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According to the American Lung Association, over 16 million adults report having Chronic Obstructive Pulmonary Disease, also known as COPD. If you have been diagnosed with COPD, you may find that your health coverage needs exceed what is offered through Original Medicare (Parts A and B). What does Medicare cover for COPD? Are there other options for more benefits?

Original Medicare COPD Coverage

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Medicare Parts A and B (Original Medicare) will cover select services if you have Chronic Obstructive Pulmonary Disease, or COPD.

Medicare Part A (hospital) helps to provide in-patient hospital care coverage. If your COPD symptoms lead you to seek care at a hospital, Medicare Part A may cover your treatment. You pay 100 percent of the cost for non-Medicare-covered services.

Medicare Part B (medical insurance) offers:

  • Pulmonary rehabilitation programs
  • Oxygen equipment
  • Oxygen therapy or supplemental oxygen
  • Nebulizers and nebulizer medication

For most Part B covered Medicare services, you are responsible for the 20 percent Medicare coinsurance.

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Additional Benefits with Medicare Advantage

Original Medicare (Parts A and B) does not include coverage for numerous important benefits that individuals diagnosed with COPD may be interested in, including:

  • Vision
  • Dental
  • Hearing
  • Prescription Drugs
  • Fitness

Medicare Advantage Part C is offered by private insurance companies and includes all the same coverage as Original Medicare. Many Medicare Advantage plans come with additional coverage, like the ones listed above, as well as potential additional savings. Because Medicare Advantage plans include Part A hospital care, Part B medical care and may include Part D prescription drugs, as well as additional benefits in a single plan, you may find that managing your Medicare coverage is more convenient.

If you have been diagnosed with COPD, a Medicare Advantage plan may be right for you financially. Medicare Advantage plans are known for the possibility of low to no cost premiums, deductibles or copayments. You will still be responsible for the Part B premium. Because many Medicare Advantage plans include Part D prescription drug coverage, it’s possible that your prescription medications will cost less.

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Chronic Special Needs Plans (C-SNP) for COPD

Some Medicare Advantage plans are designed to cater to specific chronic conditions. These plans are called C-SNPs. Some plans are geared toward lung disorders, like COPD, bronchitis, emphysema, or asthma. This means that these plans may offer access to specialists and cover common prescriptions used by individuals with a lung disorder or disease.

Frequently Asked Questions

What is COPD?

Chronic Obstructive Pulmonary Disease is a chronic condition which causes difficulty breathing, as well as coughing, wheezing, fatigue, and more.

Are COPD inhalers covered by Medicare?

Inhalers used by individuals with COPD, such as bronchodilators or COPD inhalers, are not covered under Medicare Parts A or B. Instead, coverage for these prescriptions falls under Part D prescription drug coverage. In order to have access to Part D, you will need a standalone Part D plan, or a Medicare Advantage Prescription Drug plan.

Does Medicare cover a COPD care plan?

Medicare Part B covers a pulmonary rehabilitation program for those with moderate to severe COPD. As with most Part B covered Medicare services, you are still responsible for the 20% Medicare coinsurance.

Does Medicare cover a COPD diet?

No. Medicare does not offer coverage for a change in diet.

Enrollment Eligibility

Annual Enrollment Period (AEP)

Medicare Annual Enrollment Period runs each year from October 15 to December 7. What is the Annual Enrollment Period vs. Open Enrollment Period?

Initial Enrollment Period (IEP)

Your Initial Enrollment Period generally surrounds your 65th birthday but may occur if you otherwise become eligible for Medicare for the first time.

Special Enrollment Period (SEP)

You may be eligible if you experience a qualifying life event such as moving to a new zip code, losing employer coverage, or change in Medicaid status.

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Last Updated: November 1, 2022 MULTIPLAN_ETQEZMwebsite_0722_M