPD.net.
- Prescription drugs (outpatient). Medicare.gov.
- Nebulizer Machines. DMESupplyUSA.com.