Medicare
Lung Disease
According to the American Lung Association, nearly 35 million adults report having a chronic lung disease. Common chronic lung diseases include asthma, bronchitis, emphysema and pulmonary fibrosis. If you have been diagnosed with a chronic lung disease, you may have questions about what coverage or benefits Medicare can offer. We can help with that.
Original Medicare Chronic Lung Disease Coverage
If you have a chronic lung disease, Original Medicare (Medicare Parts A and B) may offer some coverage.
Medicare Part A (hospital care) covers care when you are admitted into the hospital. For example, Part A will cover you if your condition puts you in the hospital or if you need surgery, such as a lung transplant. Original Medicare will pay 80 percent of the bill for covered services. This means that you are responsible for the 20 on Part B covered services, which may include copays, deductibles, coinsurance, and/or doctor fees.
Medicare Part B (medical care) covers outpatient care for services like doctor visits, durable medical equipment, lab tests, and preventative services. Some examples of services covered by Part B for individuals with a chronic lung disease include:
- Oxygen equipment: Systems that provide and store oxygen, as well as accessories related to the delivery of oxygen.
- Oxygen therapy or supplemental oxygen
- Nebulizers and nebulizer medication
- Pulmonary rehabilitation programs: This may help to improve lung health if you have moderate to severe COPD
- Lung cancer screenings
Like most Part B covered services, Medicare pays 80 percent, and you are responsible for the remaining 20 percent coinsurance.
Additional Benefits with Medicare Advantage
If you have a chronic lung disease, you may be interested in coverage or benefits that Original Medicare doesn’t provide. Medicare Advantage plans include Part A and B and often offer additional benefits, such as:
- Vision
- Dental
- Hearing
- Prescription Drugs
- Fitness
Part C Medicare Advantage is offered by private insurance companies. Because Medicare Advantage plans often offer coverage and benefits above and beyond that of Original Medicare, many people find that managing Medicare coverage through a Medicare Advantage plan is more convenient and financially friendly.
Many Medicare Advantage plans offer low-to-no cost premiums, deductibles and copayments. You will still need to pay the Part B premium.
Chronic Lung Disease Special Needs Plans (C-SNP)
Special Needs Plans are a type of Medicare Advantage plan that is geared toward individuals with specific conditions. Some Special Needs Plans are so specific that they cover a single chronic condition, but others include a group of related chronic conditions, such as chronic lung disorders.
The Centers for Medicare and Medicaid Services (CMS) classifies chronic lung disorders covered by Medicare C-SNP as:
- Asthma
- Chronic bronchitis
- Emphysema
- Pulmonary fibrosis
- Pulmonary hypertension
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease is a type of chronic lung disease that makes it difficult to breathe. If you have COPD, you may be seeking additional coverage or benefits from a Medicare Advantage Medicare SNP. Some Medicare SNPs are designed for individuals with COPD. This may make it easier to access COPD specialists or medication.
Lung Cancer
If you have lung cancer, you may join a Medicare Special Needs Plan (SNP) to ease the access of specialized coverage, specialists or medication. This excludes pre-cancer conditions.
Frequently Asked Questions
There are several types of chronic lung diseases, including:
·Asthma
·Chronic bronchitis
·Emphysema
·Pulmonary fibrosis
·Pulmonary hypertension
Yes. Medicare Part B covers one lung cancer screening per year, as preventative care, if you meet all of these conditions:
·Are age 50-77
·Don’t have lung cancer symptoms
·Are a current smoker or quit within the past 15 years
·Have a smoking history of 20 cigarettes per day for 20 years
·Get an order from a doctor.
If you do have lung cancer symptoms, your screening will still be covered under Medicare Part B. Instead of preventative care, Part B will cover the screening as diagnostic care. As with most Part B covered services, you are responsible for the remaining 20 percent coinsurance.
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: October 13, 2023 MULTIPLAN_ETQEZMwebsite_2024_M