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Does Medicare Cover Nebulizers? Yes, Medicare will cover the cost a nebulizer, medication and supplies if your condition requires it. Medicare covers nebulizers for patients who need treatment for respiratory problems and certain other diseases. To ensure that Medicare pays for your nebulizer you must follow the steps below: Only your doctor can prescribe a nebulizer for you, so do not order anything until you have visited your doctor, no matter what the sales person tells you. The doctor must document the need by writing information in your medical records that supports the medical necessity for a nebulizer and give you a signed and dated order (prescription) for it. The order must be received by the supplier before Medicare is billed and it must be kept on file by the supplier. If you receive your Medicare through one of Medicare Medical Advantage Plans (like a HMO, PPO) it is likely you will have to follow the plan's steps for approval and purchase. Make a point of calling your plan's customer service number and ask about their steps for coverage of a nebulizer. Qualifying for Nebulizers You must have Medicare's part B coverage and your doctor must have documented your need for the Nebulizer and required medications. The doctor must also write you an order (prescription) for the supplies clearly stating which supplies you will need. Medicare will cover a nebulizer for patients with certain respiratory problems and other illness that cause breathing problems or require the equipment for medication delivery, and can include any of the following conditions: Chronic Bronchitis Emphysema Asthma Human immunodeficiency virus ( HIV ) Cystic fibrosis (CF ) Brochiectasis Pneumocystosis Complications of organ transplants Tracheostomy Persistent thick or tenacious pulmonary secretions. Buying Nebulizers and Nebulizer Supplies You will save money if you order from a Medicare approved supplier. Suppliers must meet strict standards to qualify as a Medicare supplier and will have a Medicare supplier number. You may also buy your supplies from any store that sells them. However, Medicare will not pay for the equipment from any supplier that is not enrolled in the Medicare program. Things you should think about before you choose a supplier: There are two types of Medicare suppliers, participating suppliers and those who are enrolled but have chosen not to participate. Participating suppliers will not charge more than the Medicare allowed amount. A Medicare approved supplier who does not want to participate can charge more than the Medicare-approved amount. However, they cannot charge more than 15 percent above the Medicare-approved amount. They may also ask you to pay the entire bill when you pick up the nebulizer. In this situation Medicare will send the reimbursement directly to you. However, be prepared to wait; it may take a couple months to receive payment. If you receive your Medicare coverage through a Medicare Advantage Plan (HMO or PPO), it is likely that the plan will have its own steps for equipment purchases. In addition, the plan may have restrictions on the supplier from which you can buy. It is important to know that your health plan must supply at least what Medicare covers -- they cannot supply less. Depending on your plan you may actually receive more coverage than you would get with Medicare alone. It is wise to call your Medicare Advantage Plan's customer service and ask about your coverage before you order a nebulizer and supplies. Costs Associated with Nebulizers Nebulizers are in the Capped Rental category for durable medical equipment; that means you may choose to rent or purchase a nebulizer. How much you pay will depend on whether or not you have Part B coverage and where you buy your equipment. However in general if you are enrolled in Medicare Part B: After you have paid your yearly deductible, you will pay 20% of the approved Medicare amount. You will pay less if you buy from a supplier who accepts assignment. A supplier who accepts assignment has agreed to accept the Medicare payment as full payment and will not ask for more than your 20% deductible. If you have MediGap/Supplemental Insurance you may owe little to nothing. If you receive you Medicare through a Medicare Advantage Health Plan, you may be restricted on who you buy your Nebulizer from and you should contact your health plan for more details. It is important to do your homework. Read about the factors that affect how much coverage you will receive. Make sure all paperwork is completed correctly and that you buy your equipment through an approved supplier that accepts assignment. Medication Coverage with Nebulizers There are a number of medication that may be approved for use in a nebulizer. These are the most common medication that are available for use in a nebulizer: Albuterol Sulfate: Works by opening the airways of the lungs. It is a short acting medication. It helps to: Relaxes and opens airways Prevents spasms and contractions Helps prevent exercise induced wheezing Helps clear mucus that causes congestion Helps prevent nocturnal asthma attacks Ipratropium Bromide: Is a bronchodilator medication that has long acting results. It helps to: Opens airways Dries up secretions, which can cause mucous plugging Acetylcystine: Is used for people that have excessive mucous build up in their lungs. It helps to: Thin mucous secretions in lungs Help encourage coughing and removal of mucous Note: Medicare does not cover disposable nebulizers; they are considered to be convenience items. Also, Medicare does not cover the nebulizer unless the related medication is covered. Your Medicare coverage will include necessary supplies for use of the nebulizer. You can buy up to a three month's supply of nebulizer medications and accessories at a time.