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Does Medicare Cover Nebulizers?
Yes, Medicare will cover the cost of a nebulizer, medication, and supplies if it is deemed medically necessary by your doctor. 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 Advantage Plans (like an HMO or 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 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
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 if you are enrolled in Medicare Part B:
- You will pay 20% of the approved Medicare amount, after you have paid your yearly deductible.
- 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.
- You may owe little to nothing if you have Medigap/Medicare Supplemental Insurance.
- You may be restricted on who you buy your nebulizer from if you receive your Medicare through a Medicare Advantage Plan.
- 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 medications that may be approved for use in a nebulizer. These are the most common medications 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:
- Relax and open airways
- Prevent spasms and contractions
- Prevent exercise-induced wheezing
- Clear mucus that causes congestion
- Prevent nocturnal asthma attacks
Ipratropium Bromide: It is a bronchodilator medication that has long acting results. It helps to:
- Open airways
- Dry up secretions, which can cause mucous plugging
Acetylcystine: It is used for people that have excessive mucous build up in their lungs. It helps to:
- Thin mucous secretions in lungs
- 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 supply of nebulizer medications and accessories at a time.
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