Is My Nebulizer Covered Under Medicare?

At AireHealth, we understand that respiratory illness can be scary. AireHealth was founded to impact millions of children who live with asthma positively. We are doing this by making it easy for people with respiratory illness and their caregivers to take a proactive approach in their healthcare.

If your child has been diagnosed with wheezing or another respiratory illness, you probably have a lot of questions about their treatment options. This week we are answering some commonly asked questions about nebulizers — and what it means to be prescribed one while under Medicare.

Why Should Nebulizers Be Covered under Medicare?

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Nebulizers are not only a medical necessity but often a life-changing piece of equipment for patients who experience difficulty breathing. They are a particularly useful way to deliver asthma medications to small children, the elderly, and anyone who finds asthma inhalers challenging to use. Because nebulizers allow the medicine to dissipate into the lungs faster, they provide relief sooner.

The ability to be proactive with their respiratory healthcare is one of the biggest lifestyle concerns many people face. It is essential that the medical community addresses this concern, by giving patients the freedom of choice to improve the management of their care — and in turn their quality of life.

Does Medicare Cover Nebulizers?

Yes, we have great news! Nebulizers are covered by Medicare under Medicare Part B. According to Medicare.gov, Medicare Part B (Medical Insurance) includes the cost of medically necessary durable medical equipment (DME) if your doctor prescribes it for use in your home. Put simply, DME is equipment that helps patients to complete their daily activities and stay proactive in their care.

Does Medicare Cover Nebulizer Medication?

Yes! Medicare Part B also covers certain nebulizer prescription medications that you can use with a nebulizer at home. Nebulizer medication, which is medically necessary and falls within the list of covered drugs, is covered by up to 80% of allowable charges under the Medicare program.

What are Medicare’s rules for Nebulizer coverage?

To receive Medicare Coverage for your nebulizer, you need to meet two conditions. The first is that their doctor provides a signed prescription for their nebulizer and it’s medication after an in-office visit.

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They must also state that you need the nebulizer to help in the treatment of your respiratory illness and that you will use the nebulizer at home. The second condition is that you must source your nebulizer from a supplier with approval from your Medicare plan to get coverage. It is important to note that if your doctor or nebulizer supplier is not enrolled in Medicare, the cost of your nebulizer will not be covered.

How Much Will Medicare Cover For My Nebulizer?

If your child’s doctor and nebulizer supplier are both enrolled in Medicare, Part B, it will be covered by up to 80% of allowable charges after you meet your Part B deductible. If you choose to rent your child’s equipment rather than buy it outright, after 13 months of rental fees, you take full ownership. If your nebulizer requires maintenance or repairs by a professional, as long as they participate with Medicare, you will receive 80% of allowable charges after your deductible. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. It is essential to find out if the nebulizer supplier you are considering participates in Medicare.

If you would like to know more about AireHealth and our smart, connected-portable nebulizer, you can click here and we’ll get back to you! Altenatively, check out some of our other blog posts for useful hints and tips such as how to create an asthma action plan, and how to make your home wheezy-friendly.

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Kirstie HinesComment