Medicare Coverage of Nebulizer Machines
This article was updated on: 04/04/2019
What is a nebulizer?
A nebulizer is a machine that delivers liquid prescription medications in a fine mist you can inhale. Your doctor might prescribe medication to use with a nebulizer to help open your airways if you have certain health problems that affect your breathing, such as asthma or chronic obstructive pulmonary disease (COPD).
How does Medicare cover nebulizer machines?
Nebulizers fall into the Medicare category of durable medical equipment (DME). Medicare coverage may pay for a nebulizer, but there are certain limitations and requirements. Your Medicare-assigned doctor must prescribe it for you after determining that you need to use a nebulizer.
You have to get nebulizer machine through a Medicare-approved supplier in order to be covered. In some areas, you may be subject to the Competitive Bidding Program. Under this program, suppliers submit bids to provide DME at a lower cost than Medicare typically pays for the items, and the winning bids become contract suppliers for Medicare. Under Original Medicare coverage, you’ll pay 20% of the cost of the nebulizer, plus your Medicare Part B annual deductible if you haven’t paid it yet. You might be able to select between renting and purchasing the equipment.
How does Medicare cover nebulizer medications?
There are two important components of coverage for a nebulizer machine: the nebulizer itself, and the prescription medications you use with the nebulizer. Under Original Medicare, you receive medical insurance through Medicare Part A (hospital insurance) and Part B (medical insurance), and prescription drug coverage is limited. However, Medicare Part B may cover nebulizer medications that your doctor prescribes.
Medicare Advantage plans are designed to provide you with the same coverage you get under Original Medicare’s Part A and Part B; the Medicare Advantage plan delivers and coordinates these benefits. The notable exception is hospice services, which you still get if you’re enrolled in a Medicare Advantage plan – but you get them directly through Part A instead of through the plan. With many Medicare Advantage plans, you may also get prescription drug coverage that could help you pay for your other prescription medications.
If you decide to stay with Original Medicare, another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.
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