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.
These respiratory conditions affect millions of Americans. According to latest statistics, 8.9% of American adults have asthma and 4.3% have chronic obstructive pulmonary disease (COPD), requiring more than 1.7 million emergency room visits every year. 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 (Proventil) and fluticasone (Flovent).
You might assume that Medicare Part D covers albuterol since it’s a generic, but according to GoodRx, only 69% of Medicare plans cover it. Interestingly, a brand name of the albuterol inhaler, Proventil, is covered by as many as 96% of plans.
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.
CMS has proposed the Medicare $2 Drug List Model. Part D plans that choose to participate would decrease the cost for selected generic medications to $2 for a one-month supply. Respiratory medications on this list so far include albuterol, montelukast, and prednisone. This program could begin as early as January 1, 2027 if there are no changes to the Medicare program before then.
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 if you’re admitted to the hospital as an inpatient. You’ll be subject to a $1,632 deductible per benefit period in in 2025).
However, 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. The amount you pay for any one service cannot be more than what you would pay for the Part A deductible.
Whether you are an inpatient or under observation, Part B will pay for any physician fees. Medicare will pay 80% and you will pay the remaining 20%.
Will Medicare pay for COPD screenings?
Medicare Part B does not cover COPD screening but does cover diagnostic testing if you have symptoms like chronic cough, shortness of breath, or wheezing. 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 who is a long-term smoker. Medicare does, however, cover lung cancer screening for smokers between 50 and 77 years old who continue to smoke or who quit within the past 15 years and who have smoked an average of a pack per day for 20 years. This would be the same as two packs per day for 10 years.
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.
Footnotes
Tags: albuterol, asthma, chronic conditions, COPD, inhaler
