Medicare will cover some medically necessary treatments for Chronic Obstructive Pulmonary Disease or COPD. Medicare doesn’t cover at 100%; getting additional coverage can lower your out of pocket expenses.
As you grow older, you may have symptoms of a serious illness or condition and not even know it. Many seniors overlook their symptoms, mistaking them for signs of aging.
Patients with COPD don’t always realize they have it, making this disease extremely dangerous. Partially because of this, COPD is the 3rd leading cause of death in the U.S.
Chronic obstructive pulmonary disease (COPD) is the official name, according to the National Heart Lung and Blood Institute (NHLBI). COPD is a group of diseases that cause breathing issues, such as emphysema, chronic bronchitis, and asthma.
COPD is a severe, chronic inflammatory lung condition. The inflammation is causing a blockage of the airflow from the lungs. This makes it difficult to breathe and it continues to get worse over time.
Unfortunately, this COPD isn’t curable. While this may be true, this condition is treatable. The good news is, your Medicare plan may offer coverage for costs of treatments.
Medicare Can Cover COPD
Part B offers coverage for a lung cancer screening with Low Dose Computed Tomography (LDCT). This screening is once per year for qualifying beneficiaries.
Qualifying beneficiaries are between 55-77. Who are showing no signs of lung cancer, currently smoking or have quit smoking within the last 15 years? Beneficiaries with a tobacco history of smoking 1 pack a day, for 30 years also qualify.
All patients must have a written order from their healthcare provider. Your doctor should accept Medicare assignment, so you pay nothing for the service.
However, not all patients with COPD are smokers. According to the Centers for Disease Control and Prevention (CDC), 20% or less with COPD aren’t smokers.
COPD – The more you know, the easier you breathe
Patients with COPD are more likely to struggle with simple things like walking or climbing the stairs. The likelihood of eventually being unable to work due to this condition is high. COPD patients also run a higher risk of getting other serious diseases.
Hope isn’t lost just yet. You can help yourself; but first, you must know what to look for. If you suspect you have COPD, or catch it early, treatment works best during the earlier stages. So, waiting to seek medical care isn’t in your best interest.
In a healthy person, daily activities shouldn’t cause shortness of breath. Noticing a change in your breathing could be an early sign of COPD.
Many patients with COPD have the inability to even take a deep breath. Constantly feeling out of breath even when not doing anything physical, is another warning sign. Other symptoms like coughing often or constantly; sometimes known as a “smoker’s cough” or wheezing.
Treatments for COPD
For now, there is no known cure for COPD. Treatments, however, are available. Sometimes it just takes some lifestyle changes. Shifting some habits to help in slowing the progression of the disease. In turn, you prevent further complications and health issues.
Doing so will positively impact the way you feel overall. For instance, if you currently smoke, quit. Medicare will cover smoking cessation therapy if you need help quitting.
Medicare Part A Covers COPD
Part A and Part B offer coverage for most treatments that are medically necessary for qualifying individuals with COPD. Part A is responsible for an allowable amount of your hospital or inpatient services.
For example, if you need therapy or to stay in-patient nursing facility.
Medicare Part B Covers COPD
Part B is your medical insurance. Meaning, Part B pays for services like doctor’s visits and outpatient services.
Individuals with moderate or severe COPD may need a pulmonary rehabilitation program. If it’s prescribed as medically necessary by your doctor, Part B may cover costs.
Rehabilitation programs help patients cope with their illness, grow stronger, and learn to breathe better. Providing them with a happier, healthier life.
Services can be in both, a hospital outpatient setting as well as your doctor’s office for Medicare to cover costs. Your doctor should be within the Medicare network, otherwise, you may be responsible for the bill.
Within your plan’s network, you’re responsible for 20% of the costs of services. Medicare covers the additional 80%. Medicare has an allowable amount for medically necessary services and treatments.
Moreover, when receiving treatments or services in a hospital/outpatient setting, you’re responsible for the co-payment amount at each visit.
Part B will provide, at no cost to you, eight smoking cessation sessions per year. If you need help quitting to properly treat your COPD use these services. If your healthcare provider accepts Medicare assignment, Part B will cover these sessions.
Patients with COPD often are prescribed a nebulizer machine to help them to breathe better. Part B covers 80% of durable medical equipment (DME) and the medication for nebulizers. Then, beneficiaries are responsible for the remaining 20%.
Make sure to confirm with your healthcare provider that they’re a Medicare enrollee and accepting Medicare assignments, as some prefer not to.
Durable Medical Equipment for COPD
If the patient is in a hospital or nursing home setting, Part B doesn’t cover costs for nebulizer machines or medications. Part B covers costs for medications or DME when they’re a home treatment for COPD.
Part A covers the costs for any service or treatment inside a hospital setting or other inpatient facility.
DME makes it possible for Medicare beneficiaries to live in the comfort of their home. Many prefer this over the commute to and from nursing facilities and outpatient hospitals.
It’s important to understand the most efficient way to receive the equipment you need to properly care for yourself or someone you love.
Will Medicare Part D Cover COPD
Costs of prescription drugs for treating COPD can be costly, sometimes draining. If you need extra help with these costs, you’re not alone. You could benefit from enrolling in a Medicare plan that has prescription drug coverage, like the Part D program.
One option is to enroll in a stand-alone prescription drug plan to work alongside your Original Medicare benefits. Although, some medications like those for nebulizers might require Part D for the enrollee to receive benefits.
Medicare Advantage Plans Can Cover COPD
Another option is to enroll in a Medicare Advantage plan (MA) to replace your Original Medicare benefits. MA plans are private medical insurance policies, that work with the government’s Medicare Program.
These plans are an alternative way to receive Original Medicare benefits and still receive prescription drug coverage. MA plans often offer additional benefits that Original Medicare doesn’t.
Medicare Advantage plans require you to still pay your premium, any premium your MA drug plan may charge, co-payments, coinsurance, and deductibles.
Like Parts A and B, MA enrollees will receive coverage for treatments and pharmaceutical needs. There are many Medicare Advantage Plans so be sure to look at all options before deciding what plan to enroll in.
Get Help Getting a Medicare Plan That Cover COPD
When looking for what health insurance plan is best for your needs, the task can be overwhelming. Medicare is full of information, and many times things are changing.
Don’t worry! We’re here to help you. Using a professional Medicare agent can save you time and potentially money. Learn about all your options, including Medicare Supplements.
Our team is dedicated to comparing plans and quotes for you and discussing options. We want to help you find the best coverage to fit your needs and budget.
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