Can Medicare help with COPD?

Medicare can help with different services and tools to help with chronic obstructive pulmonary disease (COPD). Different parts of Medicare will cover different things.

COPD, or chronic obstructive pulmonary disease, is a disease that makes it hard to breathe. It includes emphysema and chronic bronchitis and most people with COPD have both of these conditions. According to the National Institutes of Health (NIH), more than 12 million Americans are diagnosed with COPD and another 12 million people likely have the disease and do not know it.

COPD is caused primarily by smoking cigarettes; however, according to the National Heart, Lung and Blood Institute (NHLBI), up to 25 percent of people with COPD have never smoked. Pipe, cigar and other types of tobacco smoke also can cause COPD, especially if the smoke is inhaled. Breathing in secondhand smoke, air pollution, chemical fumes or dust from the environment can contribute to the disease.

COPD develops slowly, and early symptoms may be overlooked or discounted.

• Ongoing cough, or a cough with a lot of mucus present
• Shortness of breath, especially during physical activity
• Wheezing, a whistling-like sound when breathing
• Chest tightness

COPD is a progressive disease and symptoms get worse over time. Severe COPD can interfere with basic activities like walking and taking care of oneself, and while treatments and lifestyle changes may help slow the progression of COPD, there is currently no cure. Different parts of Medicare may cover different COPD treatment services and tools. See below to understand what each part (or parts) of Medicare covers.

The first order of business with COPD is to quit smoking. Relieving the lungs of this irritant is extremely important. Medicare Part B covers counseling to stop smoking. Beneficiaries may receive up to 8 face-to-face visits in a 12-month period. Aids to help you stop smoking, such as nicotine patches, are also covered.

Medicare Part B also covers oxygen therapy. Oxygen therapy is given through nasal prongs or a mask for severe COPD cases and may be needed either infrequently or constantly. It helps pay for the rental of oxygen equipment as durable medical equipment (DME) and all oxygen and supplies. If the equipment is owned, Medicare will help pay for oxygen and supplies for qualified beneficiaries. Medicare will only pay for oxygen therapy provided by a contracted DME supplier.

Beneficiaries pay a 20% coinsurance for most COPD services covered under Part B once the Part B deductible is met. Copayment amounts for medications depend upon the specific Part D plan.

Bronchodilators, inhaled steroids or both may be prescribed, depending on the severity of symptoms. Both medications help open airways to make breathing easier. Bronchodilators and inhaled steroids for COPD are covered by Medicare Part D.

Pulmonary Rehabilitation is a program designed to help maintain normal daily activities. It may include exercise, education and nutritional and psychological counseling. For moderate to severe COPD, Medicare will help pay for pulmonary rehabilitation. Up to two one-hour sessions per day for up to 36 lifetime sessions of pulmonary rehabilitation may be covered. The rehabilitation program may be delivered in a doctor’s office or in a hospital outpatient setting and must meet Medicare’s mandatory requirements.

If you or someone you know is experiencing symptoms of COPD, don’t wait for them to become severe. Talk to your doctor and find out what is going on. The sooner treatment starts, the better for your lungs and for your overall health.

For more information about COPD visit the National Heart, Lung and Blood Institute or the American Lung Association. For more information about how Medicare may cover COPD you can visit Medicare.gov or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.