Inhalers are handheld, pocket-sized devices that deliver medication directly into your lungs. Typically, they are used to treat diseases like asthma or chronic obstructive pulmonary disease (COPD), but can also help with general shortness of breath as well as anxiety attacks.
The price of inhalers and other respiratory medications has skyrocketed over the past decade. Thankfully, those with Medicare Part D may at least see these costs partially covered, with rates varying depending on the inhaler drugs you are seeking.
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Does Medicare Cover Inhalers?
Medicare covers asthma inhalers if prescribed by a doctor, and your plan includes Medicare Part D. While optional, Medicare Part D is a crucial piece of the Medicare program that could save you money on medication in the long run.
Original Medicare includes Medicare Part A (hospital insurance) and Part B (medical insurance). Part D (prescription drugs) can be added on separately. Only Medicare Part D covers inhalers. Part A covers any hospital visit incurred due to an asthma attack, while Part B covers any outpatient treatment required for asthma.
Medicare Advantage, or Medicare Part C, is a Medicare-approved plan provided through a private company. Most Medicare Advantage plans include Part D and would therefore cover inhalers prescribed by a doctor. However, if your Medicare Advantage plan doesn’t include Part D, you can enroll in a separate Medicare drug plan.
Medicare Supplement Insurance, or Medigap, is sold through private companies and is designed to fill gaps in your Original Medicare coverage. While Original Medicare covers most of the cost of covered health care services, you are still left with some costs. These costs include coinsurance/” target=”_blank” rel=”noreferrer noopener”>copays, coinsurance, and deductibles, which may all be covered by a Medigap.
However, Medigap is not creditable prescription drug coverage and would not cover inhalers. You would be free to enroll in Medicare Part D separately, covering inhalers prescribed by a doctor.
What Respiratory-related Medications Does Medicare Cover?
While Medicare Part D covers some costs of a prescribed inhaler, your copay or coinsurance will vary depending on your specific drug plan. The covered cost of related respiratory medications will also vary depending on the brand of the drug and whether they are generic or brand-name specialty drugs. Some examples:
- Albuterol is prescribed to help treat difficulty breathing, shortness of breath, wheezing, and chest tightness caused by lung diseases like asthma or COPD (chronic obstructive pulmonary disease). 53% of an Albuterol prescription would be covered by Medicare Part D.
- Flovent is a long-term asthma control medication for asthma patients whose symptoms aren’t well-regulated by a rescue inhaler. Over 90% of Flovent is covered by Part D.
- Symbiocort is also prescribed to help treat asthma and COPD. Symbiocort is not covered by most Part D plans, though the manufacturer often offers coupons to help customers moderate costs.
- Ventolin treats bronchospasm in people with reversible obstructive airway disease and helps prevent exercise-induced bronchospasm. About half of all Medicare Part D plans cover Ventolin.
What Respiratory-related Treatments Does Medicare Cover?
Medicare also covers certain respiratory treatments, including some hospital and outpatient procedures. These include:
- COPD inhalers and bronchodilators are covered through Medicare Part D. COPD is a group of diseases that cause breathing problems or airflow blockage, including bronchitis and emphysema.
- Pulmonary treatments help address high blood pressure that affects the heart and lungs. Medicare Part B would cover most outpatient rehab treatment of pulmonary conditions like asthma, COPD, pulmonary fibrosis, emphysema, and cystic fibrosis.
- Emergency care would be covered by Medicare Part A if a beneficiary were to go to the hospital due to an asthma attack.
- Nebulizers are small machines that turn liquid medications into mist for inhalation. Nebulizers are considered durable medical equipment and are therefore covered under Medicare Part D.
How To Get Medicare Coverage for Inhalers
If you have asthma and are signing up for Medicare for the first time, make sure to include a Medicare Part D plan to ensure your inhaler and any related medications will be covered. Purchasing a Part D plan after enrollment will result in a Part D penalty that’s permanently added to your monthly premium. You should also research the plan you are choosing and make sure that it covers your specific prescriptions.
While Medicare might cover a portion of your prescription under Part D, it is best to consult your doctor and pharmacist to find the least expensive possible regimen. Generic alternatives to name-brand medications are generally less expensive and typically available following a consultation with your doctor. A medication’s out-of-pocket cost is also occasionally lower than some insurance plans’ actual copay, so make sure to verify this with your pharmacist before settling on a prescription.
- Centers for Medicare & Medicaid Services: What Medicare drug plans cover
- Centers for Medicare & Medicaid Services: Medical equipment & supplies