If you struggle with asthma-related symptoms or chronic obstructive pulmonary disease (COPD), a nebulizer and medications may help improve your condition. Some physicians prefer this method of delivering medications to treat respiratory infections or asthma. A nebulizer changes liquid medication into a mist that a patient will inhale, making the breathing treatment more effective. Nebulizers can provide “breathing treatments” for immediate relief from an asthma attack or a respiratory infection, or long-term maintenance for an on-going condition. If your doctor has recommended a nebulizer machine and medications, will Medicare benefits cover the expense?

Buying or Renting DME with Medicare Coverage 
Medicare Part B benefits cover medically necessary services, including doctor visits, outpatient care, and durable medical equipment (DME). DME must be prescribed by your doctor for use in your home. In order for Medicare to cover the costs of a nebulizer, your doctor must determine that you have a medical necessity for the treatment and has to prescribe it for you. Some medications may be covered by Part B for use in the nebulizer if they are considered reasonable and necessary. The doctor’s prescription should include the supplies that you need to use the machine and must outline which condition the nebulizer use addresses.

If your doctor prescribes a nebulizer, it may be rented or purchased from a Medicare-approved supplier. Medicare will only pay for the costs if the supplier is participating in Medicare and accepts assignment. If you have Original Medicare and your supplier accepts assignment you will likely pay 20% of the Medicare-approved amount, and the Part B deductible applies.

If you receive your Medicare coverage through a Medicare Advantage (MA) plan, you will have at least the same benefits as Original Medicare Part A and Part B, but many MA plans offer additional coverage, including prescription drug coverage and an annual out-of-pocket maximum. Contact your plan directly to find the cost of a nebulizer and any medications your doctor prescribes to treat your condition.

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