Chronic obstructive pulmonary disease, or COPD, is a scary diagnosis. It can mean a significant reduction in your quality of life, and there is unfortunately no cure for the condition. But there is some hope: elderly people who partake in pulmonary rehabilitation programs can see a significantly improved quality of life. The rehab program will not cure any lung disease, but it will help with breathing problems and give you more strength. Does Medicare cover pulmonary rehabilitation programs, and if so, what are the requirements?
What Is Pulmonary Rehabilitation?
Pulmonary rehabilitation is a nonpharmacologic treatment program targeting the symptoms of COPD. It’s a broad-based, outpatient program that provides exercises, peer support, and education for people who need it.
You can access pulmonary rehab services in your doctor’s office, a clinic, or in a hospital outpatient facility. During pulmonary rehabilitation, you will learn more about COPD, lung function, and exercises that can help you gain strength and breathe more efficiently. As we stated above, it can help improve your quality of life, even if it can’t cure your COPD.
Medicare Part B Coverage
Medicare Part B, medical insurance, covers a comprehensive pulmonary rehabilitation program if:
You have moderate to severe COPD
Your doctor gives you a referral for COPD treatment
You had a confirmed or suspected case of Covid-19 and have persistent systems, including respiratory dysfunction, for at least four weeks.
Medicare will typically cover up to 36 pulmonary rehab sessions. Your doctor can request a coverage be increase to 72 sessions if it is medically necessary.
How Much You Will Pay?
When it comes to your out-of-pocket costs for a pulmonary rehab program, you will first have to meet your annual Medicare Part B deductible. As well as pay your Medicare Part B monthly premiums. Once you have met your Part B deductible, you will be responsible for 20% of the Medicare-approved cost of your pulmonary rehabilitation services. If you receive the treatment at a doctor’s office, you will pay 20% of the Medicare-approved amount. If you get treated in a hospital outpatient setting, you will pay the hospital copay per session.
Extra Coverage
If the 20% coinsurance that you will be required to pay for pulmonary rehab seems daunting, know that a Medicare Supplement Plan can cover some of the out-of-pocket costs that Original Medicare does not cover. These plans can help keep out-of-pocket expenses down, especially if you have a chronic condition such as COPD.
There are 10 different Medicare Supplement Plans to choose from, each offering different coverage options and rates. It’s worth looking into a Medicare Supplement Plan to save as much money as you can. So speak to an EZ agent for all of your options. EZ’s agents work with the top-rated insurance companies in the nation and can compare plans in minutes for you at no cost. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side. Or to speak to a licensed agent, call 888-753-7207.
Chronic obstructive pulmonary disease, or COPD, is most common among individuals 65 and older. It is especially common among women age 65 to 74 years old. This disease is the third leading cause of death in the United States, and anyone with COPD has a significantly increased risk of severe illness or death from complications from the flu or respiratory illnesses like COVID-19.
When it comes to those suffering from COPD, life expectancy is determined by multiple factors such as history of smoking, and other conditions that might add further complications. While most patients with COPD can live with the disease for many years, they will need to constantly manage and treat this chronic condition. For older Americans, this continuous management can be costly, but fortunately, Medicare covers screenings and treatment up to a certain point.
What Is COPD?
For the over 30 million Americans who are living with COPD, every day can mean a struggle to breathe. COPD, a group of progressive lung diseases, such as emphysema, slowly destroys air sacs in the lung, causing air flow blockage and breathing-related problems. The disease develops over a long time, and the most common cause of it is smoking tobacco.
Because the disease is progressive, there is unfortunately no cure for COPD. However, treatments can help ease the symptoms and lower the chances of complications, while improving quality of life. If not treated, COPD can cause heart problems and worsening respiratory infection.
COPD Symptoms
Some COPD symptoms include shortness of breath and tightness in the chest.
The symptoms of COPD come in stages. Early symptoms include occasional shortness of breath, a mild recurrent cough, and a frequent need to clear the throat. But if the symptoms are not treated, they can get progressively worse. Worsening symptoms include:
Shortness of breath with little exertion, such as from going up a flight of stairs
Tightness in the chest
Wheezing
Frequent colds, flu, or other respiratory infections
Chronic cough
Lack of energy
In the later stages of the disease, symptoms include weight loss, and swelling of the feet, ankles, or legs. If you are suffering from COPD, it is important to seek immediate medical care if you have trouble catching your breath, feel confused or faint, or have bluish or gray fingernails or lips.
Medicare COPD Coverage
There is no single test for COPD. Diagnosis is based on assessing the symptoms mentioned earlier, a physical exam, and diagnostic test results. To help diagnose you, Medicare Part B will cover a lung cancer screening with Low Dose Computed Tomography (LDCT). Medicare will cover this screening once a year if you:
Are 55 to 77 years old
Have a history of smoking at least 1 pack of cigarettes a day for 30 years
Are a current smoker or have quit smoking in the last 15 years
Are asymptomatic (don’t have signs or symptoms) of lung cancer
Get a written order from your doctor
As long as you meet all of the above criteria and your doctor accepts Medicare assignment, Medicare Part B will cover 100% of the screening.
If you have already been diagnosed with COPD, Medicare Part B will cover a pulmonary rehabilitation program to help manage your COPD. This program should help you breathe better and improve your quality of life. Medicare Part B will completely cover the pulmonary rehabilitation program as long as you have a referral from your doctor.
Medicare Supplement Plans will help pay for the 20% Medicare does not cover, which will help you save more money.
Getting More Coverage
Other expenses related to COPD treatment and management might only be covered 80% by Medicare, leaving you with 20% coinsurance to pay out-of-pocket. But you can save money on these expenses with a Medicare Supplement Plan, which will pay your 20% coinsurance for COPD coverage, as well as all other Medicare-covered conditions.
It can be overwhelming to review your options and go over all 10 different Medicare Supplement Plans, but that is what EZ.Insure is here for. EZ’s dedicated agent will compare all available plans in your area and review all of your options. We will provide you with quotes for free, and find a plan that fits your needs and budget, while helping you save hundreds of dollars a year. To get free instant quotes, simply enter your zip code in the bar above, or to speak directly with one of our agents, call 888-753-7207.
