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Does Medicare Cover Nebulizer Machines


Medicare pays for a nebulizer machine if a doctor prescribes it to treat a condition. People with asthma or chronic obstructive pulmonary disease 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. But, they often provide quick relief from breathing difficulties. If necessary, medications and devices obtain coverage.

Will Medicare Pay for a Nebulizer Machine

Medicare may help pay for nebulizers when they’re a necessity, such as with COPD or asthma. If you think you may qualify, talk to your doctor. Nebulizer devices are Durable Medical Equipment covered under Part B. Also, you must pay a portion of the costs. But, a Medigap plan can help with those costs.

Although, certain medications may require Part D. Most plans pay for a device. But, check with your providers to ensure they accept Medicare assignment. If a doctor doesn’t, they may decide how much a service or device costs. Always check with your plan.

Medicare Guidelines for Nebulizer Medications

If you meet the guidelines for nebulizer medications, 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. The 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. Advantage plans must provide at least the same benefits as Medicare. These plans are popular because most offer extra features, like including Part D.

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 Portable Nebulizers

Portable Nebulizers are lightweight and perfect for those needing treatment while on-the-go. Many are battery operated and plug right into your car. If your lifestyle requires portable nebulizer use – Medicare may pay for it. Respiratory conditions requiring DMEs may make patients feel isolated. Treating conditions outside of the home can mean a better quality of life.

Does a Medicare Supplement Pay for a Nebulizer

If Medicare pays for the drug, Medigap also provides coverage. A supplemental plan pays coinsurance for device rentals or purchases, such as with nebulizers. Supplemental insurance is like having secondary insurance. Part A and B remain primary; 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 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 Part D 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 it’s been lost, stolen, or damaged beyond repair (via a natural disaster or accident), the replacement has coverage.

FAQs

When is a nebulizer not covered by Medicare?
A nebulizer is not covered if your doctors and suppliers don’t accept Medicare.
Does Medicare pay for nebulizer supplies?
Your doctor should include any supplies you need in your prescription. If Medicare pays for the nebulizer, it should also pay for the supplies.
When does Part D cover a nebulizer solution?
Part D covers a nebulizer solution if its administration is through a device such as a metered-dose inhaler. These instances aren’t eligible for the Part B DME benefit.

How Medicare Plans Can Help Cover Nebulizers

Comparing plans on your own may get confusing. We have a team of experts happy to clear the air. We can help you find the right plan for you. Our agents can find a policy for you. Give us a call today at the number above.

Can’t call today? We understand. You can still fill out an online rate comparison form for an idea of rates in your area.

Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

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