Medicare Coverage for COPD and Chronic Lung Disease

Chronic Obstructive Pulmonary Disease (COPD) -- including emphysema and chronic bronchitis -- affects approximately 16 million Americans and is a leading cause of hospitalization among Medicare beneficiaries. Medicare covers a comprehensive range of COPD diagnostic and management services.

Pulmonary function tests (spirometry): The primary diagnostic test for COPD -- measures lung capacity and airflow. Covered under Part B at 20% coinsurance after the deductible.

Chest X-ray and CT scan: Covered under Part B for diagnosis and monitoring of COPD and complications.

Arterial blood gas (ABG): Blood test measuring oxygen and carbon dioxide levels -- covered under Part B.

Pulse oximetry: Measurement of blood oxygen saturation -- covered under Part B when medically indicated.

6-minute walk test: Functional assessment of exercise capacity -- covered under Part B.

Short-acting bronchodilators (rescue inhalers):

• Albuterol (ProAir, Ventolin, Proventil) -- generic available, low cost
• Ipratropium (Atrovent) -- generic available

Long-acting bronchodilators (maintenance inhalers):

• Tiotropium (Spiriva) -- brand only, higher tier
• Umeclidinium (Incruse Ellipta) -- brand only
• Indacaterol (Arcapta) -- brand only
• Salmeterol (Serevent) -- brand only

Combination inhalers:

• Fluticasone/salmeterol (Advair) -- generic available
• Budesonide/formoterol (Symbicort) -- brand only
• Umeclidinium/vilanterol (Anoro Ellipta) -- brand only
• Fluticasone/umeclidinium/vilanterol (Trelegy Ellipta) -- brand only

All covered under Part D; tier and cost-sharing vary by plan. Compare plans carefully -- inhaler costs vary significantly between Part D plans.

For COPD patients with low blood oxygen levels (oxygen saturation ≤ 88% at rest or with exertion), Medicare covers home oxygen therapy as durable medical equipment:

• Oxygen concentrator (for continuous use)
• Portable oxygen equipment
• Oxygen tanks and supplies
• Tubing, masks, and cannulas

Coverage: Medicare pays 80% of the approved rental amount; you pay 20%. After 36 months of rental, ownership transfers to you. Medigap Plan G covers the 20% coinsurance.

Documentation required: Qualifying oxygen saturation test performed by your doctor.

For patients who cannot use inhalers effectively, Medicare covers nebulizers (machines that convert liquid medication to mist) and the medications used in them:

• Nebulizer machine: Covered as DME
• Albuterol solution: Covered under Part B (not Part D) when used in a Medicare-covered nebulizer
• Ipratropium solution: Covered under Part B

Medicare covers pulmonary rehabilitation for beneficiaries with moderate-to-severe COPD -- a supervised program of exercise, education, and breathing techniques:

• Up to 36 sessions (2 sessions/week for 18 weeks)
• Additional sessions may be covered with physician documentation
• Includes supervised exercise, breathing strategies, education, and psychosocial support

Cost: 20% coinsurance after the Part B deductible. Medigap Plan G covers this 20%.

Since smoking is the primary cause of COPD, Medicare covers smoking cessation counseling at no cost:

• Up to 8 sessions per year
• Individual counseling with a qualified provider

COPD exacerbations frequently require hospitalization. Part A covers inpatient hospital care with standard cost-sharing. Medigap Plan G covers the Part A deductible.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.