Does Medicare Cover Nebulizers?
- Find out when Medicare covers nebulizers for the treatment of illness and disease, and learn about coverage for nebulizer parts, accessories and repairs.
A nebulizer is a device used to administer inhaled medications. They work by converting a liquid drug into a vapor that you breathe in. Your doctor may prescribe a nebulizer to help you breathe easier when you are sick or suffering from symptoms of a chronic condition. Understanding the costs associated with nebulizers and what Medicare typically covers can help you plan to pay for your care.
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Does Medicare Cover Nebulizers?
Generally, Medicare pays for nebulizers, provided that they are:
- Necessary to administer a specific medication
- Used in a home setting
- Prescribed by a medical provider who participates in medical care
- Purchased or rented through a supplier who participates in Medicare
- Guaranteed to have a life span of at least 3 years
What Diagnoses Cover a Nebulizer?
Nebulizers are commonly used to deliver treatments for:
- Chronic obstructive pulmonary disease (COPD)
- Cystic fibrosis
- Respiratory infections
What Types of Medications Are Delivered Through Nebulizers?
Some medications you may take through a nebulizer include:
- Bronchodilators, which help widen the airways to promote easier breathing
- Antibiotics to fight infections
- Anticholinergics, which interfere with the actions of acetylcholine and are generally used to relax muscles and airways
- Corticosteroids, which reduce inflammation
Will My Doctor Give Me a Nebulizer?
If you need to inhale medication to treat an illness or chronic condition, your doctor may prescribe a nebulizer. Typically, you'll need to arrange to rent or buy one from an approved supplier once you have the prescription.
Is a Nebulizer Covered Under Medical or Pharmacy?
Generally, the nebulizer is covered under durable medical equipment. The medications that you place in the nebulizer are considered pharmacy or drug expenses.
How Much Does a Nebulizer Cost?
The Allergy and Asthma Network reports that most portable nebulizers for home use cost $50 to $200. How much you'll pay depends upon the type of nebulizer, where you live and which supplier you choose.
Which Part of Medicare Pays for a Nebulizer?
If you're treated with a nebulizer in a hospital or long-term care facility, Medicare Part A will typically cover the device. When used at home, nebulizers are covered under Medicare Part B. With both Parts A and B, you'll need to satisfy your deductible before coverage begins. With Medicare Part B coverage, you're responsible for paying 20% of your expenses. For example, if the nebulizer costs $100, and you have already met your deductible, you would pay 20% of $100, or $20 out of pocket.
Do Medicare Advantage Plans Cover a Nebulizer?
Yes, Medicare Advantage Plans or Part C must cover the same items that Parts A and B do. Your plan may require you to receive a prescription from an in-network doctor.
Do Medigap Plans Pay for a Nebulizer?
Medigap plans pay for all or some of the costs that you're responsible for under Medicare coverage guidelines. Typically, they will cover at least a portion of the 20% of the price for at-home nebulizers that Medicare Part B requires you to pay.
Which Nebulizers Will Medicare Cover?
Medicare will usually cover the type of nebulizers that a participating doctor deems medically necessary. For your treatment, your doctor may choose one of three types:
- Jet nebulizers that use compressors to turn liquid into vapor
- Vibrating mesh nebulizers that turn a liquid into vapor by passing it through tiny holes in a screen
- Ultrasonic nebulizers that convert liquid into vapor by vibrating
Does Medicare Pay for Nebulizer Equipment and Accessories?
Yes, Medicare generally pays for equipment and accessories needed to use a nebulizer prescribed by a participating doctor, provided you buy them from an approved supplier. Some supplies you may need to purchase include:
- Replacement tubing
- Replacement mask
- Replacement mouthpiece
Does Medicare Cover Medications for a Nebulizer?
Usually, Medicare Part D pays for medications used in nebulizers. Your plan may choose to cover only some inhaled medications and is likely to charge more for brand name drugs than for generics. How much you'll have to pay for a covered drug also depends on the phase of coverage, as follows:
- Pre-deductible. You'll have to pay for the entire cost of the medication until you meet your plan's deductible.
- Post-deductible. Once you have paid your deductible, you'll likely only have to pay for coinsurance or a copay.
- Donut hole. When you reach a drug-spending limit known as the donut hole, you'll begin paying 25% of the cost of your medicine.
- Post-donut hole. After your drug-spending exceeds a second limit, you enter catastrophic coverage and are usually only responsible for a copay or coinsurance.
Does Medicare Cover Nebulizer Repairs?
Medicare generally pays for replacement parts and repairs for covered nebulizers. If you've been using your nebulizer for at least 5 years, Medicare will usually pay for a new unit if your device can't be fixed.