Does Medicare cover nebulizers?
Medicare Part B covers nebulizers and their accessories if theyâ€™re prescribed for at-home use. It also covers the medications delivered by a nebulizer for use at home.
Medicare Part B will pay 80 percent of all costs associated with a nebulizer once youâ€™ve met your deductible. In 2020, the Part B annual deductible is $198.
If you use a nebulizer as an inpatient in a hospital or another facility, such as a nursing home, your nebulizer medications may be covered by Medicare Part A.
If Part A doesnâ€™t cover your stay in the facility, your medications may be covered by Part D. Medicare Part D is optional prescription drug insurance that pays for a portion of the medications not covered by original Medicare (parts A and B).
What if I have Medicare Advantage?
If you have a Medicare Advantage (Part C) plan, itâ€™ll cover at least as much as Medicare Part B. It may also pay for any medications not covered under Part B, if your plan includes prescription drug coverage.
Keep in mind that the cost of the nebulizer, as well as your out-of-pocket costs, may vary based on your plan and location. Plus, you may be limited to using in-network providers and suppliers outlined by your plan.
What equipment and accessories are covered?
Like all DME, nebulizers must meet specific requirements to be covered. This includes having an expected life span of at least 3 years.
Types of nebulizers
There are three different types of nebulizers that your doctor may prescribe for you. These types include:
- vibrating mesh
Your doctor will determine which type is best for your condition.
Some nebulizers come with a filter thatâ€™s already installed, plus additional new filters. If you need extra filters, Medicare will cover their cost as long as you have a prescription from your doctor.
You must also purchase the filters from a Medicare-approved supplier.
Nebulizers deliver breathable medications, known as bronchodilators, into the body.
Bronchodilators open your airways and bronchial tubes to help you breathe more easily. There are many kinds of bronchodilators that your doctor may prescribe for use with your nebulizer.
Nebulizers are also used to deliver other types of medications, including:
- hypertonic saline steroids
Replacement and repair
If your nebulizer breaks and canâ€™t be fixed, Medicare will pay to replace it â€” but only if youâ€™ve used it for at least 5 years.
Medicare will also pay to replace your nebulizer if itâ€™s lost, stolen, or damaged beyond repair in an accident or natural disaster. Youâ€™ll need to provide proof if any of these criteria apply.
If your nebulizer requires repair during its life span, Medicare will cover that expense up to the cost of replacement.
You may also need to replace some of the various parts of your nebulizer over its lifetime. These parts may include tubing, an air compressor, infusion bottles, medication cups, mouthpieces, masks, and more.
Medicare does cover replacement parts.
How do I qualify for coverage?
To qualify for a nebulizer, youâ€™ll need a confirmed diagnosis to support a medical need for this device. Youâ€™ll need to see a Medicare-approved provider and apply for the device within 6 months of an in-person visit. Some diagnoses that may be approved for coverage include COPD and cystic fibrosis.
Your doctor will provide signed prescription for the specific type of nebulizer you need, as well as for the accessories and medications. The prescription must state that all these items are medically necessary to treat your condition. It should also indicate that the nebulizer and medications are meant for use in your home.
To receive maximum coverage, you must purchase or rent your nebulizer from a Medicare-approved supplier thatâ€™s currently accepting assignment. This means they must accept the Medicare-approved amount for the nebulizer.
Ask the supplier directly whether they accept assignment. Donâ€™t assume that every Medicare-enrolled supplier is participating. Suppliers enrolled in Medicare but not currently participating can charge you any cost for your nebulizer. This may be higher than the approved amount.
Make sure youâ€™re up to date on your Part B monthly premiums. This will help ensure that you canâ€™t be denied coverage for your nebulizer or any other medical service you require.
How do I get the equipment and medication?
Medicare may require you to rent or buy your nebulizer and its accessories. In some instances, it might be up to you to decide which you prefer.
Your supplier can usually file your claim with Medicare for you. If you have original Medicare, you may be asked to pay your portion up front: 20 percent of the cost of your nebulizer and medications.
In some instances, the supplier may be able to deliver your nebulizer to your home.
To find Medicare-approved DME suppliers in your area, call 800-MEDICARE or use Medicareâ€™s online search tool.
Medications for nebulizers can be filled with a prescription at your DME supplier or at a Medicare-approved pharmacy.
What are nebulizers?
A nebulizer is a small medical device used for breathing therapy. Nebulizers turn liquid medications into a fine mist, which you inhale through a mask or mouthpiece while breathing naturally.
These medications help dilate and relax your bronchial passageways to ease your breathing and promote airflow into and out of your lungs.
Nebulizers are used to treat many conditions, including:
- bronchitis COPD
- cystic fibrosis
- respiratory infections
Since nebulizers donâ€™t require you to take deep breaths, they may be more effective than inhalers in some instances.
Nebulizers may be battery operated or electric. Some models are handheld and portable. Others are somewhat larger and may need to be kept on a table or other flat surface.
Your doctor will give you the specifics on how to use your nebulizer. Follow those instructions exactly, and read the manual that comes with your nebulizer. The manual will give you specific information on how to clean each part of your nebulizer. Never use a nebulizer or nebulizer filter thatâ€™s dirty.
In some instances, your medication will come premixed. Other times, you may have to measure or mix your own medication. To get the exact dosage you need, always use a measuring cup or spoon with marked measurements, rather than daily-use cups or spoons.
If your nebulizer is electric, check that itâ€™s plugged in and the liquid medication is misting. If itâ€™s battery-operated, always have an extra battery pack charged and on hand.
During treatment, breathe in the medication until itâ€™s completely gone. This usually takes around 15 minutes.
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