If you struggle with asthma, you know there’s nothing more frightening than suddenly not being able to breathe. If you qualify for Medicare coverage, you probably wonder how you can use your coverage to pay for your medical needs regarding asthma.
Now, if your question is, “Can I get Medicare if I have asthma?” the answer is no, having asthma alone will not qualify you for Medicare coverage. You need to qualify based on being 65 and over or under 65 with qualifying medical needs.
Does Medicare cover inhalers? How can you get the care you need with your Medicare insurance? Here’s what you need to know.
In Original Medicare, Medicare Part A covers inpatient hospitalization. If you should ever find yourself hospitalized due to your asthma, your Part A coverage would kick in. That means you would pay your annual deductible (if it hasn’t already been covered), as well as the daily copayment if you stay in the hospital for more than 60 days.
If you have Medicare Advantage (Part C), inpatient hospitalization is also covered. However, you might have different deductible and copayment or coinsurance amounts.
If you need specific medical equipment to administer medication, that is usually considered Durable Medical Equipment (DME). If you have Original Medicare, equipment is covered under Medicare Part B.
One example would be if you need a nebulizer. Or, if you’re wondering “Does Medicare cover oxygen for asthma,” Medicare Part B would cover oxygen and equipment for use at home if it’s medically necessary.
Medicare Advantage plans cover at least as much as Original Medicare, so you will be able to get medically necessary equipment through those plans as well. You might have to use a DME provider within the insurance network, however, and the deductible and copayment will be different.
Some patients ask, is albuterol covered by Medicare Part B? Because this is a prescription drug, it is not. Instead, you would look for coverage from your Part D drug plan.
Medicare Part D is optional, but very important if you need medication for asthma or other illnesses. You can get Part D by enrolling in a stand-alone plan if you have Original Medicare, or you can enroll in a Medicare Advantage plan that includes Part D. For either option, you’ll need to review the drugs included and make sure it meets your needs.
A stand-alone part D plan will provide coverage for prescription medication and may cover biologics as well. In addition, a Medicare Advantage plan will provide coverage for medical care and doctor's visits. Not every Part D plan covers the same drugs, so be sure to check the formulary to see what’s covered before you commit to a specific plan.
Similarly, you’ll want to select an Advantage plan that covers the drugs you need. If the Advantage plan doesn’t include prescription coverage, you’ll need to buy a separate Part D plan just like you would with Original Medicare.
Finding out exactly what asthma inhalers are covered by Medicare requires you to understand the drugs your plan includes. You can contact your Medicare Advantage or Part D plan directly if you have questions or concerns.
If you have Medicare and want coverage for your inhalers for asthma, you’ll need to have a Part D drug plan or an Advantage plan that includes drug coverage. You’ll also need to use a pharmacy that’s part of the drug plan’s network. That way you’ll get the maximum coverage you can from your plan.
Keep in mind that you may have a Part D deductible or copayment to cover, and the plan will cover the rest. You can look at the details of your plan so you know what to expect.
Having Medicare can make paying for prescription drugs much more affordable. Be sure to get a Part D plan if you anticipate needing medication!
With proper medical care, your asthma can be well-controlled and you can enjoy your life with confidence. Medicare can give you the coverage you need for inpatient and outpatient care, along with prescription drugs to treat this condition.
If you have more questions about how Medicare covers asthma or asthma inhalers, we can help. Or, you might want to talk to a licensed agent to compare Medicare plans to ensure you have the coverage you need. Either way, contact us today!
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