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Q: Will Medicare cover treatment of asthma and other breathing conditions?
A: Medicare will pay to treat lung and breathing disorders such as asthma and chronic obstructive pulmonary disease (COPD). But Medicare Advantage may go one step further.
Nearly 15 percent of middle-aged and older Americans suffer from breathing problems such as asthma or COPD. Thankfully, seniors enrolled in Medicare are entitled to coverage for chronic conditions such as asthma and COPD.
Does Medicare cover the cost of nebulizers?
Medicare Part B will cover the cost of durable medical equipment – such as nebulizers – that aid in breathing. However, it’s worth noting that medical supply companies do not have a cap on what they can charge. Medicare may pay toward the approved amount of this equipment, but the patient is stuck with the rest. It is important to shop around.
Medicare Part B will also cover the cost of supplemental oxygen for patients with COPD – and for a number of other respiratory conditions.
With regard to equipment, Part B will generally pay 80% of the Medicare-approved cost of the items in question, while you, as a patient, pay the remaining 20%.
Does Medicare cover albuterol and other medications for asthma or COPD?
Medicare Part D will cover the cost of prescription asthma and COPD medications. Some of these medications are taken by mouth – like montelukast (Singulair) and theophylline (Theo-24). Others are inhaled – like albuterol (Ventolin) and fluticasone (Flovent).
You might assume that Medicare Part D covers albuterol since it’s a generic, but according to GoodRx, only 90% of Medicare plans cover albuterol it and 64% of Part D plans cover the branded inhaler, Ventolin.)
Medications covered under Part D are subject to a copay, the cost of which depends on the plan you choose and the tier that plan places your medication in. Generally speaking, brand name medications tend to cost more than generic ones.
Will Medicare cover a hospital visit due to asthma or COPD?
If you require hospital care as the result of an asthma attack or COPD flare-up, you’ll be covered under Medicare Part A, but you’ll be subject to a $1,556 deductible per benefit period if you’re admitted to a hospital.
And remember that Part A only covers an inpatient hospital stay. Many asthma and COPD stays – including emergency room visits – fall under observation services which is covered by Part B. This is important to point out because you will pay 20% for each service rather than a flat deductible rate.
Will Medicare pay for COPD screenings?
Of course, prevention of breathing issues is the best course of action if that risk exists, and so Medicare Part B will also pay for COPD screenings. And if you’ve already been diagnosed with moderate to severe COPD, Part B offers a pulmonary rehabilitation program designed to help your breathing improve.
Keep in mind that COPD screening is not for everyone – even for someone is a long-term smoker. Medicare does not cover COPD screening tests for people who do not have symptoms.)
How might Medicare Advantage supplemental benefits help with asthma or COPD costs?
Depending on the Medicare Advantage plan you’re enrolled in, you may be entitled to supplemental benefits that help ease your asthma or COPD symptoms. These supplemental benefits aren’t medical in nature, but rather, aim to improve quality of life while alleviating medical symptoms and promoting better overall health.
If you have asthma or COPD, and your Advantage plan offers supplemental benefits, you may be entitled to air purifiers or filters for your home that lend to better breathing. You may also be entitled to carpet cleanings to reduce allergens and irritants that could more easily trigger asthma attacks. (But note that a 2022 Better Medicare Alliance analysis noted that only 166 plans offered “indoor air quality and services” nationwide – and that’s out of thousands of MA plans.)
Your specific coverage will depend on your Advantage plan, though it’s worth noting that if yours doesn’t offer supplemental benefits, it could pay to switch to a plan that does. Keep in mind, however, that Original Medicare doesn’t offer these added benefits. (They’re a feature of Advantage plans only right now.)
Get the help you need
Living with asthma or COPD can be challenging, especially as you age. It pays to read up on the coverage you’re entitled to and take advantage of any additional benefits that lessen your symptoms and lend to a healthier existence.
Maurie Backman has been writing professionally for well over a decade, and her coverage area runs the gamut from healthcare to personal finance to career advice. Much of her writing these days revolves around retirement and its various components and challenges, including healthcare, Medicare, Social Security, and money management.