Asthma is a chronic lung disease in which the airway to the lungs become inflamed, therefore narrowing the passageway to the necessary organ, making it difficult for the affected individual to breathe.
Symptoms of asthma include shortness of breath, difficulty breathing upon exertion (like exercise or climbing stairs), chest tightness, wheezing and coughing.
Asthma affects people of all ages. In some cases, children can be born with it and then there are other cases when adults get diagnosed later on in life.
Most commonly though, this disease tends to, affect children early on in life or during their adolescent years. According to the National Heart, Lung and Blood Institute, more than 25 million people are affected with the disease in the United States alone. Of the 25 million, 7 million are children.
In some cases, asthma will go away on it’s own as the disease resolves as the individual ages. In other cases, people continue on with the disease into their adult life and need maintenance. Worse case scenario, the disease can worsen over time and with age.
Does Medicare Cover Asthma Inhalers
Asthma inhalers, while considered a device, they technically provide medication. Medication is not covered by either Medicare Part A or Medicare Part B benefits. And while some medical devices are considered durable medical equipment or DME, an asthma inhaler does not fall under the DME category.
With some DME, Medicare Part B provides coverage. So while Medicare Part B won’t cover an asthma inhaler, it may provide coverage for a nebulizer.
A nebulizer is an at home breathing device that delivers medication from liquid form into a mist that can be easily inhaled into the lungs. To obtain a nebulizer, you must obtain a RX from your medical provider stating the reasons of medical necessity in order for the Medicare Part B benefits to pick up coverage.
The device itself would be covered at 80% once the Part B deductible has been met which leaves 20% remaining for the Medicare beneficiary.
What Pulmonary Treatment Will Medicare Cover
Medicare Part A and Medicare Part B will cover asthma related treatment outside of medication management. If you’re hospitalized due to an asthma attack, your Medicare Part A benefits will pick up your hospitalization charges.
Any outpatient treatment for asthma at your doctor’s office is covered by your Medicare Part B benefits. Additionally, if you have a chronic pulmonary condition, such as asthma, cystic fibrosis, COPD, emphysema, pulmonary fibrosis, sarcoidosis or s/p lung resection, and you’re given outpatient pulmonary rehab, your Medicare Part B benefits pick up the tab.
Pulmonary rehabilitation focuses on lung restoration. It’s also a preventative program, lasting anywhere from 6-8 weeks, for those suffering from chronic lung conditions.
These rehabilitation programs entail exercise training, education regarding your disease and how to manage it, mental health counseling and group support. The primary purpose of this rehabilitation program is to restore the individuals function and improve life quality.
As long as your primary care physician or pulmonologist recommends the therapy as medically necessary and there are recent pulmonary test finding that indicate poor lung function, Medicare Part B will provide coverage for the therapeutic rehab.
Does Asthma Require Medication
When asthmas is exacerbated, it’s called an asthma attack. Symptoms of an asthma attack include difficulty breathing or shortness of breath, in which an inhaler or nebulizer treatment is needed.
In some cases, when an asthma attack is severe, hospitalization is needed for oxygen and IV medications, or worse case scenario, intubation. Severe asthma attacks can sometimes be fatal.
Common symptoms an individual experiences with an asthma attack:
- Chest tightness
- Shortness of breath
Asthma attacks can be caused from a number of reasons including:
- Cigarette smoking or second hand smoke
- Medicines including NSAIDS (non-steroidal anti-inflammatories), Aspirin and beta blockers
- Sulfates in food
- Infections like upper respiratory infections (URI)
- Allergies caused from mold, pollen, grass, trees, dust, animal fur and dust
The disease itself can be well-controlled with medications such as an inhaler or nebulizer as well as avoiding situations in which the condition can be exacerbated. There are two types of main medications in which asthma is controlled. Using a long-acting and a short-acting (or quick-relief) asthma inhaler.
Asthma inhalers are a small device that provide metered inhalation medication into the lungs. Long-acting medication is preventative in that they reduce the airway inflammation and prevent the asthma attacks from occurring in the first place. The quick acting inhalers are considered, “rescue inhaler”, as they help alleviate asthma flare-ups almost instantly.
How to Get Extra Help with your Asthma Inhalers
While 80% of your medically necessary inpatient and outpatient asthma treatment is covered through Medicare benefits, unfortunately medications aren’t covered at all.
With some inhalers costing upwards of $250.00, seniors are unable to afford medically necessary asthma medications to control their pulmonary disease. Obtaining a Medicare Part D Plan, or Prescription Drug Plan, can help cover some of the medication cost.
A Prescription Drug Plan is a stand alone insurance plan that can be purchased for medication coverage not provided by your Medicare benefits.
Additionally, there are Medicare Supplement Plans, that are also stand alone insurance plans, purchased from the individual insurance companies.
These insurance policies work alongside your Traditional Medicare benefits and provide additional coverage for things like deductibles, copayments and other medical costs not covered by straight Medicare.
With Medicare only providing 80% benefit coverage, regardless of the treatment, and seniors already on fixed incomes, a Supplement Plan is a great way to save extra money on healthcare costs.
You can contact us today for more information on these policies. Our licensed insurance agents can tell you everything you need to know, answer any questions you might have and find you the best plan suited for your individual needs, when it comes to the supplemental insurance.
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5 Fast Asthma Facts
Did you know, according to the online article on dosomething that:
- Over the last decade, people affected by asthma has increased by 15%.
- Asthma costs the United States greater than $50 billion dollars each year in healthcare costs.
- Asthma/asthma attacks cause school-age children to miss greater than 10 million school days each year.
- With adults, women are more likely to develop asthma than men but for children, little boys are more likely to develop asthma then little girls.
- More likely than any other racial group, African-Americans, are 2-3 times more likely to die from asthma.