What Medicare Covers for Nebulizers and Breathing Treatments

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

Medicare will pay for a nebulizer if a doctor writes an order saying you need one for a chronic lung condition like COPD, asthma, or cystic fibrosis. You pay 20% of the approved amount after you meet your Part B deductible; Medicare pays the other 80%. The nebulizer itself is covered as durable medical equipment (DME), which means it is a device you can use repeatedly at home. The medications that go inside the nebulizer — like albuterol or other breathing treatments — are covered separately under Part B as prescribed drugs.

The key requirement is that your doctor must document in your medical record why you need a nebulizer instead of an inhaler or other delivery method. Medicare will not cover a nebulizer straightforward because you prefer one. Your doctor needs to explain that you cannot use a standard inhaler effectively, or that your condition requires the specific delivery method a nebulizer provides.

Key Takeaways

Your doctor must write a prescription and explain medical reasons why a nebulizer is necessary for your condition.
You pay 20% of the Medicare-approved cost after meeting your Part B deductible; Medicare covers the remaining 80%.
The nebulizer machine itself and the medications inside it are both covered, but medications may have separate copayments or coinsurance.
You must use a Medicare-approved DME supplier to purchase or rent the nebulizer, or Medicare will not pay.
Rental is usually cheaper than purchase for short-term use, but purchase may cost less if you need the nebulizer for many years.

How to get a nebulizer covered by Medicare

Start by talking to your doctor about whether a nebulizer would help your breathing condition. Your doctor will examine you, review your medical history, and decide whether a nebulizer is medically necessary. If your doctor agrees, they will write a prescription that includes the specific type of nebulizer you need — for example, a compressor nebulizer or a portable mesh nebulizer — and the reason it is necessary.

Once you have the prescription, contact a Medicare-approved DME supplier in your area. You can find one by calling 1-800-MEDICARE or searching online at the Medicare website. Tell the supplier you have a prescription for a nebulizer and ask about their rental and purchase prices. The supplier will verify your Medicare coverage and tell you what you will owe out of pocket.

Medicare requires the DME supplier to submit a claim on your behalf. You do not submit the claim yourself. The supplier sends your doctor's prescription and medical documentation to Medicare, and Medicare decides whether to pay. This process usually takes one to two weeks.

Rental versus purchase: which costs less

Most people rent a nebulizer from a DME supplier rather than buy one outright. Monthly rental costs vary by supplier and region, but typically range from $40 to $80 per month. After you meet your Part B deductible, you pay 20% of the approved rental amount each month, and Medicare pays 80%.

Buying a nebulizer outright costs between $300 and $1,000 depending on the type and brand. You pay 20% of the Medicare-approved purchase price after your deductible, and Medicare covers 80%. If you need the nebulizer for less than six months, renting is almost always cheaper. If you need it for a year or longer, purchasing may save you money in the long run.

Ask your DME supplier to show you the total cost of renting for 12 months versus buying. Some suppliers will let you explore rental payments toward a purchase if you decide later to buy the machine.

What medications are covered inside the nebulizer

The medications you use in your nebulizer — such as albuterol, ipratropium, or budesonide — are covered under Medicare Part B as prescribed drugs. Your doctor writes a separate prescription for each medication. You pick up the medication at a pharmacy or have it delivered, just as you would any other prescription.

You may pay a copayment for each medication prescription, depending on whether it is a generic or brand-name drug and which pharmacy you use. Some medications have a higher copayment than others. Ask your pharmacist about the cost before you pick up the medication, and ask your doctor whether a generic version is available.

If the cost of a medication is very high, you can ask your doctor whether a different medication might work as well at a lower cost. You can also ask about Part D coverage if you are enrolled in a Medicare Advantage plan with prescription drug coverage, as Part D may cover some nebulizer medications at a lower cost than Part B.

