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November 18, 2020
Medicare and COPD: What You Should Know

Medicare and COPD: What You Should Know

Living with COPD can be scary, especially when it comes to figuring out your Medicare options. There’s a lot to consider, which can be extra stressful when you are already dealing with your health.

This struggle might feel overwhelming sometimes, but you are not alone. In fact, the entire month of November is National COPD Awareness Month. This whole month is dedicated to educating and empowering both individuals with COPD and healthcare providers.

Healthcare is important, especially if you are living with COPD. We want to make sure you know your options on how to get coverage regardless of your condition.

What Is COPD?

COPD (aka chronic obstructive pulmonary disease) is a group of diseases that affect your ability to breath, resulting primarily in the following:

  1. Chronic Bronchitis, which is an illness that happens when your airways are inflamed and full of mucus.
  2. Emphysema, which happens when the air sacs in your lungs get damaged.
  3. Asthma which causes your airways to narrow and produce extra mucus.

This is a serious illness that makes it harder for the individual to breathe over time. However, many people with COPD don’t even know that they have it because their symptoms have progressed over time and become a part of their daily life.

Some symptoms of COPD are:

  • Chronic cough (smoker’s cough)
  • Shortness of breath
  • Excess mucus in your lung

While COPD does not have a cure, there are ways to treat it than can improve symptoms, activity, and quality of life.

Pulmonary Rehabilitation

The most common treatment for COPD is pulmonary rehabilitation. This therapy includes 2-3 sessions a week, for about a month. 

There are a variety of techniques that are used during this treatment to help patients with COPD:

  • Breathing techniques to avoid feeling out of breath
  • Exercise training to strengthen all your muscles, including your lungs
  • Education about managing symptoms and using a combination of lifestyle tools and medication to help you feel your best
  • Counseling to decrease stress and anxiety related to your condition

If you experience any of the symptoms described above, talk to your doctor to see what treatment plan is right for you.

Does Medicare Cover COPD?

It’s easy to worry when you’re newly diagnosed with a disease. However, treatments work best when illnesses are caught early, so don’t be afraid to contact your doctor.

Medicare is here to help. If you already have moderate to severe COPD, Medicare Part B covers a pulmonary rehabilitation program.

If you aren’t sure what is included in different coverage options, sign up for the free, Medicare 101 Email Course. This can help you learn more and empower yourself when dealing with your healthcare.

Does Medicare Part D cover COPD inhalers?

Whether or not your Medicare Part D will cover COPD inhalers will depend on your specific plan formulation.

While this might sound confusing, never fear! We at Medicare Allies can give you a comparison of many plans that include your exact desired prescription and preferred pharmacy to make sure you are getting the best bang for your buck.

Can I Qualify for a Medicare Supplement Plan with COPD?

When you are filling out your Medicare Supplement application, there are a few questions about preexisting conditions that will show up every time.

This is where it gets a little tricky. If you have COPD, the application might not explicitly ask you if you have “COPD or Emphysema.” Instead, it will be categorized generally as lung or respiratory disorders.

Sadly, the majority of companies will deny your application if you have COPD. The most common reasons that people with COPD get declined are:

  • Use of a nebulizer or oxygen (within the past 2 years or sooner)
  • Treatment through more than 3 medications
  • Use of tobacco

Additionally, the use of certain medications, like Spiriva, Atrovent, Prednisone, or DuoNeb can automatically disqualify you.

However, a few companies will accept applications from people with this disease under special circumstances.  

If you aren’t eliminated by the guidelines above, some providers might accept you with a “modified rate.” This means that you will pay a higher rate because of your condition, but you will still get coverage.

The moral of the story is: don’t give up! Even though having COPD can make it more difficult to get coverage, you have Medicare Allies on your side. This means if there’s a way, we’ll find it.  

Read more: Can I still get a Medicare Supplement if I have COPD or emphysema?

Can I Qualify for a Medicare Advantage Plan with COPD?

If you have COPD, you have likely endured years of elevated rates and expensive medical necessities. Medicare Advantage plans don’t have underwriting, which makes them a great option for someone with COPD or other disqualifying diseases.

This means that your premiums and rates can’t grow based on your COPD – what a win!

Additionally, if you already are on a Medicare Supplement plan, you typically can’t qualify for another supplement, even if your rates are sky-high.

Switching to a Medicare Advantage plan could be the best choice, particularly if you have the option for a low or $0 premium plan.

In particular, take a look at Lasso Healthcare’s Growth MSA if you want to learn about a particularly efficient low-cost plan. The maximum-out-of-pocket limit for this plan is a cool $3,000, which is fantastic compared to the sky-high premiums that most people with COPD deal with on Medicare Supplement plans.

You are also responsible for paying: 1) Your monthly Part B premium, and 2) 100% of any non-Medicare covered Qualified Medical Expenses (QMEs), via either your MSA bank account funds or out-of-pocket, before and after you reach the plan deductible.
*Deposit and deductible amounts shown above are full calendar-year amounts, based on a January 1, 2021 effective date. If you enroll for a partial calendar year, the deposit and deductible amounts will be prorated based on the month your coverage becomes effective with Lasso Healthcare MSA.

The bottom line is it is up to you! The best way to make sure your plan is working for you is to stay informed. Weigh the pros and cons with a qualified agent to see what is right for your lifestyle.

Reminder! The Medical Annual Open Enrollment Period ends December 7 – call us at 833-801-7999 make changes to your health and drug plans before it's over!

Conclusion 

If you think you might have COPD or another lung disease, be sure to stay informed about your health and visit your doctor for a screening. By listening to your body and taking action when you think there might be an issue, you are setting yourself up for more effective treatments and a better quality of life.

Medicare Supplement and Medicare Advantage plans can seem complicated, but even if you have COPD and do not qualify for any plan, our Medicare Allies team will explore every option in your state to ensure amazing coverage for the best possible price.

Contact us to find out more about your coverage options.

Luke Hockaday
By
Luke Hockaday
Luke Hockaday is a Customer Success Rep here at Medicare Allies. Luke has been helping Medicare-eligible clients with their insurance and retirement-planning needs since 2011. Luke is passionate about 3 things, and 3 things only: senior insurance, football, and food!

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