Allergy and Asthma Health - Asthma, Medicare and You

Asthma, Medicare and You

By Helen M. Sorenson, MA, RRT, FAARC

If you are over the age of 62 or 65 and on Medicare, the path you need to navigate may seem confusing at times. Why? Because it is confusing! If you are also a patient with asthma who is on medications, the confusion may be multiplied.

I would love to tell you that it’s “as easy as pie” to figure everything out, but that would not be the truth. Perhaps I can help, though. I too am over 65, and have had to learn how to navigate the Medicare Maze.

Let’s begin with the basics. There are four parts to Medicare — Parts A, B, C, and D.

Medicare Part A is basically hospital insurance — let’s keep your asthma under control so you don’t need to use that!

Medicare Part B is important. This covers your durable medical equipment (DME) such as nebulizers, as well as medically necessary doctor’s services, outpatient care, home health services, and other durable medical equipment.

The DME benefit also covers oxygen equipment and supplies, but YOU must make sure your doctors and DME suppliers are enrolled in Medicare.

Other important components covered under Part B are immunizations (pneumonia, influenza, and hepatitis B shots). If you are still smoking, Medicare covers smoking and tobacco use cessation counseling as well.

If you have COPD along with your asthma, you may qualify for pulmonary rehabilitation. If you also have sleep apnea, Medicare will cover a three-month trial of continuous positive airway pressure (CPAP) and then continue the coverage if your doctor feels it is helping you and is medically necessary. In many cases, you will be expected to pay 20% of the cost. There are other special considerations with CPAP, which you will need to discuss further with your physician.

Medicare Part C is actually a health care plan known as Medicare Advantage and is offered by private companies that have been approved by Medicare.

Medicare Part D is the prescription drug coverage plan usually associated with the Medicare Advantage plans. If you have your own private health insurance, through employer, union, or VA benefits, they should pay for your prescription drugs, or a portion of them. If you have Medicare Part D, you can also get help paying your health and prescription drug costs with a service called Extra Help, but it is based on your income and resources.

Medicare is inherently confusing, but it is an earned benefit for many of us. Don’t let the “red tape” prevent you from getting the help you need. If you have more complex questions (which I am sure you do) you can call Medicare directly at 1-800-MEDICARE or visit Medicare.gov.

So, if you have asthma, keep taking your meds, keep exercising, eat healthy, and think positive as you navigate the Medicare Maze. Everything helps!

Helen Sorenson is an AARC member from San Antonio, TX, who currently serves as an adjunct faculty member in the department of respiratory care at the University of Texas Health Science Center at San Antonio.