Medicare Part B covers nebulizers as durable medical equipment, but only if your doctor prescribes one and it meets specific conditions

Medicare will pay for a nebulizer if a doctor writes an order saying you need it to treat a chronic respiratory condition like asthma, COPD, or cystic fibrosis. The machine itself is classified as durable medical equipment (DME), which means Medicare treats it the same way it treats wheelchairs, oxygen tanks, and hospital beds. You pay 20 percent of the approved amount after you meet your Part B deductible; Medicare pays 80 percent.

The catch is that Medicare does not pay for every nebulizer. The device must be medically necessary — meaning your condition cannot be managed adequately with inhalers alone — and your doctor must document that in your medical record. A nebulizer you buy without a prescription, or one prescribed for a condition Medicare does not consider serious enough, will not be covered.

You do not buy the nebulizer outright in most cases. Instead, you rent it from a Medicare-approved DME supplier. The supplier bills Medicare directly, and you pay your share at the time of service. Some suppliers will eventually sell you the machine if you rent it long enough, but that is between you and the supplier — Medicare's role ends once the rental period is complete.

Key Takeaways

  • Your doctor must write a prescription stating that a nebulizer is medically necessary for your condition; Medicare will not cover one without this order.
  • You rent the nebulizer from a Medicare-approved DME supplier, not buy it directly, and you pay 20 percent of the approved rental cost after your Part B deductible.
  • Medicare covers the machine itself but not the medications (albuterol, ipratropium, etc.) that go inside it — those are covered under Part D if you have prescription drug coverage.
  • If your doctor prescribes a nebulizer but you want to buy one instead of renting, you can do so out of pocket, but Medicare will not reimburse you.

How to get a nebulizer covered by Medicare

Start by talking to the doctor who treats your respiratory condition — your primary care doctor, pulmonologist, or asthma specialist. Explain that you are having trouble managing your symptoms with inhalers alone, or that you cannot use an inhaler effectively (for example, if you have arthritis in your hands or trouble coordinating the breath needed for an inhaler). The doctor will examine you and decide whether a nebulizer is the right tool.

If the doctor agrees, they will write a prescription that includes the specific type of nebulizer you need (compressor-driven, mesh, or ultrasonic) and the frequency of use. This prescription goes to a Medicare-approved DME supplier. You can ask your doctor which suppliers they work with, or you can find one yourself using the DME Supplier Locator on Medicare.gov. Call the supplier, give them the prescription, and they will handle the paperwork with Medicare.

The supplier will ask for your Medicare number and will verify your coverage before the nebulizer is delivered. You will receive a bill for your 20 percent coinsurance. The rental typically costs between $50 and $100 per month, depending on the type of machine and your local market, which means your out-of-pocket cost is usually $10 to $20 monthly.

What Medicare does not cover for nebulizers

Medicare covers the machine but not the medications you put in it. Albuterol, ipratropium, budesonide, and other nebulized drugs are covered under Part D (prescription drug coverage) if you have it, or under Part B if the drug is administered in a doctor's office or hospital. If you do not have Part D, you will pay out of pocket for the medications, which can range from $20 to $100 per month depending on the drug and your pharmacy.

Medicare also does not cover replacement parts, filters, or cleaning supplies unless they are essential to the function of the machine and the supplier includes them in the rental agreement. Some suppliers bundle these items into the rental cost; others charge separately. Ask the supplier upfront what is included in the monthly rental.

If your doctor prescribes a nebulizer but you decide to buy one from a pharmacy or online retailer instead of renting from a Medicare supplier, Medicare will not reimburse you. You can do this if you choose, but you will pay the full cost yourself. Nebulizers sold retail typically cost $40 to $300 depending on the type and brand.

When Medicare may deny coverage for a nebulizer

Medicare will deny the claim if there is no doctor's prescription on file. This is the most common reason for denial. The prescription must be recent — usually within the past year — and must state that the nebulizer is medically necessary. A vague prescription ("patient may use nebulizer as needed") is less likely to be approved than one that documents a specific diagnosis and explains why an inhaler is not sufficient.

