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Does Medicare Cover Cystic Fibrosis


We’re here to break down the basics of what Medicare will cover for you and your Cystic Fibrosis. In this content, you’ll learn how Medigap and Medicare Advantage can help cover Cystic Fibrosis care. Also, we’ll take a look at drug coverage and potential costs. Then, we’ll answer some common questions on the topic. 

Will Medicare Help Cover Cystic Fibrosis Care?

Yes, Medicare will cover cystic fibrosis treatments and care. But, you must use a doctor that accepts Medicare assignment. Any form of care you obtain at an inpatient facility or hospital will fall under your Part A benefits.

Some patients need blood transfusions and surgery to help treat Cystic Fibrosis. When necessary, Medicare will also cover a lung transplant for Cystic Fibrosis patients. Further, Part A will cover hospice and home health care, should you need it.

Now, Part B will cover any doctor visits, screenings, equipment, and procedures. If you need physical therapy like pulmonary rehabilitation, Part B covers it. These treatments can be done in the doctor’s office.

You may be wondering about the costs of doctor visits and therapy sessions. You’ll pay 20% of the costs. Also, you may need to meet deductibles or pay extra charges.

Does Medigap Cover Cystic Fibrosis?

A Medigap plan can help ease the stress of coming up with extra money for your treatments. Once you enroll in Medicare, you can choose to buy a Medigap plan.

Medigap can cover your portion of the medical bills. But, Cystic Fibrosis may disqualify you from a Supplement plan. So, if you think a Medigap plan sounds right for you, you’ll want to enroll while you’re eligible for the Medicare Supplement Open Enrollment Period.

If you delay enrollment, your insurance carrier could require medical underwriting before approval. Then, you can be charged more or denied coverage due to pre-existing conditions.

Will Medicare Advantage Cover Cystic Fibrosis?

Medicare Advantage plans will help you receive the Cystic Fibrosis care you need. Also, Advantage plans cover, at the very least, everything that Medicare covers.

Medicare Advantage plans will cover your Fibrosis screenings, treatments, medications, and even surgery. You’ll need to buy your Advantage policy through a private insurance company.

One thing to note is to pay attention to your network. Advantage policies have health networks of specific providers and facilities you can use. If you end up going to an out-of-network doctor, you could end up with high medical fees.

Best Medicare Drug Plan for Adults with Cystic Fibrosis?

Anyone living with Cystic Fibrosis knows firsthand the high cost. Also, costs for Cystic Fibrosis medications can exceed thousands of dollars. If you’re on a fixed monthly income, facing thousands in medication costs may not be feasible. Part D drug plans help in situations like this.

You can buy a standalone drug plan, or an Advantage plan with Part D. Part D will usually cover the Cystic Fibrosis medications your doctor prescribes. Although, it’s best to verify the plan covers your medications before you enroll. The best plan for you is the one that covers your drugs and brings you the most value.

Does Cystic Fibrosis Qualify for Medicare?

Any disability can give you access to Medicare before age 65. But, you need to receive at least 24 months of Social Security Disability Insurance before you’re Medicare-eligible.

Although, if you have Cystic Fibrosis and End-Stage Renal Disease, you may be Medicare-eligible sooner, especially if you need a kidney transplant or dialysis. If you’re unsure about your eligibility, you can always contact the Social Security office near you.

FAQs

Does insurance cover Cystic Fibrosis screening?
Health coverage can cover Cystic Fibrosis screenings. Parts A and B will also help to cover routine care you may get through clinical trials.
Does Medicare cover genetic testing for Cystic Fibrosis?
Medicare can cover genetic testing in specific situations. Your doctor must state that it’s necessary for you. Advantage policies will also cover genetic testing if your doctor finds it necessary.
How do I get help with health insurance if I have Cystic Fibrosis?
Cystic Fibrosis can be costly. Depending on your income, you may qualify for different savings programs. Medicare Savings Programs can help cover premiums and deductibles. If you need help paying for your Part D costs, you may qualify for the Extra Help program.
Does Medicare cover Trikafta?
Less than half of Part D and Medicare Advantage Part D plans cover this drug. If you need specific medications, please verify the plan covers your meds.

How to Get Medicare Coverage for Cystic Fibrosis

Medicare covers treatment for many of those who live with Cystic Fibrosis. While Cystic Fibrosis is rare, there are more than 30,000 people throughout the U.S. who live with the disease.

Medicare can be so confusing for so many people. Shopping for health coverage that includes drug, medical, and hospital coverage is essential. Especially for those with Cystic Fibrosis.

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Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

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