Do you need a nebulizer to treat asthma, cystic fibrosis or some other respiratory illness?
Nebulizers are basically breathing machines that turn liquid medication into a mist that you inhale. This ensures your lungs directly receive the medication as you breathe it in. They are great in situations where inhalers are ineffective or difficult to use.
A common question many people have about these devices is, “Does Medicare cover Nebulizers?” In this article, we answer that question in clear, plain English. You will also find the average costs of nebulizers and other helpful info.
Does Medicare Cover Nebulizers?
The short answer is yes; Medicare will cover the cost of nebulizers. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your nebulizer. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for nebulizers. If you use a nebulizer in an inpatient setting, Medicare Part A may provide coverage for your nebulizer and medications.
For at-home use, Medicare Part B will pick up the tab for nebulizers and their accessories. This coverage includes both the nebulizer and medication.
Medicare may require that you either rent or buy the nebulizer. Though sometimes you may have a choice of which option you go with.
All that said, for Medicare Part B to provide coverage for your nebulizer, medications and accessories, there are certain requirements that must be met.
One is that you have been diagnosed with a medical condition that a nebulizer can help treat. You will also need a prescription from your healthcare provider. The prescription must state what type of nebulizer you need along with medications and equipment.
For Medicare to cover your nebulizer, you will also need to purchase or rent it from a Medicare-approved provider. Also, you must apply for it within 6 months of an in-person visit.
If your nebulizer breaks and cannot be fixed, Medicare Part B will provide coverage for a replacement unit. However, they will only do so if you have used the nebulizer for at least five years. You will also need proof about what happened to your nebulizer for Medicare Part B to cover replacement costs.
They also cover replacement if your nebulizer gets lost or stolen (again, with proof!).
Medicare Part B will also provide coverage if your nebulizer needs to be repaired during its lifespan. Aside from the replacement of the unit itself, Medicare Part B also covers the replacement of some parts of your nebulizer.
Medicare Advantage plans (Medicare Part C) also provide coverage for nebulizers. They cover everything Original Medicare covers, as well as offer some additional benefits. However, exactly what they cover and how much the out-of-pocket costs are will vary depending on the specifics of your plan.
Medicare Part C also provides coverage for some nebulizer medications that Original Medicare does not cover.
Similar to Medicare Part C, Medicare Part D also provides coverage for some nebulizer medications if they are not covered by Original Medicare.
How Much Does A Nebulizer Cost?
Nebulizers typically cost anywhere from $50 to $300.It depends mainly on the type and brand of nebulizer you get. Also, keep in mind those costs do not include any extra accessories or the cost of medication.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to 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: Does Medicare cover Lyme disease treatment?