Chronic Lung Disease and Medicare | Medicare Plan Finder

A Guide to Medicare Chronic Lung Disease Coverage

Troy Frink Medicare Leave a Comment

Chronic lung diseases affect millions of people all over the world. As people age, sometimes they miss symptoms of serious conditions. You might think, “It’s all part of the aging process,” however, these symptoms might be indicative of a much bigger problem.

Some people qualify for screenings and treatments for these chronic conditions under Medicare. Read on to learn more about how your condition might fit into the Special Enrollment Period (SEP) requirement, and what treatments Medicare can cover.

What Is Chronic Lung Disease?

Doctor and Nurse Discussing Chronic Lung Disease With Patient | Medicare Plan Finder
Doctor and Nurse Discussing Chronic Lung Disease With Patient | Medicare Plan Finder

Chronic lung disease refers to any condition that causes long-term obstructions to a person’s airways. They can cause the following symptoms:

  • Shortness of breath after little or no physical exertion, or shortness of breath after normal exercise plus a brief rest period
  • A persistent cough – one that lasts longer than a month
  • Mucus or sputum production lasting a month or longer
  • Labored breathing
  • Swollen feet, ankles or legs
  • Blue lips

If you experience any of these symptoms, you should talk to your doctor immediately.  Chronic lung disease can severely impact your quality of life and shorten your lifespan considerably. The faster you get started on treatment, the better.

Chronic Lung Diseases List

The following conditions fall under the category of chronic lung diseases:

  • Asthma
  • Chronic bronchitis
  • Chronic obstructive pulmonary disease (COPD)
  • Cystic fibrosis
  • Emphysema

SEP-Qualifying Disabilities

Your condition must be severe enough that it prevents you from working, and is considered to be a disability. Two diseases will qualify you for the SEP – which allows you to change coverage at any time of year instead of having to wait like most people have to do.

One SEP-qualifying disease is Chronic Obstructive Pulmonary Disease (COPD), the other is lung cancer. Once you qualify for the SEP, you can make one change to your Medicare plan per quarter for the first three quarters of the year.

What Chronic Lung Disease Treatments Will Medicare Cover for COPD?

Two diseases fall under the term COPD: chronic bronchitis and emphysema.  Early detection of COPD is key to managing symptoms. (There is no cure for COPD, so damage control is necessary to keep a good quality of life for as long as possible.)

Medicare Part B covers yearly lung cancer screenings with Low-Dose Computed Tomography (LDCT) if you meet one or more of the following conditions:

  • You’re 55-77 years old
  • You don’t display any lung cancer symptoms
  • You smoke currently or quit smoking within the past 15 years
  • You have smoked a pack of cigarettes a day on average for the past 30 years
  • A doctor orders the screening

Medicare will also cover the following treatments:

  • Supplemental Oxygen: Medicare requires a five-year agreement between itself and your home oxygen supplier. Throughout the length of this agreement, Medicare Part B pays for 80 percent of the oxygen company’s approved charges. You must pay for the other 20 percent. (Some Medicare Supplement Plans cover the additional charges in full, so it is vital that you learn what plan is right for you before you enroll.)
  • Prescription Drugs:  Your doctor can prescribe medications to help improve your COPD symptoms. Original Medicare (Parts A and B) does not cover prescription drugs. For prescription drug coverage, you must either enroll in Medicare Part D, or in certain Medicare Advantage (Part C) plans.
Rx Discount Card | Medicare Plan Finder
Rx Discount Card | Medicare Plan Finder

Inhalers Medicare Will Cover

Medicare will cover certain types of inhalers to help clear the obstacles in your airways. They fall under two categories: Controllers and Rescue relievers.

Controllers: Doctors prescribe these inhalers to maintain their patients’ symptoms and help prevent them from getting worse. Different types of controllers:

  • Short-acting Anticholinergic Bronchodilators
  • Long-acting Anticholinergic Bronchodilators
  • Corticosteroids
  • Phosphodiesterase-4 Inhibitor (PDE-4 Inhibitor)
  • Combinations of Corticosteroids and Long-acting Beta-agonists
  • Combinations of Long-Anticholinergic Bronchodilators and Corticosteroids

Rescue Relievers: These inhalers are reserved for emergencies for fast, short-term symptom relief. Different types of rescue relievers:

  • Short-acting Beta-agonist Bronchodilators
  • Combinations of Short-acting Anticholinergic and Short-acting Beta-agonist

The right inhalers can help keep your day-to-day symptoms at bay and step in when a flare-up occurs. Your doctor will be able to help you get the right prescription medications for you.

What Treatments Will Medicare Cover if I Have Lung Cancer?

Doctor Explaining X-Ray Results | Medicare Plan Finder
Doctor Explaining X-Ray Results | Medicare Plan Finder

Along with initial lung cancer screening, Medicare will cover certain cancer treatments. Different Original Medicare treatments and services fall under Parts A and B.

Part A:

  • Hospital visits and stays, including the treatment you receive while staying at the hospital while you’re considered an inpatient. Note: You can still be considered an outpatient while you stay at the hospital if you’re considered to be on “observation status.”
  • Care at skilled nursing facilities following a three-day hospital stay
  • Limited home health care
  • Hospice

Part B:

  • Visits to doctors’ offices
  • Many chemotherapy drugs administered intravenously in a doctor’s office or outpatient clinic
  • Some oral chemotherapy drugs
  • In some cases, Medicare will cover second opinions for non-emergency surgeries, and even third opinions if the first two opinions differ.

Original Medicare plans can help cover your lung cancer screening and treatment so you can be in the best health possible. A qualified professional can help you determine which plan will cover what you need while taking your budget and lifestyle into consideration.

Get Coverage for Your Condition

A chronic lung disease is not something that should be taken lightly. If you think you might qualify for a Special Enrollment Period with your condition, call Medicare Plan Finder at 833-438-3676 or contact us here today. We can help you determine whether or not you can get Medicare benefits, and find the right plan to suit your budget and lifestyle.

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Find Medicare Plans | Medicare Plan Finder