Many people struggle with asthma and need to manage it by taking inhaled medications to help them breathe. Asthma is a chronic disease in which the airways to the lungs become inflamed, constricting air flow. In some cases, asthma will go away as you age; in others, you’ll need to continue on medication.
Medicare Part B
Medicare Part B will not cover an asthma inhaler, although it will cover a nebulizer if it is prescribed by a doctor and it is classified as durable medical equipment (DME). If it is qualified as DME, be sure to use a supplier and doctor that work with Medicare to make sure you get coverage. Under Part B, you will pay 20% coinsurance, while Medicare will pay 80%.
Medicare Part D
Most often, an asthma inhaler will be covered by Medicare Part D. This is why it’s important to have a Part D plan in place, as without it the costs of medications can become unmanageable.
Since an asthma inhaler is used to deliver medicine, it normally does not fall under DME, but under Part D. When you are choosing a Part D plan, check its formulary (list of drugs covered) to ensure that the short-acting and/or long-acting inhalers you need are covered.
Also check to see whether your plan has restrictions such as requiring prior authorization, step therapy, or limits on how much you can purchase at one time. You can either choose a stand-alone Part D plan or a Medicare Advantage plan that includes Part D coverage. Use Medicare’s Plan Finder to compare plans.
You may make changes to your plan during open enrollment each year from October 15 – December 7. You may also qualify for a special election period during which you can enroll.
What Parts A and B will cover for asthma
Aside from inhalers, Medicare Part A and B will cover the following, when medically necessary for asthma:
- Nebulizers (Part B)
- Hospitalization charges for an asthma attack (Part A)
- Outpatient treatment for asthma (Part B)
- Outpatient pulmonary rehab for a chronic pulmonary condition (Part B)
