Which inhalers are covered by Medicare Part B vs Part D?
Answered by 11 licensed agents
The best way to answer this is to give a list of inhalers you like to an agent or put them into a medicare rx calculator. Every insurance company is different.
Medications that have to be picked up a pharmacy and are self-administered are almost always charged to your part D coverage. If a doctor has to administer the medication, these are almost always charged to your Medicare Part B coverage
Most inhalers are covered under Medicare Part D because you pick them up at the pharmacy and use them at home (like albuterol or maintenance inhalers).
Medicare Part B only covers inhaled medications in more specific situations — typically when they’re given through durable medical equipment, like a nebulizer used at home. So for most people, if it’s a handheld inhaler, it’s Part D; if it’s tied to a nebulizer setup, it may fall under Part B.
A simple way to think about it is this: if it’s a typical inhaler you get from the pharmacy, it’s usually covered by Part D. If the medication is used through a nebulizer machine that Medicare considers durable medical equipment, it may fall under Part B instead. A lot of people don’t realize the delivery method is what often determines which part of Medicare pays.
The simple answer is…if the inhalers are hand held and prescribed then they are typically covered under part D. If they are in liquid form and require a nebulizer then Part B is utilized. Under Part B, the patient will pay the deductible, if there is one and then 20% of the cost unless they have a Medicare supplement or advantage plan. With an advantage plan with drug coverage or a stand alone drug plan, the max out of pocket is $2100. After that, the patient will receive the handheld inhalers for $0.
Inhalers are usually listed on a plan's formulary, though they may have varying, high-cost copays. Coverage applies to both brand-name and generic, with specific costs depending on the plan's tiers and if you have reached the coverage gap.
As a broker, I compare all inhalers against all drug plans. There are many plans that cover specific inhalers and many that do not. With the abundance of inhalers on the market, it is definitely worth talking with a broker and your doctor to find the right plan that covers the right inhalers for you. As a broker that uses inhalers, I understand the struggle.
This could vary based on carrier but normally, if it an inhaler that you can pick up at a pharmacy, it most likely will be billed under Part D. If it is a machine and you have to get a liquid vile, or dispensed in a doctors office, it normally is billed under Part B.
Your Insurance agent/broker can help you determine this by calling the insurance carrier/provider to clarify this
Part B covers medicarions that are typically administered in a Dr's office. Breathing treatments which can be done at home can use medication that is paid under part B.
Most handheld inhalers that you use at home are typically covered under Medicare Part D or a Medicare Advantage drug plan. Medicare Part B generally covers nebulizers and certain medications used with a nebulizer when they are medically necessary for home use.
