Nebulizers are medical devices that deliver liquid or powdered medications directly into the lungs in the form of a mist. They provide a convenient and effective means of controlling respiratory issues, particularly in those over 65. Unfortunately, many sufferers cannot afford these devices due to their cost.
Thankfully for Medicare beneficiaries, Medicare does cover nebulizers under many circumstances.
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Does Medicare Cover Nebulizers?
Yes, Medicare covers nebulizers. Medicare Part B (medical insurance) pays for outpatient services, doctor’s appointments, and durable medical equipment like nebulizers for patients that qualify. However, they will only be covered by Medicare if they are prescribed by a doctor for an approved medical condition.
Medicare covers nebulizers for patients that have:
- Severe Asthma
- Chronic Obstructive Pulmonary Disease
- Cystic Fibrosis
- Complications After an Organ Transplant
- Pulmonary Secretions
The condition that requires the use of the equipment determines whether Medicare offers coverage for purchase or rental. For example, if you are recovering from pneumonia, a temporary condition, Medicare may offer coverage for a rental. If you have COPD (chronic obstructive pulmonary disease), a permanent medical issue, Medicare may cover the cost to purchase one.
The patient will then need to talk to their doctor and ensure that the doctor and the durable medical equipment supplier are Medicare-approved. Once confirmed, the patient must pay the 20% co-insurance for their nebulizer while Medicare pays the rest. If the patient has Medigap (Medicare Supplement), it may cover the cost of co-insurance, diminishing the out-of-pocket cost to the patient.
Does a Medicare Advantage Pay for a Nebulizer?
Medicare Advantage plans, or Medicare Part C, will cover nebulizers as they are an alternative to Original Medicare plans that can be purchased through an independent provider, and must cover the same services. Some Advantage plans offer additional coverage for nebulizers and corresponding medications, depending on their plan.
Does Medicare Cover Nebulizer Medications?
Yes, Medicare will cover medically necessary medications to treat the pulmonary diseases mentioned above. Medications like albuterol, arformoterol, and budesonide can be covered by Medicare Part B.
Part B will only cover medicines used in reusable nebulizers. The rule stands even if the disposable medications are considered medically necessary.
Medicare Guidelines for Nebulizer Medications
Medicare typically requires medications to be covered under the prescription coverage portion of Medicare, Part D. However, the program makes a special exception for nebulizer medications to be covered under Medicare Part B.
The patient’s doctor must prescribe the nebulizer and home-use medications before Medicare approves payment. The medicines must also consider the medications medically necessary and reasonable to treat the person’s lung or breathing ailment.
What is a Nebulizer and Who Needs It?
A nebulizer is a machine that treats lung conditions and infections. It consists of a mouthpiece connected to a small pot that holds the medication. The pot is then connected to a tube that connects to a compressor.
Patients pour the medication into the pot. The device then converts the liquid medicine into a breathable mist inhaled through the mouthpiece. Nebulizers treat COPD, cystic fibrosis, asthma, and other ailments that cause difficulty breathing.
How Often Will Medicare Replace a Nebulizer Machine?
Medicare will only consider replacing machines the patients have owned for the machine’s entire life. Nebulizer owners should sterilize, maintain, and replace the machine parts as suggested by the manufacturer to make them last as long as possible.
Old or worn-out parts can cause a nebulizer’s compressor to work harder than necessary to vaporize the medication. If the compressor works too hard for too long, the machine will wear out and require replacement sooner than necessary.
The machine is eligible for replacement after it has been owned and used for five years. If a patient can prove that the device is lost, stolen, or broken beyond repair, Medicare will replace it sooner.
How Much Do Nebulizers Cost?
The price for a nebulizer varies from model to model. After insurance, a nebulizer may cost the Medicare recipient around $20 for the machine and all the parts. Others come in at over $1000, including the compressor and accessories.
Without insurance, the patient would have to pay for the nebulizer 100% out of pocket. With coverage through Medicare, the patient is responsible for 20% of the overall cost after meeting their Part B deductible for the year. The price for the machine through Medicare Part C varies based on the private insurance provider.
- Centers for Medicare & Medicaid Services: Durable medical equipment (DME) coverage
- Medicare.gov: Your Medicare coverage: Durable medical equipment (DME) coverage