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Is a nebulizer considered Durable Medical Equipment (DME)?

Medicare covers nebulizers and associated medication if they are deemed medically necessary.Some types of nebulizers may be covered depending on the medication you require. Medicare
will cover 80% of the cost of qualifying medical equipment. After meeting the Part B deductible, you will be responsible for 20% coinsurance.

Medicare will cover nebulizers if required for medically necessary treatment as they are
considered durable medical equipment (DME).

Since nebulizers are do-it-yourself items that can be utilized at home, it is unlikely that you
would receive this type of treatment as a hospital inpatient. However, it may be covered by
Medicare Part A rather than Part B if you did.

Medicare does not cover nebulizers used for humidifying the home or other non-medical
purposes. Additionally, DME only covers durable and reusable items, so a disposable nebulizer
is not covered.

Medicare Covers Nebulizers for the Following Conditions

● Pulmonary disease with obstruction (COPD)
● The disease is known as cystic fibrosis
● HIV
● Complications of organ transplants
● respiratory secretions
● Depending on which type is covered by your Medicare plan, you may need to rent or
purchase a specific nebulizer.

It is also essential to ensure that both your physician and the supplier of your nebulizer are
Medicare participants. If not, Part B will not cover the expense, and you will be responsible for
the total amount.

Medicare Part C, also known as a Medicare Advantage plan, may offer supplemental coverage
for nebulizers.

These plans offer Original Medicare coverage in addition to additional benefits and services.
If you are interested in expanded coverage for nebulizers or nebulizer medications, investigate
what options a Medicare Advantage plan may offer.

Also read: What are the different health benefits?

Coverage of Nebulizer Medications by Medicare

Some medications requiring a nebulizer are covered by Medicare Part B if deemed medically
necessary. A nebulizer is only available if your medications are also covered.
Medicare will cover the following medications for nebulizer use:

● Albuterol
● Arformoterol
● Budesonide

Some prescription drugs may be considered medically necessary, but they can only be
administered using a non-covered nebulizer, such as a disposable device. In such instances,
the medication is not covered.

Verify with your doctor or healthcare provider whether your insurance covers the recommended
treatment.

Medicare Part D may offer expanded coverage for prescription drugs. Private insurers offer this
optional benefit, which provides coverage for prescription drugs.

nebulizer machine

Who requires a nebulizer, and what is it?

Nebulizers are electronic devices that can treat lung and breathing conditions at home. The
devices function by transforming liquid medication into a mist that can be inhaled. Typically, you
breathe in the medication through a mouthpiece and tube connected to the machine for 10
minutes. It is a simple procedure. Nebulizers are also helpful in treating asthma, cystic fibrosis,
and other breathing-difficult conditions.
Inhalers also treat these conditions, but they are portable and easy to use, whereas nebulizers
require more parts and time.

The two most prevalent Medicare-covered nebulizer types

● The most prevalent and least expensive type, pneumatic compressors, convert liquid
medication into gas through airflow.
● Medicare will only cover ultrasonic or electronic nebulizers for a limited number of
treatments and medications, even though they are more expensive and quieter.
Nebulizers are particularly beneficial for chronic obstructive pulmonary disease (COPD)
individuals.

According to the Centers for Disease Control and Prevention, Sixteen million
Americans have COPD, which includes bronchitis and emphysema.

Replacement and maintenance

Medicare will pay to replace your nebulizer if it breaks beyond repair if you’ve used it for at least
five years.

Medicare will also pay to replace your nebulizer if it is lost, stolen, or irreparably damaged in a
natural disaster or accident. If any of these criteria apply, you will need to provide evidence.
Medicare will cover up to the replacement cost if your nebulizer requires repair during its useful
life.

You may also need to replace various nebulizer components throughout your lifetime. This may
include tubing, an air compressor, infusion bottles, medication cups, mouthpieces, and masks,
among other components.

Medicare does cover replacement parts.

How can I obtain coverage?

To qualify for a nebulizer, you must be diagnosed with the condition that necessitates its use.
You must visit a Medicare-approved provider and apply for the device within six months of the
in-person consultation. COPD and cystic fibrosis are among the diagnoses that may be eligible
for coverage.

Your doctor will provide you with a signed prescription for the nebulizer, accessories, and
medications that you require. These items must be listed as medically necessary to treat your
condition on the prescription. Additionally, it should indicate that the nebulizer and medications
are intended for home use.

You must buy or rent your nebulizer from a Medicare-approved, assignment-accepting supplier
to receive maximum coverage. This indicates that they must accept the Medicare-approved
price for the nebulizer.

Inquire directly with the supplier whether they accept the assignment. Do not assume that all
Medicare-enrolled providers are participants. Medicare-enrolled but nonparticipating suppliers
may charge you any price for your nebulizer. This may exceed the authorized amount.

Summary

Medicare considers nebulizers durable medical equipment, and plans cover 80% of eligible
costs.

Individuals with certain health conditions use nebulizers to deliver medications into the lungs,
thereby facilitating breathing and enhancing airflow. Medicare typically covers the cost of a
nebulizer and its medications when prescribed by a physician. The coverage amount is
dependent on whether the nebulizer is purchased or rented from a Medicare-approved supplier.

BELLE

Juliet Oforma is the owner of eventsmill.org. She is a content creator, relationship adviser, a writer, life philosopher, health, beauty and organic skin care modeler etc. articles are well analyzed before publication as well as editorial articles pertaining to enhance Health and fitness lifestyle, Marketing, Agency and customer Success content.

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