Medicare covers nebulizers as durable medical equipment, but only when a doctor prescribes one for a medical reason and you meet specific requirements.
Medicare Part B pays for a nebulizer if your doctor writes an order saying you need it to treat a chronic lung condition — asthma, COPD, cystic fibrosis, or similar diagnoses. You do not buy the nebulizer outright in most cases. Instead, Medicare pays a rental fee to a supplier, and you use the equipment at home. The supplier must be enrolled with Medicare, and your doctor's prescription must show medical necessity.
The amount Medicare pays depends on the type of nebulizer and how long you rent it. For a standard compressor nebulizer, Medicare typically covers the rental cost, the medication cup and tubing, and repairs or replacements if the equipment breaks. You pay 20 percent of the Medicare-approved amount after you have met your Part B deductible for the year.
Key Takeaways
- Your doctor must write a prescription for the nebulizer and document that you have a condition that requires it — Medicare will not cover it without medical necessity.
- You rent the nebulizer from a Medicare-enrolled supplier rather than purchasing it, and Medicare pays the rental fee directly to the supplier.
- You pay 20 percent of the Medicare-approved rental cost after meeting your Part B deductible; the exact amount varies by supplier and equipment type.
- The supplier is responsible for delivering, maintaining, and replacing the nebulizer if it malfunctions during the rental period.
- If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower because those plans often cover the 20 percent coinsurance.
How to Get Medicare to Cover Your Nebulizer
Start by talking to your doctor about whether a nebulizer would help your condition. If your doctor agrees, they will write a prescription that includes the medical reason you need it. The prescription goes to a Medicare-enrolled durable medical equipment (DME) supplier — not a pharmacy, and not directly to Medicare.
You can find Medicare-enrolled suppliers by calling 1-800-MEDICARE or searching the Medicare supplier directory online at cms.gov. When you contact a supplier, give them your Medicare number and your doctor's prescription. The supplier will verify your coverage, tell you what you will owe, and arrange delivery. The entire process usually takes one to two weeks from the time your doctor sends the prescription.
Keep a copy of your doctor's prescription and the supplier's paperwork. If Medicare denies the claim, you will need these documents to appeal.
What Types of Nebulizers Medicare Covers
Medicare covers compressor nebulizers, which are the most common type. These machines use compressed air to turn liquid medication into a fine mist you breathe in through a mask or mouthpiece. The equipment includes the compressor unit, tubing, medication cup, and mask or mouthpiece.
Mesh nebulizers (also called vibrating mesh nebulizers) are newer and quieter than compressor models, but Medicare coverage for mesh nebulizers is more limited. Some suppliers rent them, but you may have a higher out-of-pocket cost, or Medicare may not cover them at all depending on your specific situation. Ask your supplier whether a mesh nebulizer is an option and what Medicare will pay toward it.
Portable or travel nebulizers may also be covered, but again, coverage varies. Your supplier can tell you which models are covered under your plan and what your costs will be.
Your Out-of-Pocket Costs
After you meet your Part B deductible for the year, you pay 20 percent of the Medicare-approved rental cost. The approved amount is set by Medicare and does not change based on the supplier's list price. If a supplier charges more than the Medicare-approved amount, they cannot bill you for the difference — that is called balance billing, and it is illegal.
Rental costs vary, but a typical compressor nebulizer rental might be approved at $50 to $100 per month by Medicare, meaning you would owe $10 to $20 per month after your deductible is met. You continue paying this monthly coinsurance for as long as you rent the equipment.
If you have a Medigap policy (supplemental insurance), it will usually cover your 20 percent coinsurance, so your out-of-pocket cost drops to zero. If you have a Medicare Advantage plan, check your plan documents or call the plan to find out what you owe for DME rentals — coverage varies by plan.
When Medicare Will Not Cover a Nebulizer
Medicare will not pay for a nebulizer if your doctor does not prescribe one or if the prescription does not include a medical reason. Conditions that typically may have access to include asthma, COPD, emphysema, cystic fibrosis, and bronchiectasis. If you have a condition your doctor thinks might benefit from a nebulizer but is not on a standard list, ask your doctor to document why the nebulizer is medically necessary for your specific case.
Medicare also will not cover a nebulizer you purchase yourself. If you buy one without going through a Medicare-enrolled supplier, Medicare will not reimburse you. The only exception is if you choose to purchase a nebulizer instead of renting it — in that case, Medicare may cover part of the purchase price, but you will owe more out of pocket than you would with a rental.
If Medicare denies your claim, the supplier will send you a notice explaining why. You have the right to appeal. Contact your doctor's office and the supplier to find out what information Medicare needs to reconsider.
Renting Versus Buying a Nebulizer
Most people rent a nebulizer through Medicare because the monthly cost is lower than buying one outright. A new compressor nebulizer can cost $300 to $500 to purchase, while monthly rental costs are typically $50 to $100 before insurance. If you rent for more than a few months, the rental cost eventually exceeds the purchase price, but Medicare does not require you to switch to buying at that point — you can keep renting as long as you need the equipment.
If you decide to purchase a nebulizer instead of renting, Medicare will cover a portion of the cost, but the amount is usually less than the rental reimbursement, and you will owe more out of pocket. Talk to your supplier about whether purchasing makes sense for your situation.
Some people buy a nebulizer out of pocket if they want a specific model that is not available through Medicare, or if they want to own the equipment outright. That is a personal choice, but Medicare will not help pay for it.
What Happens if Your Nebulizer Breaks
If your rented nebulizer stops working, contact your supplier right away. The supplier is responsible for repairing or replacing it at no cost to you — that is part of the rental agreement. The supplier will either fix the equipment or send you a replacement, usually within a few days.
Do not try to repair the nebulizer yourself or take it to a repair shop not affiliated with your supplier. If you damage it intentionally or through misuse, the supplier may charge you a repair fee or ask you to pay for a replacement. Normal wear and tear is covered, but damage from dropping it or using it incorrectly is not.
Frequently Asked Questions
Do I need a prescription from my doctor to get a nebulizer covered by Medicare?
Yes. Your doctor must write a prescription that includes the medical reason you need the nebulizer. Without a prescription and documented medical necessity, Medicare will not cover it. The prescription goes to a Medicare-enrolled supplier, not to a pharmacy.
Can I use any supplier, or does it have to be a specific one?
You can use any Medicare-enrolled supplier. Call 1-800-MEDICARE or search the Medicare supplier directory to find one near you. Different suppliers may have different equipment options and delivery times, so it is worth calling a few to compare.
What if my doctor prescribed a nebulizer but Medicare denied it?
Ask your supplier for a copy of the denial notice, which will explain why Medicare said no. Common reasons include missing information on the prescription or a condition Medicare does not consider a medical reason for a nebulizer. Work with your doctor to provide more detail or documentation, then ask the supplier to resubmit the claim.
Will my Medicare Advantage plan cover a nebulizer the same way Original Medicare does?
Medicare Advantage plans must cover nebulizers at least as well as Original Medicare does, but coverage details vary by plan. Some plans may have different suppliers, different equipment options, or different out-of-pocket costs. Call your plan to find out what is covered before you contact a supplier.
Can I rent a nebulizer from a medical supply store that is not enrolled with Medicare?
You can, but Medicare will not pay for it. If you rent from a non-Medicare supplier, you will owe the full cost yourself. Always verify that your supplier is Medicare-enrolled before you sign any paperwork.