Original Medicare recipients receive insurance through Medicare Part A (hospital stays) and Part B (physician visits).
Medicare Part C is an alternative to Medicare Parts A & B, with restrictions on physicians based on who is recommended by your carrier at local HMOs and PPOs.
Either option for Medicare coverage will cover nebulizer treatment, with some copays and the Medicare Part B deductible to be paid by the patient.
Will Medicare Pay for a Nebulizer Machine
For Medicare recipients, nebulizer machines are only obtained with a Medicare-enrolled doctor’s prescription. Because they are DMEs, the medication needed by those who use nebulizers is usually covered under Medicare Part B.
Other items that fall under Durable Medical Equipment:
Patients on Medicare will pay 20% of the cost of the equipment and the Part B deductible. A Medigap plan to supplement your Part B insurance can help to make up the difference in what Medicare covers for nebulizers and the medications associated with them if covered by Part B.
Be sure to confirm with your provider that he or she is a Medicare enrollee and participating actively in Medicare coverage. Some prefer not to accept Medicare assignments, even if they are enrolled.
In the case of those who don’t take the assignments, they are free to charge the patient whatever they think is acceptable. Careful research and inquiries with your chosen physician can save you a lot of money.
Some medications for use with nebulizers may require Medicare Part D (Prescription Drug Coverage) for the enrollee to be eligible for benefits.
Medicare Part B will not cover nebulizer machines and medications while a patient is in a hospital or nursing home, as those are not classified as “home,” which is a requirement of DME coverage.
However, Medicare Part B will cover Durable Medical Equipment if a patient is in a long-term care facility. This same guideline applies to Medicare Part C as well.
Durable Medical Equipment (DME) can be what makes it possible for a Medicare recipient to remain comfortably living at home instead of being in and out of hospitals and skilled nursing facilities.
Knowing the best way to obtain the equipment needed is an integral part of caregiving, whether it’s for yourself or someone you love.
Durable Medical Equipment
Medicare classifies some items as Durable Medical Equipment (DME). Durable Medical Equipment includes the following descriptions:
- Is used for medical purposes
- Should last approximately three years
- A piece of equipment that is only useful to someone who is ill
- Something used in the home
- Can be used repeatedly without damage or replacement needed
You may either purchase or rent your nebulizer, depending on your situation and your physician’s recommendation. After renting a nebulizer machine for 13 months, the patient will have full ownership of it.
Once the patient has full ownership of the equipment, supplies must come from a Medicare contracted provider.
Some areas require competitive bidding for Durable Medical Equipment supplies. To find out if you live in one of these areas, you can enter your zip code for information.
You can find the right suppliers in your area with this tool. If you carry other insurance that pays before Medicare pays, you may be required to use a supplier that isn’t covered by Medicare. In cases like these, it’s possible Medicare will pay the supplier directly.
A nebulizer machine is used by people with breathing-related illnesses such as asthma, cystic fibrosis, and chronic obstructive pulmonary disease (COPD) or pulmonary hypertension.
Nebulizer machines deliver liquid-based medication, which is converted to a fine mist, for inhalation. For many of those with lung ailments, a nebulizer is an integral part of their treatment plan.
Some of the medications that nebulizer machines facilitate include:
Additional drugs used with nebulizers may include steroids and antibiotics.
Nebulizer machines are used for acute treatment of sudden onset breathing difficulties, or they are used for long-term treatment of chronic discomfort.
Since nebulizers can deliver multiple medications at once, they can be especially helpful for those who take a variety of drugs.
When someone is in the middle of an asthma attack or other types of breathing emergency, in some cases a nebulizer is more comfortable and quicker to use than an inhaler.
A nebulizer machine is an essential part of treating many lung diseases that make breathing difficult.
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