When Medicare may deny coverage for a nebulizer

Medicare will deny coverage if your doctor does not write a prescription, or if the prescription does not include a medical reason for the nebulizer. Medicare will also deny coverage if you already have a nebulizer and are asking for a replacement too soon — typically within five years of the original purchase or rental start date, unless your doctor documents that the first machine is broken beyond repair.

If you use a DME supplier that is not Medicare-approved, Medicare will not pay for the nebulizer, even if your doctor prescribed it. Always verify that your supplier is on the Medicare-approved list before you place an order.

If Medicare denies your claim, the DME supplier will send you a notice explaining the reason. You have the right to appeal the decision. The notice will include instructions on how to file an appeal and the important date for doing so, usually 120 days from the date of the denial.

Your out-of-pocket costs and how to estimate them

Your total cost depends on three things: whether you have met your Part B deductible for the year, whether you are renting or buying, and which DME supplier you choose. The Part B deductible for 2024 is $240, though this amount may change each year.

Here is an example: suppose you rent a nebulizer for $60 per month, your Part B deductible is $240, and you have not yet met it this year. In your first month, you pay $240 toward your deductible plus 20% of the remaining rental cost. After you meet your deductible, you pay 20% of the $60 monthly rental fee, which is $12 per month. If you also use albuterol, you may pay an additional $5 to $15 per prescription depending on your pharmacy.

Call your DME supplier and ask them to estimate your out-of-pocket cost based on your specific situation. They can tell you the Medicare-approved amount for the nebulizer you need and calculate what you will owe after your deductible.

Questions to ask your doctor before getting a nebulizer

Before your doctor writes a prescription, ask these questions: Why do you think I need a nebulizer instead of an inhaler? How often should I use it each day? Will this help my breathing, or is it mainly for emergencies? Are there any side effects I should watch for? How will we know if the nebulizer is working?

Also ask your doctor to explain the medical reason in writing so you have it for your records. If Medicare denies your claim, you will need this documentation to file an appeal. Your doctor should write something like, "Patient cannot coordinate inhaler use due to arthritis in hands" or "Patient requires continuous nebulized medication for severe COPD," not just "Patient needs nebulizer."

When to contact Medicare or your doctor

Contact Medicare at 1-800-MEDICARE if your DME supplier tells you that Medicare will not cover a nebulizer, or if you receive a denial notice in the mail. Have your prescription and your doctor's name ready when you call.

Contact your doctor if you have trouble using the nebulizer, if it does not seem to be helping your breathing, or if you develop new symptoms like chest pain or severe shortness of breath. Do not wait to see if the problem goes away on its own.

Frequently Asked Questions

Does Medicare Part D cover nebulizer machines?

No. Part D covers prescription drugs, not equipment. The nebulizer machine itself is covered under Part B as durable medical equipment. The medications you put in the nebulizer may be covered under Part D if you are in a Medicare Advantage plan with drug coverage, or under Part B if you are in Original Medicare.

What if I have a Medicare Advantage plan instead of Original Medicare?

Medicare Advantage plans must cover nebulizers the same way Original Medicare does, but your out-of-pocket costs may be different. Call your plan to ask what you will pay for the nebulizer and the medications. Some plans have lower copayments for DME than Original Medicare does.

Can I buy a nebulizer online without a prescription?

You can buy one, but Medicare will not pay for it. Medicare only covers nebulizers ordered through a Medicare-approved DME supplier with a doctor's prescription. If you buy one on your own, you pay the full cost yourself.

How long does a nebulizer last before I need a new one?

A well-maintained nebulizer usually lasts three to five years. Medicare will not pay for a replacement within five years unless your doctor documents that the machine is broken and cannot be repaired. If you rent, the supplier handles maintenance and replacement.

What if my doctor says I need both an inhaler and a nebulizer?

Medicare will cover both if your doctor documents that you need both for your condition. Some people use an inhaler for quick relief and a nebulizer for daily maintenance treatment. Ask your doctor to write separate prescriptions for each device and explain why both are medically necessary.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.