Medicare covers durable medical equipment under Part B. This includes nebulizers and necessary accessories and medications with a valid prescription from an approved prescriber and supplier.

A nebulizer is a device used to treat respiratory conditions such as asthma, bronchitis, and chronic obstructive pulmonary disease (COPD). It turns liquid medication into a mist that can be easily delivered to the body.

Medicare classifies nebulizers as durable medical equipment (DME) and covers 80% of their purchase or rental cost. It also also covers the necessary accessories and medications used with nebulizers.

Keep reading to learn what kinds of nebulizers and accessories Medicare covers, if you meet the eligibility criteria, and how to buy or rent the equipment to ensure it will be covered.

Medicare Part B covers nebulizers and their accessories if they’re prescribed for at-home use. It also covers the medications delivered by a nebulizer for use at home.

Medicare Part B will pay 80% of all costs associated with a nebulizer once you’ve met your deductible. In 2024, the Part B annual deductible is $174.70.

If you use a nebulizer as an inpatient in a hospital or another facility, such as a nursing home, your nebulizer medications may be covered by Medicare Part A.

If Part A doesn’t cover your stay in the facility, your medications may be covered by Part D. Medicare Part D is optional prescription drug insurance that pays for a portion of the medications not covered by Original Medicare (Parts A and B).

What if I have Medicare Advantage?

If you have a Medicare Advantage (Part C) plan, it’ll cover at least as much as Medicare Part B. It may also pay for any medications not covered under Part B if your plan includes prescription drug coverage.

Keep in mind that the cost of the nebulizer, as well as your out-of-pocket costs, may vary based on your plan and location. Plus, you may be limited to using in-network providers and suppliers outlined by your plan.

Like all DME, nebulizers must meet specific requirements to be covered. This includes having an expected life span of at least 3 years.

Additional equipment

Some nebulizers come with an already-installed filter and additional new filters. If you need extra filters, Medicare will cover the cost as long as you have a prescription from your doctor.

You must also purchase the filters from a Medicare-approved supplier.

Medications

Nebulizers deliver breathable medications, known as bronchodilators, into the body.

Bronchodilators open your airways and bronchial tubes to help you breathe more easily. There are many kinds of bronchodilators that your doctor may prescribe for use with your nebulizer.

Nebulizers are also used to deliver other types of medications, including:

Replacement and repair

If the nebulizer you purchase is lost, stolen, or damaged beyond repair within 5 years of use, Medicare will cover a replacement. That said, you’ll need to provide proof.

It can also be eligible for replacement if you’ve used it for longer than its reasonable lifetime, which is generally also around five years. This includes replacing your nebulizer’s various parts over its lifetime, which may include tubing, an air compressor, infusion bottles, medication cups, mouthpieces, masks, and more.

To qualify for a nebulizer, you’ll need a confirmed diagnosis to support a medical need for this device. You’ll need to see a Medicare-approved provider and apply for the device within 6 months of an in-person visit. Some diagnoses that may be approved for coverage include COPD and cystic fibrosis.

Your doctor will provide a signed prescription for the specific type of nebulizer you need, as well as for the accessories and medications. The prescription must state that all these items are medically necessary to treat your condition. It should also indicate that the nebulizer and medications are meant for use in your home.

To receive maximum coverage, you must purchase or rent your nebulizer from a Medicare-approved supplier that’s currently accepting assignments. This means they must accept the Medicare-approved amount for the nebulizer.

Ask the supplier directly whether they accept the assignment. Don’t assume that every Medicare-enrolled supplier is participating. Suppliers enrolled in Medicare but not currently participating can charge you any cost for your nebulizer. This may be higher than the approved amount.

Make sure you’re up to date on your Part B monthly premiums. This will help ensure you can’t be denied coverage for your nebulizer or any other medical service you require.

Medicare may require you to rent or buy your nebulizer and its accessories. In some instances, it might be up to you to decide which you prefer.

Your supplier can usually file your claim with Medicare for you. If you have Original Medicare, you may be asked to pay your portion up front: 20% of the cost of your nebulizer and medications.

In some instances, the supplier may be able to deliver your nebulizer to your home.

To find Medicare-approved DME suppliers in your area, call 800-MEDICARE or use Medicare’s online search tool.

Medications for nebulizers can be filled with a prescription at your DME supplier or at a Medicare-approved pharmacy.

A nebulizer is a small medical device used for breathing therapy. Nebulizers turn liquid medications into a fine mist, which you inhale through a mask or mouthpiece while breathing naturally.

These medications help dilate and relax your bronchial passageways, easing your breathing and promoting airflow into and out of your lungs.

There are three types of nebulizers that your doctor may prescribe for you. These types include:

  • jet
  • ultrasonic
  • vibrating mesh

Your doctor will determine which type is best for your condition.

What diagnosis qualifies for a nebulizer?

Nebulizers are used to treat many conditions, including:

Since nebulizers don’t require deep breaths, they may be more effective than inhalers in some instances.

Learn more: Types of nebulizers and how to use them.

Does Medicare cover Albuterol for nebulizer?

Albuterol (ProAir HFA, Ventolin HFA, and Proventil HFA) is a bronchodilator, which is one of the categories of inhaled medications used with nebulizers covered under Medicare.

How do you get a nebulizer covered by insurance?

For medicare coverage to kick in, an in-network doctor will need to prescribe the inhaler so that it can be deemed medically necessary. In addition, many private insurance companies cover nebulizers, though your specific coverage depends on your plan.

Nebulizers are small breathing-therapy devices that deliver medication into your body. If you’re a Medicare beneficiary, you may be eligible to rent or buy a nebulizer, along with its accessories and medication.

Your doctor must be approved by Medicare and write you a prescription for a nebulizer and medications. To receive maximum coverage, your nebulizer must be purchased or rented through a Medicare-approved supplier that accepts assignment.