Does Medicare cover nebulizers?

What does Medicare cover for nebulizers?

Medicare Part B covers nebulizers and some nebulizer medications as durable medical equipment (DME), if reasonable and necessary. CMS's DME reference list covers nebulizers if your ability to breathe is severely impaired, and CMS's Medicare Benefit Policy Manual lists nebulizers among equipment that is presumed to be medical. Part B covers medically necessary DME if your doctor or other health care provider orders it for use in your home.

Medicare can also pay for supplies needed to use DME effectively, including drugs that must be put directly into the equipment to get its therapeutic benefit. The drug itself still has to be reasonable and necessary for your treatment.

Other kinds of nebulizers are considered for coverage, when reasonable and necessary, only for narrower uses. A large-volume nebulizer and compressor that deliver humidity are covered for people with thick, tenacious secretions who have cystic fibrosis, bronchiectasis, a tracheostomy or a tracheobronchial stent. A small-volume ultrasonic nebulizer is covered only to give treprostinil, and a controlled-dose inhalation system only to give iloprost, to people with pulmonary hypertension who meet the policy's criteria.

Which conditions and drugs qualify?

The coverage policy Medicare's equipment contractors use considers a small-volume nebulizer and its compressor for coverage when they're reasonable and necessary to give FDA-approved inhalation solutions, including:

• Albuterol, arformoterol, budesonide, cromolyn, formoterol, ipratropium, levalbuterol, metaproterenol or revefenacin for obstructive pulmonary disease
• Dornase alfa for cystic fibrosis
• Tobramycin for cystic fibrosis or bronchiectasis
• Pentamidine for HIV, pneumocystosis or complications of organ transplants
• Acetylcysteine for persistent thick or tenacious lung secretions
• Hypertonic saline for cystic fibrosis, bronchiectasis or ciliary dyskinesia
• Ensifentrine as an add-on treatment for chronic obstructive pulmonary disease (COPD) for people on dual or triple long-acting maintenance therapy who still have COPD flare-ups or persistent shortness of breath

What do I pay for a nebulizer and its medicine?

After you meet the Part B deductible ($283 in 2026), you pay 20% of the Medicare-approved amount for a covered nebulizer, if your supplier accepts assignment. Medicare only pays for DME from suppliers enrolled in Medicare.

For Part B-covered drugs, in most cases you pay up to 20% of the Medicare-approved amount after you meet the Part B deductible. Doctors, other health care providers and pharmacies must accept assignment for Part B-covered drugs, so they should never ask you to pay more than the coinsurance or copayment for the drug itself.

What isn't covered?

The coverage policy and policy article Medicare's equipment contractors use deny these nebulizer items and drugs:

• The compressor, the nebulizer and related accessories, if none of the drugs used with the nebulizer are covered
• Compounded inhalation solutions
• A large-volume ultrasonic nebulizer, which offers no proven clinical advantage over a pneumatic compressor and nebulizer
• Prefilled disposable large-volume nebulizers, a convenience item
• Nebulizer equipment used mainly to humidify a room
• Kits and concentrates for cleaning respiratory equipment

Does Medicare Part D cover inhalers and other breathing drugs?

It may. Drugs that aren't given through DME, like metered-dose inhalers, aren't covered under the Part B DME benefit but may be covered under other Medicare benefits, such as Medicare drug coverage (Part D). Some inhalation drugs whose FDA-approved nebulizers aren't durable enough to count as DME, such as aztreonam lysine and amikacin liposome, are denied under the Part B DME benefit but may be eligible under a different benefit, like Part D. See how Medicare covers prescription drugs.

Does Medicare Advantage or Medigap change nebulizer coverage?

Medicare Advantage plans must cover the same medically necessary categories of DME as Original Medicare, but the suppliers you use and your costs depend on the plan. A Medigap policy may help cover some of your costs for covered DME in Original Medicare, like the 20% coinsurance.