How Often Will Medicare Pay for a Nebulizer?

A nebulizer is a medical device that transforms liquid medication into a fine mist for inhalation. This method of medication delivery is frequently used to treat respiratory conditions like asthma or chronic obstructive pulmonary disease (COPD). Understanding Medicare coverage for nebulizers and their supplies is important for beneficiaries. This article explains the coverage rules, supply replacement frequency, associated costs, and steps to obtain these items through Medicare.

Medicare Part B and Nebulizer Coverage

Medicare classifies nebulizers as Durable Medical Equipment (DME), covered under Medicare Part B. For coverage, a healthcare provider must prescribe it for home use, and it must be medically necessary to treat a diagnosed illness or condition. The prescribing doctor and equipment supplier must be Medicare-approved.

The supplier must accept assignment, meaning they agree to accept the Medicare-approved amount as full payment. In some cases, a Certificate of Medical Necessity (CMN) may be required. This document, completed by your doctor, provides detailed information about your medical condition and the nebulizer’s necessity.

Frequency of Nebulizer and Supply Coverage

Medicare generally covers nebulizer machine replacement approximately every five years, with continued medical necessity. If your nebulizer is lost, stolen, or irreparable due to damage, Medicare may cover an earlier replacement. Documentation supporting the need for an early replacement is typically required.

Coverage for nebulizer supplies is provided on a more frequent basis. Medication cups or chambers are usually covered at one to two per month, depending on medical necessity and prescription. Tubing sets and mouthpieces or masks are also commonly covered once per month to ensure proper hygiene and effective medication delivery.

Filters, essential for the nebulizer’s performance and cleanliness, are generally covered monthly or bi-monthly, with coverage for one to two filters per month. Medications administered through the nebulizer are also covered under Part B as part of the DME benefit. The frequency and quantity of these medications are determined by your doctor’s prescription and medical necessity.

Costs for Nebulizer Equipment and Supplies

Under Medicare Part B, beneficiaries are responsible for out-of-pocket costs related to nebulizers and their supplies. You must meet the annual Part B deductible before Medicare begins to pay its share. For 2025, the standard Part B deductible is $240.

After meeting the deductible, Medicare typically pays 80% of the Medicare-approved amount for DME, including nebulizers and their supplies. You are generally responsible for the remaining 20% coinsurance. Confirm your supplier accepts assignment to ensure your costs are limited to this 20% coinsurance.

If a supplier does not accept assignment, they may charge more than the Medicare-approved amount. You could be responsible for the difference, in addition to the 20% coinsurance. Some beneficiaries have supplemental coverage, such as a Medigap policy or a Medicare Advantage (Part C) plan, which may help cover some or all of these out-of-pocket costs.

Steps to Obtain Your Nebulizer and Supplies

Obtaining a nebulizer and its associated supplies begins with your physician. Your doctor will provide a prescription and any necessary medical documentation, such as a detailed written order, to support the equipment’s medical necessity. This documentation is crucial for Medicare coverage.

Next, find a Medicare-approved Durable Medical Equipment supplier. You can typically find approved suppliers through Medicare’s online supplier directory or by asking your doctor for recommendations. Confirm the chosen supplier accepts Medicare assignment to minimize your out-of-pocket expenses.

Once a supplier is selected, they will typically handle the claim submission to Medicare on your behalf. For ongoing supplies, such as medication cups or tubing, you will usually reorder them through your supplier as needed, often requiring a new prescription or doctor’s order periodically to confirm continued medical necessity. Beneficiaries are also responsible for basic maintenance of their nebulizer to ensure its proper function.