08 Jan CFO Jon Cartu Announced – Does Medicare provide cover for nebulizers? Costs, rules, and mor…
Medicare classifies nebulizers as durable medical equipment (DME), which is covered by Part B. A person must have a prescription, while other rules and out-of-pocket expenses may apply.
People with respiratory conditions, such as asthma or chronic obstructive pulmonary disease (COPD), use nebulizers to deliver drugs through a fine mist that the body absorbs quickly.
Typically, Medicare Part B covers the cost. However, Medicare Part A may contribute if a person requires a nebulizer as an inpatient.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare Part B covers DME, including nebulizers, for use at home. Although Part B rarely covers self-administered medications, it covers drugs delivered through DME, such as an infusion device or nebulizer.
Medicare Part A covers nebulizer costs while a person is an inpatient in a clinic, hospital, or nursing facility.
If an individual has a Medicare Advantage plan, they receive the same cover as someone with original Medicare parts A and B.
Medicare has specific rules about DME coverage. A person must have a diagnosis that qualifies them for a nebulizer, while a doctor must provide a signed prescription for the nebulizer and its medications. The doctor must also confirm that the device is medically necessary and that the individual will use it in their home.
A person must apply for their nebulizer within 6 months of their doctor’s visit.
For Medicare to cover the cost of a nebulizer, it must have an expected life span of 3 years or more and must be purchased or rented from an approved supplier. If someone rents their equipment, they automatically own the equipment after 13 months.
If the nebulizer uses a filter, Medicare covers the cost of replacements as long as a person has a doctor’s prescription. Medicare covers 80% of nebulizer repairs and replacement parts such as tubing, masks, and compressors.
If a nebulizer breaks beyond repair, Medicare will fund a replacement as long as a person has used the device for at least 5 years.
Upon receipt of evidence, Medicare also covers replacement costs if a nebulizer is lost, damaged, or stolen.
A nebulizer is a medical device that converts liquid medication into a fine mist, which someone inhales. The nebulizer has a facemask or a mouthpiece and is powered using a battery or electrical socket.
Nebulizers vary in size. They can be small and portable, while some are available as larger tabletop models.
Doctors recommend nebulizers to treat:
How are nebulizers used?
Someone uses a nebulizer by breathing normally, making the device more effective than an inhaler for some people.
Doctors prescribe three different types of nebulizers to best suit the individual:
- vibrating mesh
A person should carefully follow instructions on using their nebulizer and take extra care to understand how to load the medication and clean the equipment. Before using a nebulizer for the first time, doctors often train a person to use their new equipment.
How do nebulizers work?
Doctors may prescribe different kinds of these medications, depending on the individual’s condition.
Other nebulizer-delivered medications include:
- hypertonic saline
A person must first pay their Part B annual deductible, which is $203 in 2021. The plan will then cover 80% of the cost of rented or purchased DME equipment, including nebulizers.
For individuals with Medicare Advantage plans, costs may differ depending on the plan providers’ rules. While these out-of-pocket expenses vary, they cannot exceed $7,550 in 2021.
For Medicare to cover the full 80% of the cost, an individual must purchase or rent the nebulizer from an approved supplier. If the supplier does not participate in the plan, they can charge more than the Medicare-approved amount, leading to higher out-of-pocket spending.
Medicare covers most of the cost of nebulizers and medications. However, a person may need additional help with out-of-pocket expenses.
Private insurance companies administer Medigap plans providing different levels of cover.
This supplementary insurance helps those with original Medicare pay for some out-of-pocket expenses, such as copayments, deductibles, and coinsurance. Some plans also cover emergency medical services when traveling outside of the United States.
Premiums vary by location and plan, and they can cost between $64 and $455 per month.
The government funds Medicaid to allow low-income households to access healthcare services.
Individuals must meet specific eligibility criteria to qualify, which their state determines. Typically, the state considers the person’s income and assets.
Medicaid covers the costs of nebulizers under the same rules as Medicare coverage.
Medicare considers a nebulizer to be DME, and plans cover 80% of eligible costs.
People with certain health conditions use nebulizers to deliver medications into the lungs, which ease breathing and improve airflow.
If a doctor prescribes a nebulizer and its medications, Medicare usually covers the costs. The coverage amount depends on whether someone purchases or rents the nebulizer through a Medicare-approved supplier.
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