Does Medicare Cover Inhalers for Asthma?
- Older adults who use inhalers for asthma may have their medication covered under Medicare Part D, which is optional insurance that covers prescription drugs.
Medicare covers inhalers under Part D coverage, which is an optional coverage that pays prescription drug costs. When this coverage is added to Original Medicare or qualifying Medicare Advantage plans, enrollees pay an additional premium and typically have annual deductibles and copays or coinsurance. Many Medicare Advantage plans, including most HMO and PPO plans and all SNPs, have Part D coverage built into their benefits.
Overall, the average Medicare beneficiary has roughly 60 Medicare plans with prescription drug coverage to choose from, including 30 standalone drug plans and 27 Medicare Advantage plans with this benefit.
Does Medicare Cover Inhalers and Asthma Treatment?
If an individual’s doctor prescribes an inhaler to treat asthma, Medicare Part D covers it. However, the beneficiary’s copay or coinsurance varies depending on their drug plan.
To estimate the cost of inhalers, seniors can refer to their drug plan’s formulary, which lists every generic and brand name prescription drug the plan covers. Most plans split medications among three to five tiers based on the level of coverage. Tier 1 is typically comprised of low-cost generic drugs and has the lowest out-of-pocket costs. The bottom tiers include high-cost brand name and specialty drugs and have the highest copays or coinsurance.
- Albuterol: About 53% of Part D plans cover Albuterol.
- Flovent: Over 90% of Part D plans cover Flovent, and most plans assign it to Tier 3.
- Symbicort: The majority of Part D plans don’t cover Symbicort, but to help customers control costs, the manufacturer often offers coupons
- Ventolin: Ventolin is covered by about half of Part D plans and is generally listed as a Tier 2 drug.
- COPD inhalers: Medicare pays for COPD inhalers and bronchodilators under Part D coverage.
- Pulmonary treatment: Part B pays for outpatient rehab treatments, including treatment for chronic pulmonary conditions such as asthma, COPD, pulmonary fibrosis, emphysema and cystic fibrosis.
- Emergency care: If someone goes to the hospital for an asthma attack, Part A covers treatment.
- Nebulizers: Part B covers durable medical equipment, including nebulizers.
How to Get Medicare Coverage for Inhalers
Those who have asthma and are signing up for Medicare drug coverage for the first time should make sure that the Part D plan they choose covers their medications. They may talk to their doctors about generic alternatives, which are generally on a higher drug tier and have lower costs.
In some cases, a medication’s out-of-pocket cost is lower than an insurance plan’s copay, so it’s a good idea to talk to a pharmacist about the cheapest way to purchase a medication.
Whether an individual relies on prescription medications when they first sign up for Medicare, it’s best to purchase a Part D plan at the time of enrollment. Purchasing a plan later results in a Part D penalty that’s permanently added to the monthly premium. Medicare’s Extra Help program can help qualifying individuals to pay for their Part D expenses.