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Finding a Pulmonologist on Medicare

Finding a pulmonologist while on Medicare is vital for beneficiaries suffering from Chronic Obstructive Pulmonary Disease (COPD). Unfortunately, COPD isn’t curable, but the condition is treatable. Thankfully, your Medicare plan may offer coverage for treatment costs if they are medically necessary. Medicare Part B provides annual lung cancer screening coverage with Low Dose Computed Tomography (LDCT) for qualifying beneficiaries.

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Qualifying beneficiaries are between 55 and 77 years old who show no signs of lung cancer, are currently smoking, or have quit smoking within the last 15 years. Beneficiaries with a tobacco history of smoking one pack a day for 30 years also qualify. All patients must have a written order from their healthcare provider. Ideally, your care will come from a pulmonologist who accepts Medicare Assignment, so your costs are covered.

Of course, there are more things to consider aside from treatment and screenings regarding Medicare and COPD. Beneficiaries may require COPD meds covered by Medicare, which can be accomplished with the proper coverage. Let’s explore your options for Medicare benefits, pulmonologist treatments, and drug coverage.

Does Medicare Cover Pulmonary Rehabilitation?

Yes, you can receive coverage for care from a pulmonologist from Medicare. Individuals with moderate or severe COPD may need a pulmonary rehabilitation program, as may beneficiaries suffering from COVID-19. Rehabilitation programs help patients cope with their illnesses, grow more robust, and learn to breathe better. If your doctor prescribes it as medically necessary, Medicare Part B may cover costs.

If you receive healthcare services at your pulmonologist’s office, you’ll have to pay 20% of the cost for Medicare-approved services once you meet your Medicare Part B deductible.

COPD and Medicare Supplement (Medigap) benefits can also work together, as this supplemental coverage picks up where Original Medicare leaves out-of-pocket costs. With the right benefits, you can receive the healthcare you need while protecting your finances.

Do I Need a Referral To See a Pulmonologist for Medicare?

When using Original Medicare benefits, you do not need a referral to see a pulmonologist. Specialists are covered by Medicare Part A and Part B, so long as it is medically necessary. The same is true with those who are enrolled in Medigap plans. These plans do not have networks and do not require referrals when receiving healthcare from a specialist.

However, you may need a referral before receiving treatment if you have a Medicare Advantage plan. Remember, unlike Original Medicare, Medigap and Medicare Advantage are provided by private carriers, and their benefits may differ.

For those enrolling in a health maintenance plan (HMO), you’ll need a referral to see a pulmonologist with Medicare Advantage. You won’t need a referral if your Medicare Advantage plan is a preferred provider organization plan (PPO).

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Depending on your healthcare needs, Medicare Supplement plans can help you reduce healthcare costs when seeing a specialist and more freedom to do so than enrolling in a Medicare Advantage plan. But it’s still important to speak with your specialist to understand whether or not they accept Medicare Assignment and a licensed Medicare agent to ensure which coverage works best for you.

COPD Medications Covered by Medicare Part D

The cost of prescription drugs continues to rise and for many, relying on healthcare coverage is a necessary tool for affording medication. You can find COPD meds covered by Medicare, particularly when enrolling in a Medicare plan with prescription drug coverage, like the Medicare Part D program.

It’s important to understand that the healthcare needs of everyone are unique. This includes medication. Similarly, different Part D plans cover different drugs, and you’ll want to be sure that your plan covers the prescriptions you require. By checking a plan’s formulary, a list of drugs your plan covers. Certain medications, such as nebulizers, might require Part D for the enrollee to receive benefits.

Common risk factors for COPD

COPD and Medicare Coverage Options

Original Medicare may work for some beneficiaries, but others may require more benefits. Your healthcare needs are unique to yourself, and you may need additional benefits to help cover costs. Medicare Advantage plans are another option available from private medical insurance carriers that work with the government’s Medicare Program.

Medicare Advantage plans are an alternative way to receive benefits from Medicare Part A and Part B and still receive prescription drug coverage, often offering additional benefits that Original Medicare doesn’t.

Can I Get a Medicare Supplement if I Have COPD?

Yes, you can enroll in a Medicare Supplement plan if you have COPD, but there are some considerations you’ll need to remember:

  • Medigap for COPD patients is available if you are in your Medigap Open Enrollment Period or have guaranteed issue rights.
  • If you enroll in a Medicare Supplement plan outside the Medigap Open Enrollment Period and don’t have guaranteed issue rights, you’ll be subjected to medical underwriting before being accepted. Having COPD makes this highly unlikely.

Being denied Medigap coverage is not a place anyone needing the benefits wants to be. This is why enrolling as soon as you become eligible during your Medigap Open Enrollment Period is essential.

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That way, you can receive coverage sooner and avoid medical underwriting. From finding a pulmonologist on Medicare to ensuring you have the right coverage for your healthcare requirements, speaking with a licensed agent can help you pinpoint the right solution for your needs.

COPD Readmissions and Medicare

COPD readmissions are a harsh reality for many suffering from the disease. This can mean growing healthcare costs for patients and those on Medicare, the Federal government. As a result, measures such as the Hospital Readmissions Reduction Program (HRRP) have been implemented to help encourage hospitals to improve their care and reduce readmissions.

How To Find a Pulmonologist on Medicare

If you’re looking for a pulmonologist on Medicare, you will need to ensure you have the right benefits for your healthcare needs. These needs can vary based on your healthcare, location, budget, etc. While this may feel like an overwhelming task, we can help.

Speaking with a licensed Medicare agent can help you find the best benefits for your needs at no cost, including coverage for a pulmonologist on Medicare. We can walk you through every step, from helping beneficiaries find Medicare-covered COPD meds to addressing any of your other healthcare needs. Call us today at the number listed above or fill out an our online rate form.

Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.


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