Medicare covers nebulizers as durable medical equipment if your doctor prescribes one for a respiratory condition

Medicare Part B covers a nebulizer when a doctor determines you need one to treat a condition like asthma, COPD, or other chronic lung disease. The nebulizer must be prescribed by your doctor, and you will typically pay 20% of the approved amount after you meet your Part B deductible. Medicare does not cover the medication that goes inside the nebulizer — you pay for that separately through your prescription drug coverage or out of pocket.

The coverage applies whether you rent or buy the equipment. If you rent, Medicare pays the supplier directly for the rental cost, and you pay your 20% share. If you buy one, Medicare covers 80% of the approved amount. After you have rented for about 13 months, the supplier owns the equipment and you stop paying rental fees, though Medicare's payments to the supplier also stop.

Key Takeaways

  • Your doctor must write a prescription for the nebulizer and document that you have a respiratory condition that requires it.
  • You pay 20% of the Medicare-approved amount after meeting your Part B deductible; the exact cost depends on what your supplier charges and what Medicare approves.
  • Medicare covers the equipment itself but not the medication (albuterol, ipratropium, or other drugs) that you use in it.
  • You must use a Medicare-approved supplier, which you can find through your doctor's office or by calling Medicare directly.
  • If you rent the nebulizer for about 13 months, the supplier owns it after that and you no longer pay rental fees.

How to get Medicare to cover your nebulizer

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

Your doctor's office usually handles the next step: they contact a Medicare-approved durable medical equipment (DME) supplier on your behalf. The supplier verifies your Medicare coverage, confirms you have met or are working toward your Part B deductible, and arranges delivery. You do not have to use the supplier your doctor recommends, but using one they work with regularly often speeds up the process.

If your doctor does not have a supplier relationship, you can find one yourself. Call Medicare at 1-800-MEDICARE (1-800-633-4227) and ask for a list of approved suppliers in your area. When you contact the supplier, have your Medicare number and your doctor's prescription ready.

What Medicare approves and what it does not

Medicare covers the nebulizer machine itself — the compressor, tubing, mask or mouthpiece, and cup where the medication sits. The equipment must be prescribed by a doctor and deemed medically necessary. Medicare also covers replacement parts like tubing and masks if they wear out during normal use, though the supplier usually handles ordering these.

Medicare does not cover the liquid medications you put in the nebulizer. Drugs like albuterol, ipratropium, or combination inhalers are covered under your Part D prescription drug plan if you have one, or you pay out of pocket. Some people find that using a nebulizer costs less per dose than using an inhaler, but the medication cost is separate from equipment coverage.

Medicare also does not cover a nebulizer if your doctor prescribes it for a condition that does not require one — for example, if you have mild asthma that responds well to a rescue inhaler, Medicare may deny the claim. Your doctor's documentation of medical necessity is what Medicare reviews.

Renting versus buying a nebulizer

You can choose to rent or buy, and Medicare covers both. Renting is often the better choice if you are unsure whether you will need the nebulizer long-term or if you want to avoid a large upfront cost. You pay a monthly rental fee (the amount varies by supplier and region), and Medicare covers 80% after your deductible. After about 13 months of rental payments, the supplier owns the equipment and you stop paying.

Buying means you pay the full purchase price upfront, and Medicare reimburses you 80% of the approved amount. The approved amount is set by Medicare and may be less than what the supplier charges. If the supplier charges $400 and Medicare approves $300, you pay 20% of $300 ($60) and Medicare pays $240 — you are responsible for the $100 difference between the approved and actual price. Always ask the supplier what the Medicare-approved amount is before you buy.

Some people rent first to try out the equipment, then buy if they know they will need it for years. Others buy when ready if they have already met their deductible and want to own the equipment outright. There is no wrong choice, but understanding the math helps you decide what makes sense for your situation.

Your out-of-pocket costs

Your costs depend on whether you have met your Part B deductible and whether you rent or buy. For 2024, the Part B deductible is $240 per year. Once you meet it, you pay 20% of the Medicare-approved amount for the nebulizer.

If you rent, a typical monthly cost to you might be $15 to $30 after your deductible is met, depending on the supplier and your region. If you buy, you might pay $60 to $100 out of pocket (20% of a $300 to $500 approved amount), again depending on the supplier and what Medicare approves.

These are estimates. The actual amount varies by supplier, by region, and by what Medicare's approved amount is in your area. Before you commit to renting or buying, ask the supplier for a written estimate of what you will owe. The supplier should also tell you whether your deductible has been met.

What to do if Medicare denies your claim

If Medicare denies coverage, the supplier will send you a notice explaining why. Common reasons include: your doctor did not document medical necessity clearly enough, your condition does not typically require a nebulizer, or the supplier was not Medicare-approved.

You have the right to ask Medicare to reconsider. This is called an appeal. You have 120 days from the date on the denial notice to file. Ask your doctor to provide additional documentation of why you need the nebulizer — for example, test results showing your lung function, a list of medications you have tried, or notes about why an inhaler does not work for you. Send this to Medicare along with a written request for reconsideration.

If the denial was because the supplier was not approved, ask your doctor to write a new prescription and contact a different supplier. If the denial was because your doctor did not document medical necessity, ask your doctor to add more detail to your medical record and resubmit the claim.

Questions to ask your doctor

Before your doctor prescribes a nebulizer, ask: "Do I need a nebulizer, or would an inhaler work as well?" Some people do better with a nebulizer because it is easier to use or delivers medication more effectively, but not everyone needs one. Ask your doctor to explain why a nebulizer is the right choice for you.

Also ask: "Will you send the prescription to a supplier, or do I need to find one myself?" and "What type of nebulizer do you recommend — a standard compressor or a portable mesh model?" Your doctor may have a preference based on your condition and lifestyle. Finally, ask: "Will Medicare cover this, or should I expect a denial?" Your doctor has seen many insurance decisions and can often predict whether Medicare will approve.

Frequently Asked Questions

Does Medicare Part D cover the medication for the nebulizer?

Yes, if you have a Part D prescription drug plan. Medications like albuterol and ipratropium are covered as prescription drugs, not as part of the equipment benefit. You pay your plan's copay or coinsurance for each prescription. If you do not have Part D, you pay the full cost of the medication out of pocket.

Can I use a nebulizer I already own, or do I have to get one through Medicare?

You can use a nebulizer you already own. Medicare does not require you to use a new one. However, if you want Medicare to cover the cost of a new nebulizer, it must be prescribed by your doctor and obtained through a Medicare-approved supplier.

What happens if I move to a different state?

If you are renting a nebulizer and move, contact your supplier to let them know. They may be able to continue serving you, or they may transfer your rental to a supplier in your new state. If you own the nebulizer, you can take it with you — there are no restrictions on moving with durable medical equipment.

Does Medicare cover a portable or travel nebulizer?

Yes, if your doctor prescribes one. Portable mesh nebulizers are more expensive than standard compressor models, but Medicare covers them the same way — you pay 20% of the approved amount after your deductible. Ask your supplier what the Medicare-approved amount is for a portable model before you choose one.

What if my nebulizer breaks and needs repair?

If you are renting, contact your supplier — they are responsible for repairs and replacement. If you own the nebulizer, repairs are your responsibility. Some suppliers offer repair services for a fee, or you may be able to buy a replacement part. Ask your supplier about warranty and repair options when you get the equipment.