Nebulizers are medication delivery devices used to treat respiratory diseases and illnesses.
They convert liquid medication into a mist that is easier to inhale and distribute throughout the body. The conditions they help relieve include asthma, bronchitis, and chronic obstructive pulmonary disease (COPD).
If this is a type of treatment you could potentially benefit from, you ask, “Does Medicare cover nebulizers?”
This article will answer your question in clear, plain English. It will also provide the average costs of nebulizers for those who have to pay for one out-of-pocket.
Does Medicare Cover Nebulizers?
The short answer is yes; Medicare will cover the cost of nebulizers. But this is not true 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your nebulizers. Below we look at what these are so you know what to expect.
Original Medicare Coverage of Nebulizers
Original Medicare (Medicare Part A and Part B) provides coverage for nebulizers.
This Medicare plan provides coverage for your nebulizers if it is considered medically necessary for you. First, your healthcare provider will need to order the device to show this is the case.
Part B Coverage of Nebulizers
Part B of Medicare covers nebulizers because they are outpatient (or in-home) treatments. Under its policy, Part B categorizes nebulizers as Durable Medical Equipment (DME).
The plan will cover both the rental and purchase of nebulizers.
You will have to meet certain conditions in order to get Medicare to cover the cost of a nebulizer. The common ones include:
- You have a medical condition (such as the ones above) and a nebulizer can help you manage your condition.
- Your healthcare provider prescribed the nebulizer, plus the required equipment and medications to treat your condition.
- You get the nebulizer from an authorized supplier.
- The nebulizer is medically necessary to be used in your home.
- The nebulizer must have an expected lifespan of at least three years.
More Information on Part B Coverage
A couple of other important odds and ends about nebulizer coverage you should know about:
If you rent the nebulizer, the nebulizer is automatically yours after 13 months of use.
Also, if your nebulizer breaks beyond repair, Medicare Part B will provide coverage for a new one, given that the nebulizer has been used for at least five years.
If approved, you will receive coverage for replacements of filters, tubing, masks, and compressors if your nebulizer requires them.
You can also receive coverage for the medications you’ll use with the nebulizer.
Once approved, Medicare Part B covers 80 percent of the costs. You will pay for the remaining 20 percent.
Medicare Advantage Coverage of Nebulizers
Medicare Advantage plans (Medicare Part C) also provide coverage for nebulizers. These plans have to cover the same products, services and treatments that Original Medicare covers.
But Part C plans will cover other things that Original Medicare does not. What a Part C plan covers and how much the out-of-pocket costs are will vary depending on the specifics of your plans.
How Much Do Nebulizers Cost?
Nebulizers cost anywhere from $200 to $300 without insurance.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always double-check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series, including: