May 6th 2024
By Ari Parker
Explore Medicare coverage for nebulizers, a medical device that delivers medication to the lungs. Discover how to get the equipment you need.
Nebulizers are medical devices used to turn medicine into a mist so that it can be inhaled and reach the lungs. You may use a nebulizer if you have a respiratory condition (like COPD) and need medication to make breathing easier and relieve symptoms.
Nebulizers are considered durable medical equipment (DME) by Medicare. This means that Medicare will cover these devices under certain conditions. Read on to learn about eligibility requirements and how Medicare helps pay for nebulizers.
Nebulizers are used by people with respiratory conditions to turn medication into a mist that can be inhaled and reach their lungs.
Medicare covers nebulizers as durable medical equipment. After you meet your Part B deductible, you’ll pay 20% of the cost of the device.
Make sure you rent or purchase a nebulizer from a Medicare-approved supplier to receive full coverage.
A nebulizer is a machine that applies medication to the lungs in the form of a mist or aerosol. The body quickly absorbs this medicine to relieve symptoms from respiratory conditions. You may need a nebulizer if you’re managing chronic obstructive pulmonary disease (COPD), cystic fibrosis, or asthma.
Machine and use can vary, but usually you’ll start by pouring liquid medication and pour it into the nebulizer’s medication cup. The machine then converts the liquid into a mist that you would inhale through a mask that’s connected to the nebulizer.
Your doctor needs to prescribe a nebulizer and the medication so you can use them for treatment.
Yes, Medicare Part B covers nebulizers as durable medical equipment (DME) if your doctor recommends them. DME includes any equipment you need for at-home use to manage a condition. You’ll pay 20% of the cost of the equipment once you reach your Part B deductible. Nebulizers typically cost between $50 to $200 without insurance.
Medicare Part B may also cover the medications that go into nebulizers. However, you may need coverage through a prescription drug plan. It depends on what your doctor prescribes for you. Ask your healthcare or insurance provider about how your medications are covered with Medicare.
Depending on what condition you’re using a nebulizer fort, there are several types of medications you may need. The most common are:
Bronchodilators that help relax muscles around the airway
Corticosteroids, which are steroids to reduce inflammation, prevent asthma attacks, and manage chronic respiratory conditions
Mucolytics, which clear up mucus from the lungs
Antibiotics to treat respiratory infections
Yes, Medicare Advantage plans cover nebulizers. While Medicare Advantage plans must cover the same services as Original Medicare, your out-of-pocket costs can vary. Plus, your plan may cover nebulizers and DME through a network-specific supplier. Make sure you review your summary of benefits or contact your insurance carrier to understand how coverage works for nebulizers.
In order to receive Medicare coverage for nebulizers, you need to meet specific eligibility requirements:
Your doctor must prescribe the nebulizer for you to treat a condition
Your doctor must accept Medicare
You must purchase or rent the equipment through a Medicare-approved supplier
If your doctor or supplier doesn’t accept Medicare assignment, you may have to pay more (or even the full cost of the equipment). Find a supplier enrolled in Medicare near you, or ask your healthcare provider for recommendations.
You can also get in touch with one of our licensed Medicare Advisors for answers to questions around suppliers, what medical devices Medicare covers or anything else related to Medicare! Call us at 855-900-2427 or schedule a time to chat for free, personalized advice.
