Does Medicare Cover Treatment for Chronic Respiratory Disease?

Chronic Respiratory Disease

One of the reasons many chronic conditions are associated with age is the fact that most develop slowly over time. You don’t go to bed healthy and wake up with heart disease. The same is true for many chronic breathing disorders. Some respiratory diseases, such as cystic fibrosis, are hereditary. However, more common conditions, such as COPD, develop over a lifetime. Medicare covers treatments for chronic respiratory disease, as well as some preventive measures.

What Is Chronic Respiratory Disease?

The World Health Organization (WHO) defines chronic respiratory diseases as those that affect “…the airways and other structures of the lung.” The most common breathing disorder associated with age is chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis. Other examples of chronic respiratory disease are asthma, cystic fibrosis, and lung cancer.

The word “chronic” indicates that these diseases have no cure. In addition, the condition becomes worse over time. However, you can manage symptoms, which is what the Medicare-approved treatments, oxygen therapy and pulmonary rehabilitation, attempt to do.

Medicare Covers Oxygen Therapy

Chronic Respiratory Disease

Oxygen equipment and relevant accessories are considered durable medical equipment. Therefore, Medicare Part B covers their rental assuming you meet all of the following conditions:

  • Your doctor prescribes oxygen use in your home
  • Your doctor certifies that you have severe lung disease and do not get enough oxygen
  • Your doctor believes oxygen therapy will help improve your health
  • Testing reveals that your arterial blood gas levels are below accepted levels
  • You have tried alternative methods that did not work

If it’s deemed necessary for use with your oxygen equipment, Medicare may also pay for a humidifier. Medicare only covers renting oxygen equipment. If you want to buy it you may do so, but without financial assistance from Medicare.

What does your coverage include?

Medicare will pay 80 percent of the approved amount. This covers the cost to rent the equipment as well as accessories and supplies, including:

  • Oxygen contents
  • Mouthpiece and tubing
  • Maintenance, service, and repairs

Under Medicare, you rent the oxygen equipment for 36 months, but the supplier must provide the equipment – and supplies – for 5 years. After the initial 36-month period ends, the supplier cannot charge you for furnishing the equipment, supplies, or accessories.

Medicare continues paying for oxygen tanks or cylinders, as well as the contents, for the full 5 years, as long as you have a medical need for them. If your need continues after the 5-year period ends, a new one begins. You may stay with your current supplier (if they agree) or you may choose a new one.

What is the competitive bidding program?

In certain areas, Medicare has what they call their Competitive Bidding Program. This only affects certain zip codes, mostly in larger cities (click here to see which areas are included). If you have Original Medicare AND get qualifying durable medical equipment in a competitive bid area, you must use one of Medicare’s contracted suppliers. Oxygen equipment qualifies as competitively bid equipment.

You will not pay more than the 20 percent coinsurance amount (plus any remaining Part B deductible) when you get competitively bid equipment through a contracted supplier.

What Is Pulmonary Rehabilitation?

Also known as PR, pulmonary rehabilitation is a program designed to improve daily life for people who have a chronic breathing disorder. PR is used in conjunction with medical therapies and may include:

  • Breathing strategies
  • Counseling on diet and nutrition
  • Education on managing your condition
  • Exercise training
  • Group support
  • Psychological counseling
  • Techniques to improve energy

Pulmonary rehabilitation is an ongoing commitment between the patient and relevant providers. In addition to your primary care physician, this may include specialists such as respiratory and physical therapists, dieticians, nutritionists, nurses, psychologists, and social workers.

What does Medicare cover?

Medicare covers pulmonary rehabilitation if you have moderate to very severe COPD. Treatment must take place in a doctor’s office or hospital outpatient setting. Part B beneficiaries are eligible if the doctor treating their COPD gives them a referral for PR.

If you receive the service in a doctor’s office, Medicare covers 80 percent of the approved amount. If you receive treatment in a hospital outpatient setting, you have a co-pay for each session. In both scenarios, the Part B deductible applies.

Preventing COPD

The greatest risk factor for COPD is smoking. If you smoke – whether you’ve been diagnosed with COPD or not – Medicare covers smoking and tobacco use cessation to help you quit. You get up to eight counseling sessions in a 12-month period with a qualified doctor or Medicare-approved practitioner. Your cost for this service is zero. That’s how you know that insuring smokers is much more expensive than curing them of their addiction. For improved health all around, quit smoking today.

Medicare’s Chronic Care Management Services

Medicare offers chronic care management services for beneficiaries who have more than one serious chronic condition. In addition to COPD, qualifying chronic conditions include arthritis, diabetes, and hypertension. In practice, though, any chronic condition your doctor predicts will last at least 12 months qualifies for this benefit.

Taking advantage of this benefit gives you personalized help from a qualified healthcare professional to assist in developing a care plan. Your care is coordinated between your primary doctor and any specialists you need, as well as your pharmacy, preferred hospital, and testing centers. You have 24/7 emergency access to a healthcare professional, and assistance setting health goals.

Talk to your doctor about getting started. There is a monthly fee for this service, as well as the Part B deductible and co-insurance. If you have a Medigap plan, it may help cover these costs. If you have questions about your Medigap plan, or are interested in getting one, call us toll-free at 844-655-4347 to speak to a licensed agent.

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