Medicare Coverage for Nebulizers
Key Takeaways
- 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 and/or Part D (if you are enrolled) may cover costs associated with a nebulizer.
- Like all DME, Medicare will pay for most of the cost, but you will still pay a portion.
- Your doctor or medical provider can prescribe you a nebulizer device as medically necessary to ensure Medicare covers a portion of the costs.
Nebulizers are an essential piece of medical equipment, especially for people with respiratory conditions. If your doctor says you need a nebulizer and you have Medicare, your Medicare Part B plan will cover the nebulizer — but not the total cost.[i] Medicare Part A may cover nebulizer costs if you receive the care inpatient.[i]
Find out what Medicare covers and how much you will still have to pay for your nebulizer.
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How Do I Get a Nebulizer From Medicare?
The first step to getting a nebulizer from Medicare is for your doctor to prescribe a nebulizer and for you to order a nebulizer from a Medicare-approved supplier. These are suppliers that participate in Medicare’s Durable Medical Equipment (DME) program.
A nebulizer is a piece of durable medical equipment that a person with asthma or another respiratory condition can use to administer medication directly and quickly to the lungs. A nebulizer turns liquid medicine into a very fine mist that a person can inhale through a face mask or mouthpiece. Taking medication this way allows it to go straight into the lungs and the respiratory system where it is needed.
Once your doctor writes you a prescription for a nebulizer and you order it through a DME-approved supplier, you will pay the standard portion of your nebulizer cost under the DME program.
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?
Medicare will cover whatever type of nebulizer your doctor prescribes for you as long as it’s:
- Medically necessary
- For home use
- Ordered from a DME supplier
- Jet
- Ultrasonic
- Mesh
The Medicare Part B DME program 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 many medications in a nebulizer. The Durable Medical Equipment (DME) program for Part B may cover drugs commonly used in nebulizers, including bronchodilators like Albuterol. These drugs open your bronchial tubes and airway to help you breathe more easily. Other medications can be used in a nebulizer, including,
- Antibiotics
- Anticholinergics
- Beta-agonists
- Corticosteroids
- Saline
- Steroids
If your nebulizer order is “reasonable and necessary,” the cost of the nebulizer itself may also include and cover the price of your medicine.
Are you unsure about how you know if your service or item is reasonable and necessary?
The Centers for Medicare & Medicaid Services (CMS) provides simple guidelines to determine whether a service or item is reasonable and necessary. The service or equipment must be safe and effective; not experimental or investigational; and appropriate for Medicare patients for the duration and frequency that it’s considered appropriate. Of course, you can always ask your doctor if you’re unsure.
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How Often Will Insurance Cover a Nebulizer?
The simple answer is Medicare will cover the cost of a nebulizer every five years. However, it’s not that simple, and each beneficiary may have different needs. Still, you can rent or buy a nebulizer, and Medicare will cover the device. However, 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.
Does five years seem like a long time? In determining how often it will cover a nebulizer, Medicare requires the device to have an expected life span of three years or more.
When the time comes, and Medicare will cover a nebulizer, you can choose to rent or buy your device. But no matter your choice, the device must come from a Medicare-approved supplier. If you decide to rent your nebulizer, consider that you will automatically own it after 13 months of renting the equipment.
So what about bumps and breaks between then and five years?
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 repairs and replacements, including tubing, masks, and compressors, as often as necessary after you meet the deductible. 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.
Will Medicare Cover My Nebulizer?
Yes, as long as your doctor has ordered it as medically necessary. If you are using Medicare to cover the cost of your nebulizer, you must order the device through a supplier that participates in Medicare’s Durable Medical Equipment program.
How Much Do Nebulizers Cost?
The exact cost of your nebulizer will depend on what type of nebulizer you order and whether you rent or buy your equipment. Most suppliers provide DME through rental agreements.
If you own a Medicare-DME item, you will pay 20% of the 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.
If your nebulizer requires repair or replacement and you own it, Medicare will cover 80% of the cost. If you rent the equipment, any repair or replacement cost falls to the supplier.
How Much Does a Nebulizer Cost Without Insurance?
The cost of nebulizers without Medicare or insurance depends on what type of nebulizer you need or choose. Prices can range from $25 to more than $1,000.
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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.
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