Transcript (COPD and Medicare)

C.O.P.D can make breathing harder, especially during flare-ups. Smoking often leads to C.O.P.D, but it also affects non-smokers as well. Work exposure, pollution, and genetics can also play a role. C.O.P.D becomes MORE common as people get older. A genetic condition known as alpha-one deficiency is a cause of C.O.P.D for some individuals.  Medicare Parts A and B can help with prevention, diagnosis, treatment and rehabilitation.

C.O.P.D can show up as chronic bronchitis, emphyseema, or both. Chronic bronchitis often means mucus and a long-lasting cough. Emphyseema damages air sacs, making inhaling and exhaling feel harder. 

Part B covers tobacco cessation counseling. It can include multiple sessions each year when medically necessary. Important vaccines are also covered to protect lung health. This includes Flu, COVID, pneumonia, and the R.S.V. vaccines. Vaccines can reduce infection-triggered flare-ups. With certain symptoms, testing is covered by Medicare when medically necessary. 

Part B includes doctor visits related to persistent breathing issues. Severe flare-ups may require emergency care and hospitalization. Spirometry testing is commonly covered when your clinician orders it. Spirometry is a simple breathing test that measures how much air a person can blow out.  Your medical history, physical exams, and lung tests help diagnose C.O.P.D.

Part A covers inpatient hospital stays and rehabilitation treatment when medically necessary.

C.O.P.D treatments may include the use of a skilled nursing facility. Original Medicare requires a prior three-day inpatient stay to qualify for a skilled nursing facility. 

Part B covers pulmonary rehab sessions for moderate to very severe C.O.P.D.

The number of rehab sessions has limits.  Extra sessions may be approved for Medicare coverage. Home oxygen is covered under Part B as durable medical equipment. 

This includes coverage for portable oxygen equipment including concentrators, tanks, and supplies.  Respiratory Assist Devices and positive expiratory pressure may also be covered.  Device recommended usage may vary based on testing and mobility. 

For hospital stays, “inpatient admission” and “observation” are NOT the same.  In general, an inpatient admission is covered under Part A, while observation services are typically covered under Part B. The difference affects your expenses, such as Medicare deductibles and copays.

C.O.P.D inhalers may be covered through Part D drug coverage. Your costs will be determined by plan formularies, tiers, and prior authorization.  Part B usually covers injections and medications given in a medical facility.

C.O.P.D can be challenging, but steady support makes it manageable. Many people discover a new normal when they live with the challenges of C.O.P.D. This includes hobbies, travel, and the simple pleasures of life. Clear information, the right care team, and thoughtful use of Medicare can make C.O.P.D feel far less overwhelming.