Medicare may also deny coverage if your condition does not meet their definition of medically necessary. For example, if you have mild, well-controlled asthma and your doctor prescribes a nebulizer as a backup device, Medicare might determine that an inhaler is adequate and deny the claim. In this case, you can ask your doctor to submit additional documentation explaining why the nebulizer is necessary, or you can appeal the decision.

If you have already rented a nebulizer and Medicare denies the claim after the fact, the DME supplier is responsible for pursuing the appeal, not you. However, you may be asked to pay out of pocket while the appeal is pending. Ask the supplier about their policy before you sign the rental agreement.

Renting versus buying a nebulizer

Most people who have Medicare coverage rent their nebulizer because the monthly cost is low and the supplier handles maintenance and repairs. If the machine breaks, you call the supplier and they replace it at no extra charge. This is especially useful if you are not sure whether you will need the nebulizer long-term or if you want to try it before committing to a purchase.

Buying makes sense if you know you will need the nebulizer for years and want to own it outright. A retail nebulizer costs $40 to $300 upfront, depending on the type. You pay for it entirely out of pocket — Medicare will not reimburse a purchase — but you own the machine and can use it as long as it works. You are also responsible for repairs and replacement parts.

Some DME suppliers offer a rent-to-own option: you rent the machine for a set period (usually 12 to 24 months), and after that the machine is yours. The total cost of rent-to-own is often higher than buying outright, but it spreads the cost over time and lets you return the machine if you no longer need it.

What to do if Medicare denies your nebulizer claim

If the DME supplier tells you that Medicare denied the claim, ask them for a written explanation of the denial. Medicare sends a document called a Remittance information that explains the reason. Common reasons include "not medically necessary," "no valid prescription on file," or "exceeds frequency limits."

If you disagree with the denial, you have the right to appeal. The appeal process has several levels: first, the supplier or your doctor can request a review by Medicare; if that fails, you can request a hearing before a Medicare contractor; and if that fails, you can request a hearing before an administrative law judge. Most appeals are resolved at the first level if your doctor provides strong documentation of medical necessity.

To start an appeal, contact the DME supplier and ask them to file on your behalf. If they refuse or if you want to file yourself, you can submit a written appeal to the Medicare Administrative Contractor (MAC) that serves your state. You have 120 days from the date on the denial notice to file.

Frequently Asked Questions

Does Medicare cover nebulizers for children?

Medicare does not cover children because Medicare is for people 65 and older, people with certain disabilities, and people with end-stage renal disease. Children with asthma or other respiratory conditions may be covered by Medicaid (which varies by state) or by private insurance. Parents should contact their child's doctor or their state Medicaid office to learn what is available.

Will Medicare pay for a nebulizer if I have a Medicare Advantage plan?

Most Medicare Advantage plans cover nebulizers under the same rules as Original Medicare — your doctor must prescribe it, and you rent it from an approved supplier. However, your out-of-pocket cost may be different. Some Advantage plans charge a copay instead of coinsurance, or may have different approved suppliers. Call your plan's customer service number to confirm coverage before you order.

Can I get a nebulizer if I do not have a regular doctor?

You need a doctor's prescription to get Medicare coverage, so you will need to see a doctor first. If you do not have a primary care doctor, you can visit an urgent care clinic or a community health center and ask for an evaluation. Bring any medical records you have about your respiratory condition. Once a doctor prescribes the nebulizer, you can proceed with ordering from a DME supplier.

What if I need a nebulizer but my doctor says I do not need one?

If you believe a nebulizer would help you manage your condition, ask your doctor to explain why they do not recommend one. You can also request a second opinion from a pulmonologist or asthma specialist. If a second doctor agrees that a nebulizer is necessary, that doctor can write the prescription and Medicare will cover it based on that prescription.

Do I have to use a Medicare-approved supplier, or can I order from anywhere?

If you want Medicare to pay, you must use a Medicare-approved DME supplier. If you order from a non-approved supplier or buy retail, Medicare will not reimburse you. You can find approved suppliers in your area using the DME Supplier Locator on Medicare.gov, or ask your doctor for a referral.