Are asthma inhalers covered under Original Medicare? Or do you need a Part D prescription drug plan for that?
According to the Centers for Disease Control (CDC), over 18 million people have asthma. And while many people tend to associate asthma with children, many adults also deal with the condition. Inhalers are the most common method of managing asthma for both children and adults.
What is an asthma inhaler?
An asthma inhaler is a hand-held device that allows you to spray asthma medication through your mouth to inhale directly into your lungs. The medication is put into pressurized canisters that make it easy to get the medication into the lungs.
Asthma can cause coughing, wheezing, and tightness in the chest. During an asthma attack, your airway becomes smaller, making it harder to breathe, and the inhaler helps to mitigate these symptoms.
Your doctor may also prescribe a nebulizer, either in combination with or instead of an inhaler. A nebulizer turns liquid medications into mist so they can be inhaled.
How does Medicare cover inhalers?
An inhaler or a nebulizer may be covered through your Medicare Part B coverage. Both are covered as durable medical equipment (DME), which is defined by Medicare as medical equipment that is durable, intended to stand up to repeated use, and prescribed by a doctor for use outside of a healthcare setting.
You may be required to rent the equipment, purchase the equipment outright, or you may be able to choose between the two. Typically, inhalers are purchased. You pay 20% coinsurance of the Medicare-approved cost (once you've met your Part B deductible). Other common examples of DME include:
- Blood sugar meters
- Canes and walkers
- Continuous Positive Airway Pressure (CPAP) machines
- Infusion pumps
- Oxygen equipment
For DME to be covered, it must be deemed medically necessary by your doctor and the inhaler must come from a supplier that contracts with Medicare. (See the "Additional resources" section for links.)
If you get the inhaler from a provider that does not accept Medicare, you may have to pay the full cost of the equipment, even if it has been prescribed by your doctor.
While Part B covers the inhaler, your Medicare Part D prescription drug plan covers the medication that goes in your inhaler or nebulizer. Check your plan's drug formulary to see which medications it covers and what your copay would be.
Does Medicare Advantage cover inhalers?
Medicare Advantage plans (Medicare Part C) are required by federal law to offer the same level of coverage as Original Medicare Parts A and B. So yes, if the same requirements listed above are met, an Advantage plan will cover an inhaler. However, Part C plans are sold by private insurers, so your cost and coverage options vary depending on the plan you choose.
Most Medicare Advantage plans come with additional benefits, such as dental, vision, and prescription drug care. It is entirely possible that you would pay less for an inhaler through an Advantage plan, but it is best to check with your provider to see exactly what your costs will be.
Does Medigap cover inhalers?
Medicare Supplement Insurance, more commonly known as Medigap, helps cover the out-of-pocket costs associated with Medicare. Medigap plans do not, however, provide additional benefits. Instead, a Medigap plan would pay the 20% coinsurance you would typically pay (once you've met your Medicare deductible). Two Supplement plans, K and L, cover the Part B coinsurance at 50% and 75%, respectively. All other Medigap plans cover 100% of your Part B coinsurance.
You can learn more about how Medicare Supplement Insurance works with our Ultimate Guide to Medigap. And you can compare costs and benefits of Medicare Advantage, Part D, and Medigap plans by entering your zip code in our Find a Plan tool.