Medicare covers nebulizers, but only when a doctor prescribes one for a medical reason and you meet specific equipment rules

Medicare Part B covers nebulizers as durable medical equipment (DME) — the same category that includes wheelchairs, oxygen tanks, and CPAP machines. The catch is that Medicare will not pay for a nebulizer just because you want one. A doctor must write an order saying you need it to treat a condition like asthma, COPD, or cystic fibrosis. You also have to rent or buy it from a Medicare-approved DME supplier, not from a pharmacy or online retailer.

How much you pay depends on whether you rent or buy, and whether you have already met your Part B deductible for the year. Medicare typically covers 80 percent of the approved amount after you pay the deductible; you pay the remaining 20 percent. If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower.

Key Takeaways

  • Your doctor must write a written order for a nebulizer before Medicare will consider covering it.
  • You must obtain the nebulizer from a Medicare-approved DME supplier, not a retail pharmacy or online store.
  • Medicare covers 80 percent of the approved rental or purchase price after you meet your Part B deductible; you pay 20 percent.
  • Renting a nebulizer is usually cheaper upfront than buying one, but buying may cost less over time if you need it for years.
  • If you have a Medigap or Medicare Advantage plan, your actual cost-sharing may be different from the standard 20 percent.

How to get your doctor's order

Start by talking to the doctor who treats your respiratory condition — your primary care doctor, pulmonologist, or respiratory specialist. Explain that you need a nebulizer at home and ask whether they think it would help your treatment. If they agree, ask them to write a written order (sometimes called a prescription or DME order) that includes your diagnosis, the type of nebulizer you need, and how often you should use it.

Your doctor does not need to send the order to Medicare themselves. You can take it to a Medicare-approved DME supplier, or the supplier can contact your doctor directly to request it. Either way, the supplier will verify that your order meets Medicare's rules before they rent or sell you the equipment.

Finding a Medicare-approved DME supplier

Not every medical supply store or pharmacy is a Medicare-approved DME supplier. You can search for one in your area using the Medicare DME Supplier Directory on Medicare.gov. Go to the "Suppliers" section, enter your ZIP code, and look for suppliers listed as approved for "oxygen and respiratory equipment" or "nebulizers."

Call at least two or three suppliers and ask about their rental and purchase prices for the type of nebulizer your doctor ordered. Prices vary between suppliers, so comparing can save you money. Ask each supplier whether they will bill Medicare directly (which means you pay only your share) or whether you have to pay upfront and then submit a claim yourself.

Renting versus buying a nebulizer

Medicare allows you to either rent or buy a nebulizer, and the cost difference matters. Renting usually costs less per month — typically $30 to $60 — but the rental payments add up over time. If you rent for more than a few years, the total cost can exceed the purchase price.

Buying a nebulizer outright usually costs between $300 and $800 for a basic model, depending on the type. Medicare will cover 80 percent of the approved purchase price after your deductible. Once you own it, there are no more monthly payments, though you may need to replace parts like tubing or masks over time.

If you are not sure how long you will need the nebulizer, renting is often the safer choice. If your doctor says you will need it for years, buying may save money in the long run. Ask your DME supplier to show you the total cost of renting for one year, two years, and three years so you can compare it to the purchase price.

What happens after you choose a supplier

Once you have selected a supplier and given them your doctor's order, the supplier will submit the order to Medicare for review. This step is called prior authorization — Medicare checks that the order meets their rules before approving payment. This usually takes a few days to a week.

If Medicare approves it, the supplier will contact you to arrange delivery or pickup. You will pay your share (usually 20 percent of the approved amount, after your deductible) at that time or receive a bill later. The supplier will bill Medicare for their share directly.

If Medicare denies the order, the supplier will tell you why. Common reasons include that your diagnosis does not match Medicare's coverage rules, or that the order did not include enough detail. Your doctor can revise the order and resubmit it, or you can file an appeal if you believe Medicare made a mistake.

Nebulizer types and what Medicare covers

Medicare covers several types of nebulizers: standard tabletop models, portable battery-powered models, and mesh nebulizers (which are quieter and faster). The type your doctor orders depends on your condition and how you will use it — at home, at work, or while traveling.

Medicare also covers the supplies that go with a nebulizer: tubing, masks, mouthpieces, and medication cups. These are considered part of the equipment and are usually included in the rental or purchase price. If you need to replace them later, ask your supplier whether Medicare will cover replacements or whether you have to pay out of pocket.

If you have a Medicare Advantage or Medigap plan

If you are enrolled in a Medicare Advantage plan (Part C), your coverage for nebulizers may be different from Original Medicare. Some Advantage plans cover DME the same way Original Medicare does; others have different rules, deductibles, or copays. Call your plan's customer service number (on the back of your card) and ask specifically about nebulizer coverage before you contact a supplier.

If you have a Medigap plan, it may cover some or all of the 20 percent you would normally pay out of pocket. Check your plan documents or call your Medigap insurer to find out what they cover for DME.

Frequently Asked Questions

Does Medicare cover nebulizers for children?

Yes, if a doctor prescribes one. The same rules explore: the child must have a medical condition that requires a nebulizer, and the equipment must come from a Medicare-approved DME supplier. If the child is under 19 and covered by Medicaid instead of Medicare, Medicaid rules explore — contact your state Medicaid program for details.

What if my doctor prescribed a nebulizer but Medicare denied it?

Ask your doctor or the DME supplier why Medicare said no. Common reasons include that the diagnosis code was missing or incorrect, or that Medicare does not cover that particular type of nebulizer. Your doctor can submit a revised order, or you can file an appeal with Medicare if you believe the denial was wrong.

Can I buy a nebulizer from a pharmacy instead of a DME supplier?

Medicare will not cover a nebulizer from a pharmacy or retail store, even if your doctor prescribed it. You must use a Medicare-approved DME supplier. If you buy from a pharmacy out of pocket, Medicare will not reimburse you.

Do I have to pay my Part B deductible before Medicare covers a nebulizer?

Yes. You must meet your annual Part B deductible first. Once you do, Medicare covers 80 percent of the approved amount and you pay 20 percent. If you have already met your deductible earlier in the year, you will only owe the 20 percent copay.

Will Medicare cover a replacement nebulizer if mine breaks?

Medicare may cover a replacement if the original equipment is no longer working and cannot be repaired. Your doctor will need to write a new order, and you will go through the same approval process. If you are still within the rental period, contact your supplier first — they may repair or replace it at no cost to you.