Does Medicare cover COPD?

Last Updated : 09/10/20184 min read

According to the National Heart, Lung, and Blood Institute (NHLBI), chronic obstructive pulmonary disease (COPD) is a disease that makes it harder to breathe and gets worse over time. Smoking is the number one cause of COPD. According to the Centers for Disease Control and Prevention (CDC) 20% or less of COPD suffers have never smoked.

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If you’ve been diagnosed with COPD, or are at increased risk for developing the disease, here’s what you need to know about Medicare coverage of COPD treatment.

What are treatments for chronic obstructive pulmonary disease (COPD)?

According to the National Heart, Lung, and Blood Institute (NHLBI), there is no known cure for COPD, although there are treatments and lifestyle changes that can help slow its progression, prevent complications, and help you feel better.

COPD treatment includes smoking cessation therapy, surgery, and vaccines for flu and pneumonia. Oxygen therapy and pulmonary rehabilitation may also help. For more information about COPD treatment, read Chronic Obstructive Pulmonary Disease (COPD): Symptoms, Causes, and Treatment.

Does Medicare Part A and Part B cover chronic obstructive pulmonary disease (COPD)?

Under Original Medicare (Part A and Part B), you are generally covered for most medically necessary treatments for COPD. If you get inpatient care in the hospital, Medicare Part A pays for allowable charges, while treatment in your doctor’s office or other outpatient center is covered under Medicare Part B. Part A and Part B deductibles apply; other costs are discussed below.

Specifically, people with moderate to severe COPD may be eligible for Medicare Part B (medical insurance) coverage of pulmonary rehabilitation programs prescribed by your doctor. These programs are designed to help people with COPD become stronger and breathe better; you may receive pulmonary rehabilitation services in a doctor’s office or at a hospital outpatient setting. If you receive the service in a Medicare-assigned physician’s office, you’ll need to pay 20% of the amount, and if you receive the service in a hospital outpatient setting, you’ll have to pay a copayment each session.

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Also, you may be covered under Medicare Part B for equipment and supplies for medically necessary oxygen therapy for you COPD; you’d need to pay 20% of the Medicare-approved amount and any applicable Part B deductible. If you need help to quit smoking to treat COPD, you may also be eligible for eight smoking cessation sessions per year under Part B at no cost to you, provided your health care provider accepts Medicare assignment.

Does Medicare Part D and Medicare Advantage cover COPD?

If you need help with the costs of prescription drug treatment of COPD, you may like to consider enrolling in a Medicare plan that includes prescription drug coverage (the Medicare Part D program). One way is to enroll in a stand-alone Prescription Drug Plan to work alongside your Original Medicare benefits. The second way is to enroll in a Medicare Advantage Prescription Drug Plan. A Medicare Advantage Prescription Drug Plan is an alternative way to receive your Original Medicare benefits (except for hospice care, which is still provided by Part A) and also receive prescription drug coverage, along with additional benefits like routine dental and vision care in some cases. Please note that you’ll still need to pay your Medicare Part B premium, along with any premium that the Medicare Advantage Prescription Drug Plan charges, in addition to copayments, coinsurance, and deductibles.

Do you have questions about Medicare coverage for COPD?

I’m happy to help you find answers. You can also schedule a phone call or request an email with information prepared just for you by clicking one of the links below. To view a list of plan options in your area, click the Compare Plans button.

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