Does Medicare Cover Nebulizers and Nebulizer Medications?
Nebulizers and associated medication are covered by Medicare if they are deemed medically necessary. Nebulizer types vary, with some covered depending on the medication you need. For qualifying machines, Medicare will pay 80 percent of the cost. After you meet the Part B deductible, you will then owe 20 percent coinsurance.
Medicare Coverage of Nebulizers
Nebulizers are a type of durable medical equipment (DME), so Medicare will cover them if they are needed for medically necessary treatment.
Since nebulizers are a do-it-yourself item that you can use at home, it is unlikely that you would receive this type of treatment as an inpatient in a hospital. But if you did, then it may be covered under Medicare Part A instead of Part B.
Medicare will also not cover a nebulizer that you want to humidify your home or for any other non-medical reason. In addition, DME applies to durable and reusable items, so a disposable nebulizer also will not be covered.
- Obstructive pulmonary disease (COPD)
- Cystic fibrosis
- Organ transplant complications
- Pulmonary secretions
You may need to rent or buy a particular nebulizer depending on which type is covered by your Medicare plan.
It is also important to make sure that both your doctor and the supplier of your nebulizer are enrolled in Medicare. If not, Part B will not cover it and you will be responsible for 100 percent of the cost.
Additional coverage for nebulizers could be available through Medicare Part C, also known as a Medicare Advantage plan.
These plans include everything covered in Original Medicare and additional benefits and services.
If you are interested in expanded coverage for nebulizers or nebulizer medications, check what options could be available through a Medicare Advantage plan.
Medicare Coverage of Nebulizer Medications
Medicare Part B will cover some medicines that require a nebulizer if they are deemed medically necessary. You are only eligible for a nebulizer if your medications are also covered.
Some prescription drugs could be considered medically necessary but can only be used in a type of nebulizer that is not covered, like a disposable nebulizer. In those situations, the medication will not be covered.
Be sure to check with your doctor or healthcare provider whether their recommended treatment falls under your coverage plan.
Expanded drug coverage could be available through Medicare Part D. This optional benefit is provided by private insurers and offers coverage of prescription drugs.
What is a Nebulizer and Who Needs It?
Nebulizers are electronic machines that you can use in your home to treat lung or breathing conditions. The devices operate by turning liquid medicine into an inhalable mist.
You breathe the medication in, usually for 10 minutes, through a mouthpiece and tube connected to the machine. It is a painless process.
Nebulizers are also helpful for treating asthma, cystic fibrosis and other conditions that make breathing difficult.
Inhalers are also used to treat these types of conditions but are handheld devices that can be used quickly, while nebulizers require more parts and time.
- Pneumatic compressors turn liquid medication into gas through airflow and are the most common and less expensive type.
- Ultrasonic or electronic nebulizers are more expensive and quieter, but Medicare will only cover it for specific treatments and medications.
Nebulizers are especially useful for people with chronic obstructive pulmonary disease (COPD). According to the Centers for Disease Control and Prevention, 16 million Americans have COPD, including bronchitis and emphysema.
9 Cited Research Articles
- U.S. National Library of Medicine. (2021, May 4). How to use a nebulizer. Retrieved from https://medlineplus.gov/ency/patientinstructions/000006.htm#
- American Lung Association. (2021, March 5). How to Use a Nebulizer. Retrieved from https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/treating/medication-management-tips/how-to-use-a-nebulizer
- U.S. Centers for Disease Control and Prevention. (2021, February 22). What is COPD? Retrieved from https://www.cdc.gov/copd/index.html
- U.S. Centers for Disease Control and Prevention. (2019, July 19). Basics About COPD. Retrieved from https://www.cdc.gov/copd/basics-about.html
- U.S. Centers for Medicare & Medicaid Services. (2018, April 30). Nebulizer. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/Electronic-Clinical-Templates/Downloads/Nebulizer-Order-Template-Draft-20180430-R10a.pdf
- Rady Children’s Hospital – San Diego. (n.d.). What’s the Difference Between a Nebulizer and an Inhaler? Retrieved from https://kidshealth.org/RadyChildrens/en/kids/nebulizer-inhaler.html
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Local Coverage Article: Nebulizers – Policy Article. Retrieved from https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52466
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Local Coverage Determination (LCD): Nebulizers. Retrieved from https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33370&ver=30&keyword=nebulizer&keywordType=starts&areaId=all&docType=NCA,CAL,NCD,MEDCAC,TA,MCD,6,3,5,1,F,P&contractOption=all&sortBy=relevance&bc=AAAAAAQAAAAA&KeyWordLookUp=Doc&KeyWordSearchType=Exact
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Nebulizers & nebulizer medications. Retrieved from https://www.medicare.gov/coverage/nebulizers-nebulizer-medications