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Does Medicare Cover Nebulizer Machines?

Medicare can provide coverage for nebulizer machines. But how does Medicare cover nebulizer machines? Medicare will pay if a doctor prescribes a nebulizer machine to treat a condition.

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People with asthma or chronic obstructive pulmonary disease (COPD) may find relief from a nebulizer. Many doctors favor this method for treating asthma and other respiratory ailments.

Nebulizers convert liquid medication into an inhalable mist and often provide quick relief from breathing difficulties. If necessary, you can obtain coverage for medications and devices.

Will Medicare Pay for a Nebulizer Machine?

Medicare nebulizer coverage happens when it is a necessity, such as with COPD or asthma. Talk to your doctor if you think you may qualify to receive a nebulizer machine from Medicare. They can provide you with an accurate Medicare nebulizer price for your device.

Nebulizer devices are durable medical equipment covered under Medicare Part B. Thus, you must pay a portion of the cost via the 20% coinsurance. However, a Medicare Supplement plan (Medigap) can help with those costs.

Although certain medications may require Medicare Part D, you can usually get coverage for a necessary device through Medicare Part B or your Medicare Advantage plan. It is essential to check with your providers to ensure they accept Medicare assignment. When you have a Medicare Advantage plan, ensure your practitioners are within your network.

Always check your coverage, as receiving a nebulizer covered by Medicare will play a role in determining how much a service or device costs.

Medicare Guidelines for Nebulizer Medications

If you meet the guidelines for nebulizer medications, Medicare Part B may pay some of the costs. Medicare must consider the drugs reasonable and necessary. Also, your doctor must prescribe treatments for in-home use.

Your prescription must include any supplies you need for using the machine. Orders must also state the condition requiring nebulizer use and list the medications for use in conjunction with the nebulizer.

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Medicare Advantage plans must provide at least the same benefits as Original Medicare (Part A and Part B). These plans are popular because most offer extra features, like prescription drug coverage.

The local coverage determination (LCD) specifies nebulizer medications and the maximum daily dose amount allowed. Also, budesonide is a conventional medication the program covers. The maximum dosage is 0.5 mg two times daily or 1.0 mg one time per day. Refer to the LCD for more information on dosage restrictions or coverage for specific nebulizer medications.

Does Medicare Cover Nebulizers for Asthma?

A nebulizer is an asthma treatment machine. When a doctor who accepts Medicare prescribes one, seniors with asthma and Medicare will receive coverage for the equipment.

Does Medicare Cover Portable Nebulizers?

Medicare may cover a portable nebulizer, but you’ll need a prescription from your doctor showing it is necessary for your health.

Portable nebulizers are lightweight and perfect for those needing treatment while on the go. Many are battery-operated and plug right into your car.

Respiratory conditions requiring DME may make patients feel isolated. Treating conditions outside of the home can mean a better quality of life.

Does Medicare Part D Cover Albuterol for a Nebulizer?

Most Medicare Part D prescription drug plans cover albuterol. Seniors will want to check their formulary, a list of the drugs covered by your plan, to ensure that their healthcare coverage includes this medication.

Does a Medicare Supplement Pay for a Nebulizer?

If Medicare pays, Medigap also provides coverage for the balance. A supplemental plan pays coinsurance for device rentals or purchases like nebulizers.

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Medicare Supplement plans are a form of secondary insurance for those on Medicare. Thus, Medicare Part A and Part B remain primary, while Medigap plans help fill the gaps in your coverage.

Nebulizer medication may include antibiotics and steroids. Medigap plans cover any nebulizer supplies or medications that Part A or Part B covers.

As these devices can administer several medications together, patients taking multiple drugs may benefit from using a nebulizer. However, Medigap doesn’t pay for drugs. A Medicare Part D prescription drug plan can help with drug costs.

How Often Will Medicare Replace a Nebulizer Machine?

Medicare only replaces worn-out equipment you’ve had for its entire life. Replacement eligibility begins five years from the day that you start using the equipment.

But, if you can prove that your nebulizer has been lost, stolen, or damaged beyond repair (via a natural disaster or accident), the replacement has coverage.

When is a Nebulizer Not Covered by Medicare?

Medicare will not pay for a nebulizer if your doctors and suppliers don’t accept Medicare. You also cannot receive coverage through Medicare for a nebulizer if your doctor does not accept it as health insurance.

Does Medicare Pay for Nebulizer Supplies?

As we state above, nebulizers and nebulizer medications can receive coverage through Medicare. If your doctor includes any supplies you need in your prescription, Medicare should also pay for those.

When Does Medicare Part D Cover a Nebulizer Solution?

An approved supplier must sell or rent a nebulizer with a life expectancy of three years or more before Medicare covers its cost. Medicare Part D covers a nebulizer solution if its administration is through a device such as a metered-dose inhaler.

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These instances aren’t eligible for the Medicare Part B DME benefit.

How To Get a Nebulizer for Free Through Medicare

Because Medicare Part B covers durable medical equipment, you can receive a nebulizer machine. However, there are still financial responsibilities seniors will have to uphold.

In addition to any premiums for which you may be responsible, you’ll also need to cover 20% of the Medicare-approved amount of your nebulizer machine.

The same goes for your coverage under Medicare Part D. While you will receive coverage for your healthcare, it is not entirely “free” because there are premiums to cover.

Medicare Supplement plans will also come with costs depending on your coverage and deductible.

If you’re confused, we understand. Comparing plans on your own may seem overwhelming. But we have a team of experts happy to clear the air.

Our enrollment specialists are here to help find the right plan for you and can find protection that makes the most sense for coverage toward your nebulizer. Give us a call today at the number above.

Can’t call us today but would still like help? Fill out an online rate comparison form for monthly premium rates in your area.

Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

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